OTR/COTA Relationships
Off into another topic here today. Since the relationship between the COTA and OTR determine the cohesiveness of the rehab team, I thought this topic would be a good one to give my thoughts on.
In my past years of working as a COTA, I have met and worked with many great OTRs. Of course, I've worked with some not so good, too. What makes the difference? Let me get my brain working on this idea, and see where I head.
Supervising a COTA is something that will vary with each person. If the COTA is a new grad, or has little experience, this supervision will definitely take more of an OTRs time. With an experienced COTA, hopefully supervision will not consume as much of the OTRs time.
What does a COTA need to know? This question could take volumes, but the first basic thing would be to ensure that the COTA is comfortable with treating people. (this would involve touching others, personal care, directing people in exercises and other activities, educating with different adaptive equipment, and so on) Hopefully, this is something that has been covered in their Fieldwork practicum. Secondly the COTA should know the facility layout. This would include where to find linens, the showers, bathrooms, room layout, offices, and facility staff. Third, the COTA needs to know the OT office and rehab area. This would include equipment location, cleaning standards, inventory, issuing adaptive equipment to patients, paperwork and files, log books, and so on. Fourth, and most important, is the tracking of RUG categories, or PPS minutes. This is probably the most frustrating item to deal with, but revenues depend on proper tracking of treatment minutes. Part A patients take precedence here, as their minutes determine their RUG group. Part B patients need accurate reporting of minutes too, using the standard 8 minute rule in order to capture the most billable units.
An experienced COTA should have had exposure to most of these things, but a new hire or temporary staff will still need to know the facility layout, office, and how to determine the RUG categories of each patient.
A good OTR will be able to determine the strengths and weaknesses of the COTA they are supervising, and educate them to enhance their strengths. Teaching of new information should be done through co-treatments, demonstration, and if time allows demonstration of techniques on each other. I believe that there is no better way to experience what your patients feel than to feel it yourself. In the past, I have used many types of e-stim, Ultra-Sounds, and exercise equipment. As a therapist, it is important to know what you are requiring the patient to endure. Of course with any modality, knowledge of parameters and settings are most important for the safety of your patients.
What makes for a bad OTR? I can describe this with one word, attitude. On this note, let me relate a short story about a past experience. A patient on our caseload had a severe distal radius fracture, and as a result, pitting edema throughout the entire hand. They had been casted in a typical thumb to elbow plaster cast with strict orders to not jeopardize the integrity of the cast. My new grad OTR set a goal for contrast baths. I utilized hot packs and ice bags with good results, and to avoid contact with water that may have softened the cast. Several days later I was presented with a copy of a contrast bath technique copied from a web source, and told "this is the only method to be used". My prior experience in this area was ignored, as well as my concerns of getting the cast wet. The OTR refused to discuss the matter further.
An OTR who possesses a broad knowledge of therapeutic techniques will find education of the COTAs they supervise a much easier task. If an OTR is not experienced in a certain modality, it should not be expected that the COTA you supervise utilize that modality in their treatments. However, if the COTA has more experience or training than the supervising OTR, teaching can go both ways. Being open minded and willing to learn can not only enhance your skills, but can offer our patients additional resources to enhance their rehabilitation.
Hope all your thoughts are good,
Tim