Therapist Profile - Dennis Baloy

MP Celebrate

By Jamie Funk, Therapy Recruiting Resource
Dennis Baloy is one of our more recent additions to the Ensign affiliated therapy leadership team. As the Director of Rehabilitation at St. Elizabeth Healthcare & Rehabilitation Center, Dennis immediately recognized our unique culture: “I just want everyone to know how lucky I feel to be part of this wonderful organization that truly embodies the value of Customer Second, where we as therapists and employees are celebrated, valued and appreciated. I am even more humbled to be surrounded by really bright, talented and passionate leaders. Everyone is so inspiring in their unique ways. Collectively, this is what truly sets us apart!”

Dennis has been a therapist for 15 years and a Director of Rehabilitation for the past eight years. He graduated with his Bachelor of Science in Occupational Therapy in the Philippines and later completed his Clinical Doctorate in Occupational Therapy with Geriatric Certification in the United States. As a child, Dennis always wanted to become a doctor and thought therapy might be a stepping stone to that career. However, as he immersed himself in his first OT internship, Dennis realized that OT was it for him — a career that would allow him to care for others, be creative and be human. Dennis has two brothers who are his biggest inspiration and mentors: Paul and Kirby. “They are the biggest reasons why I am where I am with my career,” Dennis says.

During the Ensign transition at St. Elizabeth, Dennis saw that culture was a top priority. “It was refreshing to see how involved all employees are in the facility. No longer does each department feel separate from one another. Every staff member is valued equally and has a voice. The support from our resources and Service Center is always present when you need it — this was definitely a big change in mindset for me coming from a corporate hierarchical structure,” Dennis remembers.

Dennis says that his biggest challenge has been being new in our company, new in his role and then having relentless COVID outbreaks in the community to deal with. “It has been stressful at times, but for the most part it is just a big challenge that I am willing to face. I feel like I don’t know a lot of things and that I still need to learn a lot of technical items, but I am excited to listen and grow. There is a huge sense of fulfillment if you know you can be of service to others and spread positive and enriching influence.”

Dennis has shown himself to be a wonderful leader. He loves being able to see his colleagues go out on their own and feel like they can do their jobs well because they feel valued, appreciated, empowered and loved. “Nothing beats the feeling of knowing that they love coming to work, they love their patients and their profession, and they can provide for their families and be themselves,” Dennis explains, “My favorite core value is Love One Another. Love at its core is selfless — the moment we think less of ourselves and more of the betterment of others. This allows us to build a community of trust, and this trust allows us to better serve our facility, our patients and our community.”

Dennis finds mentors throughout his facility. “I see everyone in my facility as my mentor,” he says. “I learn so much from each of the department heads and especially my administrator and DON — they all have strong attributes that complement each other and the whole facility.” Dennis also loves his nursing team and treats them like family. He has been able to build strong relationships with nursing through honest and genuine communication.

In his off-work hours, Dennis is passionate about photography and videography. He owns his own company, and pre-COVID, was very busy providing those services at weddings and other events. He still spends a lot of time taking photos and creating videos for fun. Dennis has also fallen in love with the world of triathlons and has set a goal to complete an Ironman competition in 2021. Favorite movies include “Braveheart,” “50 First Dates,” “Memento,” “Crash,” “Into the Wild” and a variety of Disney movies that he watches with his family.

As for the future, Dennis is focused on both family and work. “I would just love to see my daughter grow to be a nice kid — a good, smiling and happy kid. I want her to get to be who she wants to be and be happy doing that and being helpful to others. I have a goal to spend more quality time with my wife at home and hopefully some future trips together.” Dennis is looking forward to seeing his facility GROW. His goal is to serve more residents with inpatient and outpatient services and be recognized in the community as a skilled nursing facility that provides excellent clinical care that is warm, loving and inviting. He would also love to help spread this to the other Ensign affiliates in his area.

It always seems like something magical and wonderful has happened when a great therapist finds a great place to work and grow. Magic is definitely happening at St. Elizabeth!

Think Thin! Collaboration in Flagstone

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Morgan Nebo
Aggie Smith

Morgan Nebo, Dietary Supervisor at Victoria Post-Acute, and Aggie Smith, Flagstone Dietitian, provided a great presentation to the Flagstone DORs and SLPs on best practices for therapy and dietary collaboration with emphasis on ThinkThin!

