Teamwork in the Burn Unit
It might be Monday, but I’m so excited for two reasons:
Less than a week until Burn Camp
I have my Burn Unit shirts from Artery Ink (yes, plural! Are you surprised?)
Late last week, I was talking with my friend, Melissa, the director of Burn Camp and the Nurse Practitioner on the Burn Unit here in Milwaukee, and the presentation I give about occupational therapy’s role on the Burn Unit was a topic of conversation. She had an idea to give a talk about how nursing and therapy work collaboratively in the BICU, so I thought I should write about that for the blog because she’s right: those collaborative efforts are important and are often overlooked.
The title of this post might be “Teamwork in the Burn Unit,” but I’m going to touch on the collaborative efforts between nursing and therapy in the hospital, period. While I speak a lot about my love of co-treats with physical and speech therapies, I don’t often talk about how much I also love treating alongside nurses! Nurses are amazing; they bring their own skill set to the table, and it only serves to enhance treatment sessions. I feel that the skill sets that therapy own and that nursing own serve as a Venn diagram.
Here are some skills Rehab Services have that Nursing relies on us for:
Evaluating the patient’s mobility. This includes bed mobility, transfers, and ambulation. They turn to us when it comes to choosing what type of mobility device is best, whether or not the patient is able to use the toilet (or if a bedside commode is a better option), and how many people it will take to safely transfer the patient.
Functional strength. Us OTs and PTs are able to formally measure and document not only the patient’s strength but their range of motion which nursing needs (especially in neuro, cardiac, and ortho units).
Participation. It isn’t uncommon for the nurse assigned to a patient to tell me they haven’t gotten up that day (or at all) due to, shall we say, reasons. I won’t say that Nursing relies on us to get the patient up, but they do appreciate when we’re able to coerce them into washing up at the sink, using the toilet, or going for a walk so they can do a quick skin check, remake the bed, or do anything they need to do while the patient is out of bed.
ADLs. See above! In addition to those reasons, we OTs are assessing the patient’s functional independence in many areas: balance, endurance, fine motor, gross motor… the list is long! Why are we doing it? From the minute we start our chart review, we are already thinking about…
Discharge recommendations. Part of being an acute care occupational therapist (and physical and speech therapist) is that you are thinking about a d/c plan from the moment you get the evaluation assigned to you. Generally speaking, nursing agrees with our assessment, and they then work with that decision in regard to patient and family education. In my experience, it’s a supportive system.
Here are the skills Nursing has that we Rehabbers rely on them for:
Admission, overnight, any history or detail that isn’t in the chart. Nurses are in the hospital 24/7. God. Bless. Them. They have eyes on their patients all the time, and they have patient handoff systems from day-to-night-to-day so each room’s nurse is able to communicate with the nurse coming on shift. That helps us therapists because goodness knows patient intake charts do not contain all the most pertinent information—especially if the patient has been there a couple of days before therapy has been able to get in for their initial evaluation.
Medication distribution (including turning the IVs off!). While I do believe there is a place for Pharmacology in Occupational Therapy coursework, it was not a class I took when I was pursuing my Bachelor’s or Master’s. While I always had access to the medication rooms at work, I definitely did not have the ability to unlock the med cart itself! It’s the nurses I rely on to give my patients their pain medication prior to the start of our sessions, as well as any other medication they’re due. It’s also the nurses I turn to when the IV lines or a tube feed need to be powered off for a treatment (primarily because I need their permission to turn these off, but also because I wouldn’t trust myself to turn them off!).
Suctioning trachs. This one is tricky because technically I do know how to suction, and at my first job, I was permitted to suction my patients. However, I recognize this was the exception and not the rule. Generally, nurses, respiratory, and speech therapists are the primary suction-ers. They are also the ones providing education to patients on how to self-suction. Therapists know the anatomy behind tracheostomy, so we are able to provide additional support and education.
The ol’ cooter canoe. Yeah, I’m being crass, but this expression still makes me laugh, like, five years later. Sure, I can take it out and put it back in, but I also know I’ve gotten in mild trouble for doing both because sometimes nurses are quite particular about the way it’s placed. I can’t say I blame them! I’ve been trained formally and informally, yet I always feel under pressure when I’m putting it in place—tell me I’m not the only one!
Communications. I can send a message to a specialist in the patient’s electronic medical record (EMR), and I swear, it’ll take ten days for me to hear back. But if I (politely) ask a patient’s nurse or the charge nurse to send the same message… a reply will come within, like, one-to-two hours. Remarkable. And it doesn’t bother me in the least! I appreciate that there’s an open line of communication, as long as I am somehow able to tap into it…
What do we have in common?
The ability to safely transfer patients. While the nurses may wait to hear from us on how exactly the patient transfers, they are capable of safely transferring the patient themselves. This is especially true of those nurses who take time to watch us then practice the transfer itself.
Documentation. All the employees who work in direct patient care at a particular hospital use the same EMR, so we all document in the same fashion. Thus, we all have access to each other’s notes (unless a particular patient has a lock on their information). We’re all able to see what the other observed, what the other documented, etc. That way we can come prepared with questions for that nurse, or they can contact us with questions about our session!
Education and encouragement. All patients require both, no matter the reason for their hospitalization. All nurses and all therapists are willing and able to provide these:
Education on: diagnosis, comorbidities, surgical intervention, precautions, discharge location, etc.
Encouragement on: getting out of bed, participation with ADLs, eating meals, keeping up communication with loved ones, observing precautions, performing therapeutic exercises, etc.
Wound care. Lucky me! Previously, it had just been physical therapy and nursing (and MD/Dos) who had been licensed or certified to provide wound care. Not anymore! Now occupational therapists can. In the past, I had turned to wound care nurses for informal mentorship; once this PhD journey is complete and I formally begin the wound care licensure journey, that mentorship will take on a much more formal structure.
A passion for patient care. Do I need to expand on that? Truly, if this is not the case, none of us would even be here.