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Toni Talks about PT Today

Who is Responsible?

Published March 26, 2008 2:55 PM by Toni Patt
Like most therapists, I'm a veteran of interdisciplinary turf battles. Usually the problem is PT and nursing going around over getting a patient out of bed. Sometimes it's about whether out of bed to chair is a PT or a nursing order. This time was a little different. The conflict arose over a VAC. I'm starting to really dislike those things.  Night shift had taken the VAC off over night because it wasn't working. I was leery to put it back on because the location made getting a good seal difficult. The patient's nurse was angry at me. She told me she wasn't going to be responsible for the VAC not being on the patient. 

I still don't understand why she was upset. At that facility, PT is responsible for all wound care including VACs.  If I didn't put the VAC back on, I would write a note and document what I did and why I did it. At the same time, I would have applied an appropriate dressing to promote wound healing.  Other than letting me know the VAC was off, nursing had nothing to do with this. The issue here wasn't the VAC. It was the nurse not wanting to be blamed for something that didn't happen. She wasn't concerned that the patient might not have received wound care. She was concerned that she would be blamed. I'm not a nurse, but I don't think that's the best philosophy for patient care.

Responsibility or as in this case, blame avoidance, is an ongoing point of contention. Disciplines are concerned only with their specific area of care. Frequently, the issue isn't that something was or wasn't done. Instead, the issue is who is to blame. 

Tunnel vision isn't limited to departments. We do this within the rehab arena. I wonder how many PTs fully assess the arms of a patient who receives both PT and OT because OT "does the arms."  I've been guilty at times. One problem with this is using the arms to help with gait and mobility. How can I assess accurate goals if I don't know how much the patient can use his arms?  You can't walk on a walker if you can't support yourself with your arms. It's a minor example, because most PTs will figure this out very quickly. On a much larger scale, such as when rehab and nursing are butting heads, the problem is much more significant.

A friend of mine is working on her PhD in nursing. Her area of concentration is process improvement through improved team work. She puts nursing and medical students together and simulates a patient care situation, then observes the results. So far her research has shown better outcomes result when everyone works together. That shouldn't be a surprise. What is less obvious is that individuals are reluctant to accept responsibility for making a mistake. She has had to show the video tapes to individuals to prove her observation. That is a little frightening.  

Everyone gets sucked into the blame game. Rehab and nursing will forever argue over whose responsibility it is to get patients out of bed. No one will ever agree on who should be responsible for cleaning a dirty patient. But we must remember the big picture which is taking care of the patient.  My VAC patient received appropriate treatment. PT and OT work together to mobilize patients regardless of what body parts are involved. As long as we keep that in mind, we won't sink to the level of these two doctors: Neither one wanted to be the one to pronounce a patient. While the they argued, the expired patient was lying in a room waiting for someone to take responsibility so he could officially be pronounced dead and taken to the morgue. 



Nothing new with the blame game between nsg and PT.

Yet nsg learns Mazlows Pryamid as a background and foundation to patient care, you would think they would look at the whole patient and not just who did what and sit to figure out why.

We need more people in health care to "man up" take the responsiblility of care and admit when they did not do what they should have.  

Also we as PT's and PTA's should acknowledge that nsg has difficult job, one that could kill a patient if a dose is wrong.  The ratio in nsg homes is ridiculous one nsg to 30+ pts is wrong. The CNA ratio can be almost the same in some areas.  

Yet we complain because our patients are not up?  Should we assess bed mobility, leg and arm volitional motion during transitional functional activity?  Yes.  So, transfer the patient, tell nsg, and above all, ask them if they need help.  

If we as professionals, some with advanced degrees, don't know how to communicate with nsg how can we be effective in our jobs.

jason, PTA March 29, 2008 1:18 PM

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