Disclosure I have no relevant financial relationships with any - PDF document

Disclosure I have no relevant financial relationships with any companies related to the content of this course. Occupational Therapy in Acute Care: Liver Transplant UCSF Transplant 2018: Pioneering Advances in Transplantation Mary “Molly” Catherine Murphy, OTD, OTR/L September 20, 2018 Molly Murphy, OTD, OTR/L Goals and Objectives  4 th generation Bay Area native  Define Occupation and Occupational Therapy (OT)  Cal Poly San Luis Obispo (2005), Earth Sciences, BS  Understand the role of the Occupational Therapist as a member of  Washington University in St Louis (2014), OTD the multidisciplinary Liver Transplant Team  Understand common assessments, interventions, discharge - Productive aging recommendations for patients that are pre- and post-liver transplant - Fall prevention and aging-in-place  Identify when to consult an occupational therapist for your patients - Medication management  Provide practical clinical suggestions and ideas to help enhance  Occupational therapist since 2015 patient care and empower your patients to live their lives (with a new - Skilled Nursing Facility liver!) to the fullest - Acute Rehabilitation - Acute Care  Currently UCSF Liver and Kidney Transplant since May 2017 3 Occupational Therapy in Acute Care: Liver Transplant 4 Occupational Therapy in Acute Care: Liver Transplant 1 | [footer text here]

What is an occupation? Areas of Occupation • Bathing • Functional mobility • Dressing • Personal device care Activities of Daily • Toileting and toilet hygiene • Personal hygiene and grooming Living (ADLs) • Swallowing/Eating • Sexual activity “ Occupation is the everyday…the things • Self-Feeding • Care of others • Health management and maintenance people need to , want , or are expected to • Care of pets • Home establishment and management Instrumental • Child rearing • Meal preparation and cleanup do everyday ” (Polatajko, 2007) Activities of Daily • Communication management • Religious and spiritual activities and • Driving and community mobility expression Living (IADLs) • Financial Management • Safety and emergency maintenance • Shopping • Rest • Sleep Preparation Rest and Sleep • Sleep Participation  Occupations give meaning to our lives • Formal education participation • Informal education needs, interests and  Create our identity Education participation  Define our life roles and responsibilities • Employment interests and • Employment seeking and acquisition Work pursuits • Retirement preparation and adjustment • Job performance • Volunteer exploration and participation • Leisure exploration • Leisure participation Leisure • Community • Peer, friend Social Participation • Family 5 Occupational Therapy in Acute Care: Liver Transplant 6 Benefits of Occupations Occupational Therapy American Occupational Therapy Association (AOTA)  Reduce the risk for disability and enhance the recovery process  OT is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities. from an ADL disability (Mendes de Leon et al, 2003)  OT practitioners enable people of all ages to live life to its fullest by helping them  Social and productive activities are as protective as physical activity promote health, and prevent—or live better with—injury, illness, or disability. in lowering the risk for mortality (Glass et al, 1999)  OT is inherently patient-centered, holistic, dynamic, and optimistic  Protects against cognitive decline and depressive symptoms (Bassuk et al, 1999)  Restriction for participation causes physiological deterioration , leading to the loss of ability to perform competently in daily life (Kielhofner, 1992) 7 Occupational Therapy in Acute Care: Liver Transplant 8 Occupational Therapy in Acute Care: Liver Transplant 2 | [footer text here]

