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OCCUPATIONAL THERAPYCOMPLETED SBAROCCUPATIONAL THERAPY SBARLearning Objectives: ? Describe the value of interprofessional communication for your profession and your clients/patients ? Effectively communicate to another profession your professional insight (e.g. holistic care, safety evaluation) about this patient using SBAR S (Situation): You receive a referral from the primary provider for an 82 year old widow. The patient’s daughter is visiting from out of town and is concerned about her mother. The daughter is concerned because upon arrival last night, she noticed both a contusion and laceration on her mother’s left arm and her mother’s home in a state of disarray when the house is usually neatly kept. She asked her mother about the contusion and her mother reported falling once in the kitchen while bending over to unload the dishwasher. After walking through her mother’s home it appeared her mother may have fallen in the bathroom as the shower curtain was on the floor. Upon further probing her mother admitted to falling in the bathroom while taking a shower in addition to the falling in the garden two weeks ago. The daughter has noticed that her mother’s house has become increasingly cluttered and unclean since her father passed away a year ago and her mother seems to be isolating herself from the family and no longer attending church on Sundays. Her mother has reported an increase in fatigue, dizziness, and memory loss since the daughter’s latest visit and her mother looks like she has lost weight. Her mother’s daily routines have changed as she no longer cares to clean house, cook, or clean up after the family dog. The daughter is worried her mother may not be able to live alone safely and requested you complete an evaluation. This evaluation includes assessment of body functions such as vision, balance, strength, cognition, and psychosocial status; ability to complete valued and necessary occupations, activities, and functional tasks; and home safety, home modification needs, and adaptive equipment/DME needs. You and the daughter collaborated with the patient’s physician to receive a referral for home health occupational therapy. B (Background): Upon arrival you observe the patient lives in a two story brick home in a rundown neighborhood. The sidewalks are narrow due to overgrown shrubs, weeds, and flowerbeds. Five wooded steps lead up to the porch and the handrails are wobbly. The patient answers the doorbell and leads the way to a large living room. Multiple throw rugs are scattered on the worn, carpeted floor. A window air conditioner is present, but is not turned on. Heavy drapes are pulled closed and dim lighting illuminates the room; all doors leading out of the room are shut. A long extension cord snakes across the floor powering a small oscillating, electrical fan. The patient’s daughter is present and the patient struggles to lower herself to an overstuffed recliner after answering the door. The patient shows little interest in what is happening and lets the daughter do most of the talking. Upon interviewing the daughter and the patient you find out the patient graduated from her local high school in Nebraska and worked as a salesperson until her retirement at age 65. She was married for 55 years. She and her late husband had three children, none of whom live locally. The patient’s daughters live in eastern Iowa and maintain telephone contact weekly, but visit only occasionally due to financial and time constraints. During the interview you learn the client has a fixed income, relying only on social security to pay the bills and obtain her meals. The patient mentions her husband’s death this past year has been very hard on her. The patient reveals she enjoys knitting, playing with her dog, and gardening; however, she has been too tired to do much of anything. While seated in the living room during the interview you observe the patient drink some water to take her afternoon pills, triggering excessive coughing. The patient requires about 2 minutes to recover from the episode. You observe the patient performing several activities of daily living throughout the house. The patient is noted to furniture walk as her fatigue worsens during the evaluation. During a shower transfer, the patient holds on to a towel rack by the tub / shower combination and catches her foot on the tub wall when attempting to step in, requiring you to steady her. The patient struggles to reach down on the floor to pick up her dog’s water dish and has a loss of balance which she is able to recover from independently. A quick vision screen reveals the patient wears bifocals and has impaired visual acuity for near tasks. MMT reveals 4/5 strength throughout upper and lower extremities. The patient reached 5 inches on the Functional Reach Test, indicating she is at a high risk for falls. On the Montreal Cognitive Assessment (MoCA), the patient scored in the mild cognitive impairment range. After completing a walkthrough of the house and assessing the patient you ask the patient and the daughter what they wish to gain from the visit and the mother states, “I want to live alone in my own home, but my daughter seems to think I can’t!”A (Assessment):Impaired visual acuity, balance, and strength affect patient’s independence and safety with ADL and IADLMild cognitive impairment affects patient’s safety and problem solving during daily occupations and activities Impaired psychosocial status with possible depression associated to the client’s recent loss and financial income may be contributing to social isolation, weight loss, and fatigue. Depression may also be contributing to the client’s recent falls secondary to inattention and disregard for safety. Polypharmacy and difficulty with medication administration may be contributing to falls, fatigue, dizziness, decreased balance, and minor memory loss. Clutter, poor lighting, and uncleanliness outside and within the home affect patient’s safety Limited financial resources and access to transportation may be affecting her ability to afford food. R (Recommendation):Occupational Therapy would recommend the following:Continued occupational therapy intervention to address independence and safety with ADL/IADL, strengthening, balance retraining (during functional tasks like dressing, feeding the dog, gardening, etc.), home safety (e.g., removing throw rugs, adjusting lighting, reducing clutter, etc.), DME/adaptive equipment needs (e.g., tub transfer bench, toilet safety frame vs. raised toilet seat, etc.), home modifications (e.g., securing wobbly porch rails, consider ramp or threshold modification, etc.), and psychosocial status (e.g., exploring healthy grieving and coping strategies, stress management, promoting social participation, etc.)Physical Therapy to assess and improve the client’s strength and balance within mobility to reduce falls and improve independence Speech Therapy for assessment of swallowing/aspiration during self-administration of medication.Home Health Aide a few hours a week to provide assistance with light meal prep, light housekeeping, and some yard maintenance; occupational therapist to collaborate with aide to educate on ways to promote patient independence to maintain the client’s health Case Management / Social Work to provide the client and family with information on community resources to address mental health needs and assist the family with financial planning for healthcare related servicesCollaborate with team to secure appropriate supervision and support (e.g., establishing routine family check-ins, Lifeline medical alert system, etc.) ................
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