Formulation and Implementation Donald E. Katz, C.O., L.O. Kevin Felton, C.O., L.O.
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Transcript of Formulation and Implementation Donald E. Katz, C.O., L.O. Kevin Felton, C.O., L.O.
TSRHC Orthotic Residency Program
• 7:1 CO/CPO to Resident
• Closed ended 12 month
• Orthopedic children’s hospital– No charge for services
• Treat employees and family members
• Multiple education opportunities– POC, O&P monthly, Brandon Carroll, Dallas
Short Course
Our Philosophy
• Resident is responsible for patient care
• CO is responsible to assure that the resident provides appropriate care
• Drop-in policy assures that patients change practitioners - numerous opportunities to accept responsibility of care.
Self-Paced
• CO in the exam room until comfort level reached
• CO checks work throughout the year
• Patient load increases and fabrication decreases
Self Paced
• Filling casts
• Pulling plastic, trimming out orthoses
• Delegating orthoses to technicians
• Bending metal
Self Fabrication“Until Competent”
• Numerous AFO’s; One of each new system
• Technical supervisor inspects work
Self Fabricationvs. Delegation
• Understanding of processes
• Knowledge of material properties
• Pride in workmanship
• Communication skills
• Team work
• Documentation
Quarter System
• 1st Below Knee–AFO, SMO, UCBL, FO
• 2nd Above Knee–KAFO, HKAFO, RGO
• 3rd Scoliosis
• 4th Everything
Drop Ins (Clinic Referrals)
• Evaluate orthoses made by others–See what works
–See what doesn’t work
–Provision of “follow-up” care
Clinic Attendance
• Spina Bifida and Scoliosis–Familiarity with the clinic team
–Evaluation of orthoses made by others
Standards of Practice
• Compilation of treatment philosophies–Clinical decision making
(Rx considerations)
–Technical decision making (when to use what; trimlines, etc.)
• LE orthoses
• Boston Braces
Standards of Practice
• Written reference
• Provide some uniformity
• Additional learning modality
• Require input when revising these documents
Patient Education Handouts• Provide consistent instruction
• Ease documentation
• Provide talking points
• Leave room for patient specifics
Functions of Measurement Form• Forces resident to think about design
–Ankle joint type
–Plastic type and thickness
–Wedges or posts
–Medial or lateral flange
–Extended forefoot walls
• Acts as a work order
Dictation Formats
• Paired Formats:–“Initiation of Orthotic Treatment”
–“Initial Orthotic Fitting”
• Narrative Formats
Paired Dictation FormatsCasting Visit:• Demographics
• Orthotic History
• Physical Evaluation
• Treatment Goals
• Questions / Concerns
• Plan
Delivery Visit:• Goals met?
• Skin Integrity
• Special Modifications
• Patient Education
• Special Instructions
• Plan
Formulation of Treatment Plan• Tx goals and expected outcomes
• Consult with Dr./referral source
• Identify material, design, and components
• Develop a plan for patient needs
• Document treatment plan
• Inform Px, etc. of financial responsibilities
Implementation of Tx Plan• Inform Px
• Select materials/techniques
• Provide preparatory care
• Prepare Px
• Implement procedure (e.g. cast)
• Select materials
• Consult technical component/material resources
• Prepare for fabrication
• Modify
• Fabricate
• Assess device
• Assess / align
• Ensure ... fit/delivered
• Complete fabrication
• Educate
• Reassess
• Document
The Tough Stuff
• Observational gait analysis
• “Orthotic Eye”
• Communication
• Working efficiently