on 17/11/02 11:28 pm, Britt Hyman at [log in to unmask] wrote:
> We are currently working on this also. We plan to have a blue section in the
> notes for physio, green for OT etc. We are designing assessment forms for
> all the usual referrals e.g. back pain, mobility, stroke etc. We are also
> planning to have a multidisciplinary care plan. Let me know if you want to
> see what we have done so far although it is far from complete.
> Britt
> ----- Original Message -----
> From: "Nicky Mackenzie" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, November 16, 2002 8:23 AM
> Subject: multidisciplinary notekeeping
>
>
>> Our hospital is about to begin mutidisciplinary notekeeping. If you do
> this
>> already please share your experiences?
>>
>> The doctors seem to think we can just write in the notes, but CSP
>> guidelines on notekeeping advise that we maintain an accurate physio
> record
>> of treatment.
>>
>> We are trying to design a sheet to add to the notes, but if anyone has
>> done this already please share.
>>
>> Thankyou
>>
>>
>> Nicky
I have worked somewhere where exactly that system was tried - blue for PT,
green for OT etc. There was no improvement in communication as everyone just
continued to only look at their own section and you found yourself telling
people things that were already documented elsewhere. If anything it made
things worse as several people wanted the notes at the same time.
A far better system is a truly interdisciplinary system where the whole team
is working together on client centred interdisciplinary goals e.g.
transfers, nutrition, continence This is succesful where an area is fairly
self contained. At St Marys CRU in Leeds, the successful development of
interdisciplinary notes was accompanied by a complete rethink about how the
team worked together, including developing a shared office space, having a
forum where unidisciplinary jargon was explained and developing a greater
awareness of each professions roles / contributions.
e.g. working towards a goal of independent self catheterisation for a lady
with multiple sclerosis; medics may prescribe oxybutinin and administer
botulinum toxin to adductors, physios ( +/- OTs ) work on alignment,
wheelchair posture,transfers,mobility, muscle length & activity, OTs may
explore environmental & adaptation issues, nurses / continence nurse work to
find the best way of dealing with bladder wash outs etc to minimise bladder
spasm triggering adductor spasm, dietitian work to improve awareness of the
role of choice of fluid intake and general nutrition etc etc
The important part of the documentation to get right is the goal setting and
treatment planning. After that it is a case of ensuring the treatment
delivered is aimed at that treatmnet plan - it is not about writing a recipe
for others to follow ( this is in neuro ) so e.g. one planned physio
intervention might be to increase selective extensor activity in trunk,
pelvis and lower limbs to allow wieght transfer during the stance phase of
gait and thus the ability to take a step. On one day this may be done by
working between perch standing and standing and the next day by working in
step standing alongside a plinth with the free leg sliding on a bean bag or
whatever.
Sorry a bit wordy but I hope you get the general idea.
D.Neal
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