Person-Environment-Occupation-Performance (PEOP) Model Acute Care Considerations Spiritual Social Supports  Limited time with patients, short length of stay Psychological O CCUPATION - Simultaneous evaluations, interventions, discharge planning Social Capital and  Quality metrics and cost reduction Cognitive Economic Systems  Medical instability P ERSO OCCUPATIONAL E NVIRONMENT  Environmental limitations PERFORMANCE N (Intrinsic Factors) AND  Appropriateness of referral (Extrinsic Factors) PARTICIPATION  Care protocols and activity precautions Physiological Culture and Values  Infection control Neurobehavioral  Need for flexibility P ERFORMANCE Built Environment  Lines, tubes, monitors and Technology Sensorimotor  Productivity Natural Environment Biomechanical Well-Being Quality of Life 9 10 Occupational Therapy in Acute Care: Liver Transplant Stages of Liver Transplant (Scott, 2011) STAGE # COMMON SYMPTOMS PARTICIPATION 1. Decline in health • Fatigue • Likely no impact on • Gastrointestinal performance of ADLs Self-awareness that problems and IADLs something is “wrong” • Puritis 2. Organ failure • Ascites • Chance of some decline Loss of capacity • Decreased initiative in meaningful • Mental health Diagnosis occupations Occupational Therapy and Liver Transplant (depression, anxiety, Validation: something is denial, fear, frustration) wrong  **Occupational therapy services likely not indicated 11 12 Occupational Therapy in Acute Care: Liver Transplant 3 | [footer text here]

Stages of Liver Transplant Pre-Transplant Occupational Therapy Evaluation (Scott, 2011) STAGE # MENTAL PHYSICAL PARTICIPATION HEALTH HEALTH  Gather an occupational profile: WHO is the patient?  Patient-centered short-term and long-term goals: WHAT motivates the patient? 3. Referral to • High stress, • Lab fluctuations • Loss of ability to frustration, fear determine eligibility transplant team participate in  Environment: home set-up/barriers, access to durable medical equipment • Need for staying • Laxatives for HE roles begins Fear, uncertainty, healthy, yet sick • Frequent BMs  Assessments: denial, search for enough for • Restricted information transplant travel - KATZ Index of Independence in Activities of Daily Living (ADL) • Stigmatization • Skin integrity - Lawton Instrumental Activities of Daily Living (IADL) Scale • “Patient role” • Accidents • Increased fatigue - The Occupational Therapy Pretransplant Historical Interview (OT-PHI) 4. Waiting for the • Encephalopathy • Decreased • Malnutrition (HE) causes call ADLs, IADLs, • Muscle loss  Structured interview of self-awareness, initiative, coping, support, limitation forgetfulness, • Water retention mobility Loss of control - Role Checklist confusion, stress, • Skin breakdown • Travel planning Anxiety, fear slowed processing, • Back pain  Self-reported roles performed in past, present, and planned in future + Value associated with role is impacted to Loss of capacity and impaired safety • Abdominal stay close to - Functional cognition • Exacerbation of role strain distension underlying disorders hospital • Shortness of breath  MoCA, EFPT, Menu Task, heath literacy, medication management (depression, • Family education • Impaired balance adjustment, anxiety)  Discharge options and planning: home, home health, placement, community needs resources 13 Occupational Therapy in Acute Care: Liver Transplant 14 Occupational Therapy in Acute Care: Liver Transplant Pre-Liver Transplant ADL and IADL participation Pre-Transplant Occupational Therapy Interventions (Samoylova et al, 2016)  Fatigue management  Awareness training and education  >50% unable to participate in one or more ADL/IADLs  Energy conservation  Caregiver education  Memory strategies  Patients with cirrhosis have functional disability > 80 y/o adult  Adaptive equipment  Coping and adjustment  ADL and IADL disability is significantly associated with wait-list  Durable medical equipment  Pain management mortality  Home environment safety  Transfer training  Most common ADL impairments: incontinence and transferring  Social support and isolation  ADL re-training  Home exercise programs  Most common IADL impairments: shopping, food preparation  ADL/IADL adaptation  Delirium management  Predictors of waitlist mortality:  Communication strategies  Breathing techniques - Toileting  Balance for ADLs  Relaxation and stress management - Transferring  Sequencing  Skin integrity - Housekeeping  Functional Cognition  Medication management - Laundry  Planning for transplant  Incontinence planning  17% are dependent for medication management  Personal goal-setting 15 Presentation Title 16 Occupational Therapy in Acute Care: Liver Transplant 4 | [footer text here]