Key takeaways from this presentation:
1. CMS — Quality of Care Intent: “To the extent possible, MAINTAIN or IMPROVE before complications arise.”

● Resident HYDRATION is the key (and the challenge) with thickened liquids.
● F692, Quality of Care Nutrition and Hydration, requires that a resident is offered sufficient fluid intake to maintain proper hydration and health.
● As a general rule, most residents will require 1500–2000 cc daily under “normal” circumstances — SLP collaboration.

2. Nutritional Assessment and Risk Identification: Collaboration with SLP and Food/Nutrition to assess a variety of areas.
3. Become familiar with using the information in PCC: i.e., Nutritional Assessment UDA along with CNA input/output reporting.
4. Collaboration is super important during quarterly assessments
5. Become familiar with the facility menu system in the affiliate you are servicing. Review the diet manual standards and follow facility nomenclature. If a facility-wide change is needed, collaborate!

The training was so successful, the LMS team is working on a recording so everyone in the organization can benefit from the great information and have continued collaboration for Think Thin!

Sharing Vital Sign Tips

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By Dawn Thompson, DOR, Victoria Post Acute Care, El Cajon, CA

Over the last several months, Victoria Post Acute Care [VPAC] has honed in on vital sign monitoring as part of our daily practice in both nursing and therapy. I’ve been nominated to lead our vital signs committee, and during the next few weeks I’d like to share some of the best practices and education that assisted us through COVID and landed VPAC Vital Sign Grand Champions.

We’ll start with the vital sign we’re all monitoring daily, body temperature. After 8 months of daily screening, you’ve probably noticed a pattern and can guess your morning temperature within a few tenths of a degree; you’ve established your baseline temperature.

Do you know your residents’ baseline temperature? Would you be able to identify a fever and assist in early recognition of an infection?

Regularly measured body temperature is used to establish a baseline temperature and define the threshold temperature for fever. The elderly are noted with a lower baseline body temperature and a shift of 2.4*F above baseline is a fever, even when falling below definition of a fever at 100.4*F.

At VPAC, once a baseline temperature has been established, it is then added in special instructions in the Care Profile in PCC [See photo below]. This baseline temperature can then be used to assist in identifying any potential infection or COC with our residents.

Please don’t hesitate to reach out with any questions. (DawnThompson@ensignservices.net).

 

CAPLICO Moment: Momentum Therapist Spotlight

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By Paul Emerson L. Baloy OTD, OTR/L , DOR, The Hills Post Acute Care, Santa Ana, CA

Denise Del Cano, COTA, ADOR, has dedicated her career in The Hills Post Acute. An alumnus of Santa Ana College, she earned her associate’s degree in Occupational Therapy Assistant 12 years ago and has been with the facility since then. She was promoted to Assistant Director of Rehab last year and completed the DORITO program this year. Denise did her internship here at The Hills. She was supervised by Vonda Gaier, COTA, who then became her colleague. She is a Filipino American born in Los Angeles, California, the eldest of five and a loving mother to her 16-year-old daughter, Elizabeth. Interestingly, Denise was introduced to the field of therapy when her daughter received therapy for several years. Denise saw the importance and relevance of Occupational Therapy and has been an advocate ever since.

Customer Second: Residents approach her knowing that she will listen and immediately respond to their requests. She will ask any of our facility staff how well each one is doing and how she can assist them to make their day better.

Accountability: She assists her supervisor in creating daily schedules and follows up on department needs and requests.

Passion for Learning: She is seeking ways of learning new things, being receptive to new information and understanding, and embracing the Hills Post-Acute way of doing things.

Love One Another: She genuinely cares for the staff. She will hand you a cookie or any treat to perk up your day.
Intelligent Risk Taking She will listen and learn our new way of doing things. Willing to unlearn past habits, think outside the box and develop better and efficient new systems.

Celebration: She will bring in breakfast or lunch to celebrate the day’s hard work, keeping each one’s morale in check and in good shape. She will celebrate birthdays or becoming a new member of the team.

Ownership: She demonstrates ownership by making everything personal because she believes in her heart that this is her second home and that her co-workers are her family.

