therapy

[busy-bee]

I took an order off last week for a resident to receive PT to decrease left hip pain. I tried to call the therapist to ask...when did pain start, etc, resident has dementia? Unable to contact PT, but needed to still notify family to let them know of the new order. I called family to let them know (they visit several times a week) of new order. Family member states she is unaware of hip pain. I suggest to her to speak with therapist, for I am as well unaware. I am off for the following two days and return for the weekend. When I return to work there is an order for xray to pelvis, left hip, knee and femur. I ask in report why and none of the nurses on the unit knew. The xrays come back negative...mind you nothing is charted in the nursing notes related to any type of pain, reason for xray, etc. Today I make a point of finding PT and asking them about this...oh yes, the therapist states resident c/o left hip pain so she asked for xrays. I asked if she talked with the nurse regarding this and she states noooo, she doesn't have to go through a nurse. I told her I asked her only if she spoke with a nurse....and she stated no. She went to walk away and I calmly asked her if she would like the results in which I told her they were negative. I have never heard of nursing being bypassed like this before. Not to mention, if PT thought there might of been a fx, the PT should of been placed on hold..not continued....what the heck? Am I wrong thinking like this. From the time PT was odered to the results of the xrays was six days...something isn't right with this. The order actually read..... Xray to pelvis, left hip, femur, and knee to rule out fracture, not an emergency........ I would think any of those would be considered an emergency to know. I guess you all get the meaning of all this....it just isn't right. What do you think?

[steelcityrn, RN]

I feel the physical therapist should be in communication with the nurses. I think its time for a meeting between the diciplines to clear up some rules. The nurse would need to know what the therapist noticed so precautions are taken such as pain mng and ambulation. Of course you look pretty poor when you tell a family member no one seems to know whats going on with their loved one. It makes no sense to behave the way this therapist did. It almost comes across like the therapist is way above the nurse, no need to even talk to you. And as we know, all good facilities use good teamwork.

[leslie :-D]

that's why it's called the healthcare team.

does rehab's notes reflect pt c/o pain?

getting an xray is appropriate.

not sharing this w/nsg, is inappropriate.

starting PT w/o xray results, is also inappropriate.

you need to confer w/your DON and let him/her speak w/PT.

best of everything.

leslie

[EmmaG, RN]

Was the therapy begun before the xrays were taken? If not, I don't see the problem as a positive xray would have been reported. There's always a lag-time between when the xrays are read and when the actual report gets to the chart. Anything of concern, such as a fracture, would have been verbally reported by the radiologist to the PT or doc.

Something else that isn't clear:

I took an order off last week for a resident to receive PT to decrease left hip pain.

Was that order written by a physician? If so, I think the PT was doing exactly what she should by insisting on an xray before therapy.

But then again, I'm not too clear on your post just what the sequence of events were and who ordered what. And doesn't PT write progress notes? I do agree that she should have shared her concern with the nurses.

[jessiern, BSN, RN]

Therapy should have definitly been on hold till clear results came back, that is a very simple fact.

What bothers me is, why didn't anyone simply ask the patient if she/he was experiencing hip pain? Seems like that would have been a simple way to get some of your answers. Even a pt with dementia can sometimes tell you if they are hurting.

Sounds like a lot of poor communication. Perhaps PT was unable to find the nurses, as you were unable to find them.

[busy-bee]

The therapist wrote the order: PT to decrease left hi pain on 1/28/07. The xray order was written on 2-1-08 by the Dr. because the therapist stated the resident c/o left hip pain. The therapist told me she doesn't need to talk with the nurses....very matter of factly. Obviously the therapist doesn't even have to speak with the family either. I just don't think therapy should of bypassed nursing like this.

[ktwlpn, LPN]

if complaint's of pain are not reflected in the nurse's notes you'll be lucky to paid for these x rays..

[busy-bee]

That will get someones attention.

[EmmaG, RN]

The therapist wrote the order: PT to decrease left hi pain on 1/28/07. The xray order was written on 2-1-08 by the Dr. because the therapist stated the resident c/o left hip pain. The therapist told me she doesn't need to talk with the nurses....very matter of factly. Obviously the therapist doesn't even have to speak with the family either. I just don't think therapy should of bypassed nursing like this.

Ok, then PT was in the wrong, IMO. The doc should have been notified and PT should have been withheld until results were back. Thanks for clarifying.

I think your director needs to have a little talk with the PT.