Service Management Functions



Service Management Functions



On plucking thistles and planting flowers . . .


How one lives life or chooses an occupation can be simple and straightforward or a long journey. As an undergraduate student, I wanted to be in premed—convinced that my calling was to be a physician. During undergraduate school, I explored two directions.


My first job was as a genetics technician in a university-based medical center. My days were spent centrifuging and fixing samples on slides, counting chromosomes, and photographing and creating karyotypes. When I closed my eyes each night, all I could visualize was chromosomes floating in emulsion. I would briefly meet people when they gave a sample in the laboratory, but I never got to know them or know what having the test meant to the greater scheme of their lives.


My second exploration was as a volunteer in an occupational therapy department in a psychiatric hospital. Suddenly, I was fascinated by people and their stories—intrigued by what went wrong and how their lives could be reorganized, allowing them to return to some sense of normalcy in their day-to-day lives. Occupational therapy seemed less scientific yet so very meaningful—listening while we were doing. I found that change and growth can be found through doing. I was a potential “agent of change”—the very meaning of the word “therapist” directed me to choose occupational therapy. The process of occupational therapy reminds me of Abraham Lincoln’s words, which I have embraced: “I want it said of me by those who knew me best that I always plucked a thistle and planted a flower where I knew one would grow.” I chose occupational therapy and have been plucking and planting. What a garden has grown and continues to grow each and every day!


ANN BURKHARDT, OTD, OTR/L, BCN, FAOTA


Director, Division of Occupational Therapy


Associate Professor of Occupational Therapy


School of Health Professions


Long Island University


Brooklyn Campus


Brooklyn, New York




Objectives


After reading this chapter, the reader will be able to do the following:


• Explain the various service management functions


• Identify factors in a safe and efficient clinical environment


• Describe how the spread of infection is prevented in the workplace


• Define the three major categories of funding sources that reimburse for occupational therapy (OT) services


• Recognize the importance of program planning and evaluation as service management functions


• Understand the purpose of documentation


• Describe the documentation that occurs at various stages in the occupational therapy process


• Identify the fundamental elements in a client record


• Understand the integration of professional development and research into practice


• State the importance of marketing and public relations as a professional responsibility



Key Terms



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Occupational therapy practitioners work with clients in a variety of environments. Along with evaluating and intervening with clients, practitioners are involved in service management functions. Service management functions include maintaining a safe and efficient workplace, documenting occupational therapy services, getting reimbursed for services, planning programs and evaluating them, integrating professional development activities and evidence-based practice into the workplace, and engaging in marketing and public relations. These functions are essential components of professional practice.



Maintaining a Safe and Efficient Workplace


Occupational therapy practitioners provide services to clients in an orderly and safe environment to ensure the safety of clients and efficiency of intervention and work procedures. The space in which practitioners work must accommodate clients with disabilities. For example, therapy settings must be wheelchair accessible, be free of clutter, have good lighting and ventilation, and have proper storage for equipment. The setting must be large enough to carry out intervention procedures.


Each practitioner assumes responsibility for maintaining a safe and efficient work environment. He or she is responsible for reporting problems to the occupational therapy administrator or to the maintenance department. Practitioners are directly responsible for putting away equipment and supplies that they use during a session and for cleaning the work area. The department operates more effectively and with less stress when everyone participates and cooperates in maintaining a safe and efficient work environment. The following sections describe specific factors considered in the work setting.



Safe Environment


Accreditation refers to a form of regulation that determines whether an organization meets a prescribed standard. Occupational therapy clinics must adhere to accreditation standards set by specific accreditation bodies. Many of these standards relate to establishing a safe work environment. For example, rehabilitation settings must meet CARF (Commission on Accreditation of Rehabilitation Facilities) standards. Each setting develops written policies and procedures in accordance with the accreditation standards. Practitioners are responsible for following the written policies and procedures of their setting.


In general, clinical settings need to be large enough so that staff and consumers can move without bumping into equipment or objects. Equipment and furniture should be out of traffic areas. Sharp corners on cabinets should not protrude into areas where people may walk. The clinic should have non-slip floor surfaces and grab bars in bathrooms, with emergency call buttons.


The clinical setting must have proper storage for items that may potentially be a safety hazard. This may require items be placed in locked cabinets. For example, in certain settings scissors, knives, and other sharp objects may be considered potentially harmful and need to be monitored carefully and stored securely.


Some materials used in occupational therapy clinics may pose a health hazard. For example, some therapy clinics use toxic paints or stains, which need to be stored and used carefully. Toxic chemicals and flammable substances must be stored in a special cabinet for flammables. The Occupational Safety and Health Administration (OSHA) requires that manufacturers of such materials provide a material safety data sheet (MSDS), which outlines information on the proper procedures for working with the material and describes procedures for storage and disposal. The data sheet describes the type of protective equipment required to work with the material. The data sheet outlines the procedures to follow in case of a spill or accident. MSDS sheets should be read carefully before a practitioner uses any hazardous material; they are kept in a readily accessible area of the clinic. All staff must be trained in the proper use of equipment and supplies that are found in the occupational therapy clinic. Practitioners may have to use protective goggles or masks when working with materials.13


Many OT clinics have kitchen areas which must be maintained according to health standards. Guidelines are provided for how food is handled and stored in occupational therapy clinics. Practitioners should inquire about the policies and procedures for their clinical setting, including how to ensure cleanliness of the clinic space, dishes, and materials.