Code Sepsis: Pilot Program

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Submitted by Esther Allmond, DOR, The Cove at La Jolla, CA

The Cove volunteered to be a pilot site and is now entering their 3rd month for the EPIC program: CODE SEPSIS. Dr. Pouya Afshar handpicked our facility to trial this pilot program to help prevent sepsis in-house by carefully monitoring vitals throughout the day. Throughout this time, we have gained a new appreciation and respect for taking vitals before, during and after therapy treatment sessions. Rehab has taken a more active role in vital signs at The Cove, and I just wanted to share with all of you a little bit more about EPIC, CODE SEPSIS, and our current protocol at our facility.

EPIC (Excellence in Programming and IDT Care): Programs dedicated to taking IDT action with a QAPI approach in order to provide the most excellent care possible for our patients.

CODE SEPSIS MISSION: Early identification of sepsis to improve patient outcomes.

WHY: Sepsis is the leading cause of readmissions to the hospital in 2019 (20% of Medicare readmission!). With every hour that treatment is delayed for sepsis, the mortality rate increases by 8%.

CODE SEPSIS PROTOCOL: Taking vital signs early and often for each of Dr. Afshar’s patients. Nurses take vital signs Q shift (or more often). and therapists take vital signs before each treatment session and enter it into PCC. Notify charge nurse immediately with any one of the following triggers:
1. Temp > 99.5F
2. SBP < 100
3. HR > 90

CODE ACTIVATION/METRICS:
• Clinician identifies patient meeting criteria (initiation, time stamp)
• Notify charge nurse (5 minutes)
• Verify/repeat vitals (5 minutes)
• Nurse activates code (5 minutes)
• Code team clinician contacts on call MD/NP (5 minutes)
• Response back from on call MD/NP (10 minutes)
• Total time spent: 30 minutes
• Reassess at the end of each 30-day cycle
• Duration of phase 1: 90 days

CODE SEPSIS was triggered several times in the past two months, allowing us to implement interventions in a timely manner and preventing re-hospitalization for our patients! As we close the last 30 days of Phase 1, we hope to remain consistent and vigilant in monitoring vital signs for our patients, providing the most EXCELLENT care possible for patients and improving outcomes. Please feel free to reach out to me at any time if you have any questions, comments, feedback, or interest in implementing CODE SEPSIS at your own facilities!

Huge Shout-Out to Emblem Hospice

MP Celebrate

By Doug Haney, CEO/ED, Bella Vita Health & Rehabilitation Center, Glendale, AZ

I wanted to recognize this very special “Moment of Truth-esk” gesture that the entire staff of Bella Vita experienced recently. A couple weeks back, our staff was pretty worn down and experiencing a wide range of emotions dealing with the effects felt from this coronavirus. Everyone was especially hurt when we lost several of our long, long-term residents we all called family. We loved each and every one of those we lost and needed some serious support for those who knew them well.

Out of the blue, Michael and Mitch stepped in, offering a memorial service to honor and remember those we lost over the past several months. They set everything up, even though I knew their services were widely needed during that time. I can honestly tell you we cried and held each other a lot during that time. We were grateful for Emblem’s offering and kindness when we needed it the most. One of them brought a grill on wheels (not sure whose it was, but it is pretty sweet) and cooked up burgers and hot dogs for all the staff over a four-hour period. It was hot outside, but Michael didn’t seem to mind it — it was 115 that day.

At 2 p.m. in our main dining room, staff joined together and were allowed to share special memories about their lost friends and then place a leaf with their name on a potted tree. It was good to get together to reminisce, reflect, and realize we were blessed to be a part of their lives.

On behalf of the entire Bella Vita Team, THANK YOU MITCH, MICHAEL AND EMBLEM HOSPICE. You truly made our day!

Congratulations to Keystone’s Newest CTOs

MP Celebrate

By Jon Anderson, Therapy Resource, Texas
I wanted to take a few moments to celebrate our newest CTOs (Chief Therapy Officers) in Keystone. The CTO designation is the highest designation a therapy leader in the organization can receive; it is a tall order to be in this elite club. Please join me in congratulating this elite group of Texas leaders!

There is so much to say about these two incredible ladies, but I’ll keep this short and just share a few highlights.

