Any one out there had some issues with PTs regarding transfers training and simple goals for functional ambulation for self care and home management?  I've been working with several PTs who seem to think that we OTs can not ambulate a person to the toilet with a FWW or let alone do toilet transfers as that is supposedly their arena?  What the heck???  One company I worked for did not allow me to write toilet transfer goals since transfers were for PTs to address!  Another PT told me that I shouldn't be ambulating a person into the bathroom as she worked on ambulating.  I was ambulating this person as she would have to walk from her bed to the bathroom when she'd go home.  Just curious to see if any one else had some kooky PTs that had this odd thinking...

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JMK

I have had PT's not like it when OT's walk up/down the hall but never toileting.  That is crazy.  Do the PT evals have toileting on it?  I have never seen it.  I would do what you think is right, plus, if a patient can tolerate walking to the toilet or to his room from the gym or to the dining room, I think we should do it.  Just my opinion.

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Abigail

Hi Joni,

I think most of us have worked with a PT like this one.

Let the PT do the transfer - wheelchair to toilet and back over and over again.

As the OT, focus on the function, don't do "toilet transfers" work on "toilet management" which includes the transfer but more importantly the clothing management (including diapers), hygiene (througness, abilty to reach to clean, and for females- wiping back to front), flushing the toilet, reaching the toilet paper, teaching adherance to any body mechanics/spinal precatutions/hip precautions, timing to prevent incontinence, adaptive equipment and modifications etc....

Good Luck!

Cheryl Hall OT

http://www.occupationaltherapytoolkit.com/

Treatment Plans and Handout for Adult Physical Disabilities and Geriatrics

 

 

 

Thanks for both of your answers.  Part of the problem was that PTs did not have any goals with toilet transfers yet these clients couldn't even get to the toilet well.  They did not work on toileting at all.  I did work on the clothes mgmt and hygiene issues as well.  That place I worked was really odd.  Some of the PTs got upset  with us OTs having them walk from their bed to the bathroom, which they could do well and could tolerate fine.  I pretty much stood my ground with them as I told them that we had to do functional activity like how they would do it at home!  That shut them up pretty good...

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JMK

Yes, I think we have all worked with PT's like that, and now that the APTA has written 'functional' into their frame of reference it does make it harder to differentiate the goals to work on. At the core of both philosophies though, is the fact that PT needs to get the patient stronger and more mobile so that the OT can make them more functional and independent. Conversely, I do not like to see OTs just doing UE reps with a resident, to me that is not function. If the PT wants to do that with the UE, I am fine with that. I would rather have them use their gross motor and fine motor skills for something that has intrinsic value for them.

 Sometimes it just comes down to egos though, and is less about theory and more about 'capturing minutes'.

Tim
 

You said it right there Tim...."minutes"  Chalk it up to the wonderful PPS system.  It has agitated the already strained relationship between PT and OT and the territorial issues that are inherent in rehab departments.  I think that strategic documentation is becoming the latest art form.

Judy 

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Judy

That is absurd! I think they are in need of some education re: the OT scope of practice. I work in home health and have run into some PTs who still thinking "PT is for lower body and OT is for upper body!!"  :(

Wow - so much contention between the disciplines.  I'm so thankful that all the places I've worked in looks at OT and PT as a team.  We did have a period where I'm currently working where there was some of this conflict. We resolved it by forming a task force, of which I was a part, to address the concerns.  On the task force, we examined the practice acts of both PT and OT. Its amazing how much overlap there is. In the end, it was all a matter of education and documentaion. Education for the entire staff on where the overlaps and differences are. And documentation strategies to highlight how our objectives and goals vary so that we do not have issues with duplication of services.  The conflicts were resolved very quickly with this process, despite the number of people on our staff (~80 in an acute care setting)

dude its about what is in you practice act and state legislature that is really it, personally I will write about toilet transfers, either bed to toilet or w/c to toilet, and then address the ability to self toilet separately, yet the problem is with the OTs now PTs even though most PTs are stuck up @#** (insert favorite word here).  See OTs have been enchroaching on the domain of PTs for years and now some wise PT at the APTA which has more of a lobby in DC said that if PTs want to keep thier jobs they should start writing in Functional goals cause OT notes don't get denied the same way PT notes do.  PT notes have traditionally looked like pt will increase R sh AROM by 5 deg or Pt will increase L hip Flx by 20 deg  and that was it.  PTs have been getting away with it for years but this can go on forever,and they were getting paid a lot more than OT,  so Medicare became wise to the PT scam-- yes I did say SCAM!!! b/c that is what most of these PTs in home care and outpt were doing, but by making it a functional change then PT can not scam medicare,

but the problem is that OTs are not united and did not stand up to The APTA and say that they can not do this so now the domain of PT and OT is mixed and really it now comes down to the individual skill of the person

I usually tell pts ( patients)  that OTs and PTs can pretty much treat the same things but it has been a respect that OT and PT have shared but if any of my pts want me to treat a specific haullicus pollicus disorder- I do this right in front fo the PT just to show them that I know exactly what I am doing and that I am doing a much better job than the PT has in the past

but OTs should really rise up and stand up agaist the PTs and this would show them  who we are, and maybe OT would become a household name like PT

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up the irons, cause if I had money I'd buy you a beer

I am a bit uncomfortable with my OT/coworker goals which routinely read: 1. Good dynamic stand balance for ADL's and 2.  Ambulate to and from bathroom for ADL's with supervision.  It seems to reach these goals the OT emphasis would be balance and gait training....I'd appreciate some input as I worry there may be duplication of services with OT/PT treatment.

Hi Amy,  I have a suggestion.  I am an OTA of 17 years and work for a wonderful company in ohio in LTC that is very focused on clearly demarcating the clinical lines between OT and PT,  to avoid duplication of services and for the benefit of our residents.   OT's goals would read

Res. will increase stance tolerance to 3-5 mins to address lower body adls,  the second goal would we would not mention ambulation as that would be a dup of services, if PT is involved.....but the first goal,  PT has stance balance and we OT's have stance tolerance.  Now maybe if PT was not involved there could be another way to re-word that 2nd goal.  But like I said thats why I am thankful I work for the company I do as they are always educating us therapists on the latest and greatest rules and regs!  hope that helps.

Jen

Hello out there -- PT's do GAIT training. Anyone can AMBULATE a patient, even nursing. Of course, it would be prudent to "check" with the PT's regarding the patient's ambulation status before you walked them to the bathroom. I like the idea of toileting management or toileting process, as that would include all the skills and activities that make up this particular ADL -- cognitive, safety, endurance, mobility, clothing, hygiene, standing, set-up, transfer, etc. And I would never write ambulation in a goal if the patient were receiving PT services also.