OT practitioners are frequently involved in lifting and moving clients (e.g., from bed to wheelchair). It is important that practitioners use proper body mechanics to avoid injury. Employers are required to provide training on the use of proper body mechanics for lifting or transferring clients.


Each setting of practice has established emergency procedures in the case of an injury or accident in the clinic. All staff must be aware of the emergency procedures and emergency call system. Everyone must stay aware of who is in the clinic at all times. These procedures include who to contact and what to do. Many settings require OT practitioners maintain current certification in cardiopulmonary resuscitation (CPR) and first aid. Some settings require practitioners know how to determine blood pressure and pulse rate, manage a seizure, and intervene when someone is choking.13 Practitioners document any injury, accident, or incident in a report (usually a standard form) and submit it to the administration in accordance with the procedures for that clinic. Box 13-1 summarizes safety considerations in the occupational therapy clinic.



Box 13-1   Safety Considerations in the Occupational Therapy Setting




Sharp objects should be properly stored in a locked cabinet or drawer.


Keep flammables in a locked metal cabinet.


The clinical environment needs to be free of clutter so that staff and clients can move safely. Sharp corners on cabinets should not protrude into traffic areas. Equipment and furniture must be kept out of traffic areas.


Bathroom areas that are used by clients must have securely anchored grab bars.


The emergency call system should be readily available, and all staff must understand emergency procedures.


Flooring must be nonslip, and the staff must alert others to anything that changes this condition (i.e., water).


All staff are required to have proper training in the safe use of equipment and supplies found in the occupational therapy clinic.


In kitchen areas, foods must be safely stored and handled.


Staff need to be trained in the use of proper body mechanics when lifting or moving clients, equipment, and supplies.


Staff must be aware of who is in the clinic at all times and report suspicious persons.




Infection Control


The Centers for Disease Control and Prevention (CDC) is a federal agency that works to “protect people’s health and safety, provide reliable health information, and improve health through strong partnerships.”9 The CDC developed universal precautions, a set of guidelines designed to prevent the transmission of HIV, HBV, and other blood-borne pathogens to health care providers.


The CDC recommends that health care personnel consider blood and body fluids of all clients as potentially infectious and follow universal precautions.8 Universal precautions involve using protective barriers (e.g., gloves, gowns, aprons, masks, or protective eyewear) to reduce the risk of exposure to blood and other body fluids.8 For example, OT practitioners following universal precautions wear protective gloves while addressing activities for daily living (ADL), such as grooming, personal hygiene, toileting, and dressing. The practi- tioner changes his or her gloves and washes his or her hands after contact with each client. In many clinical settings, a notice is placed in the client’s medical record of the need for health care workers to use precautions. See Box 13-2 on Universal Precautions.



Box 13-2   Universal Precautions




Adapted from http://www.udsmr.org/WebModules/FIM/Fim_About.aspx.


Hand washing is the most effective method for preventing the transfer of disease. The OT practitioner washes his or her hands before and after each treatment session and before and after eating. Practitioners wash hands after using the toilet, sneezing, coughing, or coming in contact with oral and nasal areas. Procedures for hand washing are provided in Box 13-3.



Box 13-3   Techniques for Effective Hand Washing




1. Remove all jewelry, except plain band rings. Remove watch, or move it up the arm. Provide complete access to area to be washed.


2. Approach the sink, and avoid touching the sink or nearby objects.


3. Turn on the water, and adjust it to a lukewarm temperature and a moderate flow to avoid splashing.


4. Wet wrists and hands with fingers directed downward, and apply approximately 1 teaspoon of liquid soap or granules.


5. Begin to wash all areas of hands (palms, sides, backs), fingers, knuckles, and between each finger, using vigorous rubbing and circular motions. If wearing a band, slide it up or down the finger and scrub skin underneath it. Interlace fingers, and scrub between each finger.


6. Wash for at least 30 seconds, keeping hands and forearms at elbow level or below and hands pointed down. Wash longer if a patient known to have an infection was treated.


7. Rinse hands well under running water.


8. Wash as high up wrists and forearms as contamina- tion is likely.


9. Rinse hands, wrists, and forearms under running water.


10. Thoroughly dry hands, wrists, and forearms with paper towels. Use a dry towel for each hand. Water should continue to flow from tap as hands are dried.


11. Use another dry paper towel to turn water faucet off. Discard all towels in an appropriate container.


Modified from Zakus SM: Clinical Procedures for Medical Assistants, ed 3, St. Louis, 1995, Mosby.


Federal agencies, employers, and employees are responsible for controlling the spread of infection.16 The regulations are established and monitored by the CDC and by the Occupational Safety and Health Association (OSHA). OSHA monitors compliance of employers and fines those settings that do not follow the regulations, whereas the CDC monitors individuals’ exposure to disease in the workplace.


OSHA standards define the responsibilities of the employer to provide education on universal precautions and to provide the necessary protective barriers, hand washing facilities, and supplies needed by employees. Employers must provide employee health services to conduct mandatory annual testing for TB, HBV vaccine, and to maintain employee health records (i.e., tests and vaccines given and any exposure to infectious disease).16


Employees are responsible for attending educational programs that are offered and following universal precautions guidelines. Employees must have an annual TB test and report any exposures to the employee health services department. The employee may decide whether to take the HBV vaccine or to sign a waiver.16

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Related posts:

  1. From Student to Practitioner: Educational Preparation and Certification
  2. Occupational Therapy Practice Framework: Domain and Process
  3. Models of Practice and Frames of Reference
  4. Intervention Modalities

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Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Service Management Functions

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