Cara Koepsel, SLP, DOR, CTO, Golden Acres, Dallas, TX
Cara became the DOR at Golden Acres in May 2018, after being one of our first DORITOs (Director of Rehab in Training) in Keystone, and then successfully transitioning to DOR (Director of Rehab) at Lake Village for nine months. When Cara came to Golden Acres, the therapy department was doing well financially and operationally in key therapy metrics; however, Cara reminded us that GOOD is the enemy of GREAT.

Cara truly is the epitome of ownership, and quickly jumped in at Golden Acres. In fact, there isn’t a function in the facility that she is not willing to take on herself or assist with as needed. She has learned how to run payer verifications for when the BOM is off; she reviews the 24-hour report and clinical documentation to identify skill in place patients; she coaches the MDs on peer-to-peer reviews for insurance authorizations, and also plays a vital role in the Keystone North market with the education and training of our other DORs.

Cara has sprinkled her expertise in the market by assisting in the training of three additional DORITOs that are now also DORs of facilities in Keystone. She has been asked to present at many therapy leader meetings, and even at the annual Ensign leadership meeting in Dallas this past year. PNSD has steadily been above $60 for well over a year (amazing!), and Golden Acres is always in the top few buildings for productivity and cost per minute. It has been truly amazing to watch Cara grow into this tremendous therapy leader and watch her partner with an amazing CEO, Rick Forscutt, and COO Karen Calma to finish out the trifecta here, and we are so thrilled to announce her new title as a Chief Therapy Officer (CTO).

Agatha Pedro, OTR, DOR, CTO, Timberwood, Livingston, TX
Agatha relocated from outside the state of Texas into a city with such charm, known as Livingston, TX, four years ago to help lead the therapy team at Timberwood. The shift from what she was familiar with could have been a tough adjustment for some, but Agatha stepped right in and embraced the city and facility with open arms.

The transition came with some growing pains such as a very limited therapy team, ever-changing department heads, and very linear therapy services that were offered. In a short amount of time, Agatha has nearly doubled her therapy team through strong partnership efforts with our Keystone Therapy Recruiter, Richard Johnson. Agatha made a conscious decision to create an interview process that was inclusive with other team members. She prides herself on her onboarding process so each new team member can be fully immersed with the Ensign experience.

There have been changes within the leadership team at Timberwood, but those changes did not impede the flow of progress. With humility and vocal confidence, Agatha supports the needs of other departments by being an actionable leader. Patient care has always remained at the forefront, as evidenced by Agatha’s competitive productivity standards that she maintains as an Occupational Therapist. She understands the operational demands of her role as Director of Rehab, but she knows that her clinical impact provides greater depth in the overall scope.

As a DOR, some may be intimidated to comfortably partner with their ED and DON … not Agatha. Agatha will initiate meetings, bring ideas, and execute tasks through strategic implementation processes. Prior to Agatha, the therapy department had very limited programs and led a very traditional process in the services that were offered. In four short years, the Timberwood facility now offers a variety of programs and therapy services that rival competitors.

Prior to the start of the pandemic, Timberwood was on track to have a strong growth in outpatient, far more than they have ever had in the past. The reputation of the therapy department created a pathway for patients to discharge and return for outpatient services. Agatha is LSVT Big certified; this is a world-recognized certification used in treating movement aspects of Parkinson’s disease. Long-term care programming has been a goal for Agatha, and she has steadfastly kept her focus there for the last two years. Through her passion for learning and intelligent risk taking, she has transformed long-term care at Timberwood.

We are half-way through 2020, and Agatha is projected to finish the year with her highest revenue performance to date. More importantly, the clinical backbone has remained solid. Therapy continually finishes with exceptional MSCA scores, and therapy has also maintained a vested interest in helping to support the quality metric performance. Agatha has only begun to tap into her potential as a therapy leader, and we are honored to recognize Agatha Pedro as Chief Therapy Officer.

 

Congratulations Carl Meyer, PT SPARC Winner!

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Carl Meyer, PT
Marquette University, Milwaukee, WI — Grad Date: 05/08/2021
In the midst of the current health crisis and social justice demonstrations, I see a world needing communities to be filled with sparks, small bright lights that the darkness cannot overcome. Indeed, as I examine my own education, talents, and abilities, I know that it is not just an opportunity, but my responsibility to step into my community as this light, and I write this encouraged, knowing that I have been equipped by those who have come before me to be that exact spark in the community I call home.

As a physical therapy student at Marquette University, my work at the local Milwaukee Rescue Mission as the Sports and Recreation Coordinator has been a foundational piece of my education. My time at the Mission has opened my eyes to the health disparities in the inner city of Milwaukee; particularly among young African-American men and in the communities they call home. The first time I drove one of my high school students to his home in north Milwaukee, I encouraged him to get his ankle examined, as he had badly sprained it that day at our Youth Center. Laughing, and shaking his head, he told me that he’d never been to the doctor before, and he wouldn’t even know where to find one. As I watched him limp to his door, the reality of Milwaukee’s environment settled in and my passion was sparked, leading me to choose a career in the medical sciences to reduce health disparities in the impoverished communities of Milwaukee.

My passion for impoverished communities and my calling to these areas of need started long before Milwaukee. Growing up in Albuquerque, New Mexico, I was a minority in the diverse and ethnic landscape of New Mexico, often witnessing the hardships of my classmates, and the health disparities experienced by Native American and underserved classmates from the reservations and poor communities of the southwest. These childhood experiences became the foundation of my mission to serve the poor by reducing health disparities, and led me to Colorado State University.

In my time at Colorado State, I was able to experience leadership as an Intern for the Office of Admissions, as an Academic Success Coordinator for the Department of Health and Exercise Science, and as a Resident Assistant. Most importantly, however, was my undergraduate thesis, which was titled “Project Play: A Mission to Study and Improve Areas of Need for Health and Wellness in Homeless and Underserved Youth Populations.” My work was written after spending a semester working with youth at the Matthew’s House, an organization that provided programming for homeless and immigrant families in northern Colorado. If my foundation was forged in New Mexico, my vision was truly carved during my time in Colorado. After graduating as a cum laude Honors student with Dean’s List distinction, and
with the Myron Ludlow Brown and Eddie Hanna Awards, my experience at the Matthew’s House led me directly to Milwaukee, and into the ZIP code with the highest rate of incarceration for men in the nation.

At the Milwaukee Rescue Mission, I provide exercise and leadership programming for homeless youth at the Mission, as well as for local students. I have frequently witnessed the impact of health education on the outcomes of the inner city youth that I work with, and this service has given me the vision of how to use my education to be a part of the outreach in Milwaukee, with an emphasis on communities with health disparities due to socio-economic divisions. I was able to start a local mentorship program for area youth at the Mission, and as my education has progressed, my vision of how to make this goal a reality beyond graduation has coalesced. I see an incredible opportunity for physical therapy to provide low-income healthcare, at clinics with high accessibility, leading to the training that can make
community mentorship a reality.

My first year at Marquette only enhanced my awareness of these disparities through my work as a Student Physical Therapist at Marquette’s Pro Bono Clinic for the uninsured. Like the Mission, I have seen the hard realities of limited access to healthcare, including one gentleman who visited our clinic after suffering from crippling pain for years and came to our clinic as a last resort. Bringing access and resources to communities that lack both has the power to drastically improve quality of life, making the reduction of health disparities not simply an opportunity, but a matter of justice. As a service-oriented University, I found further opportunity at Marquette to practice leadership by being elected Vice President of my class, and as a WPTA Emerging Leader Nominee.

Given my experiences, without the traditional corporate limitations of healthcare, I truly believe that physical therapy can reduce health disparities in a unique and practical way. My vision is to supplement my clinical practice with an initiative called The Friday Project, a project crafted during my time at the Rescue Mission. Supplementing normal clinical income with grants, those physical therapists partnered with the initiative would be able to offer community health screens every Friday, along with youth mentorship activities, including job shadowing for local students and scholarship assistance. As experts in musculoskeletal conditions among a population in which millions suffer from chronic pain, I believe we carry the education to refer high need patients, and to economically help and treat all others, bringing equity to the communities that need it most. As doctors face increased demands on their time, in which patients get less and less time, physical therapy offers the opportunity to partner healthcare with the mentorship needed to truly treat the disparities we see in the clinic.

My connections to Marquette and the communities of Milwaukee have given me the passion and platform to increase healthcare access for those who are underserved, and this is why I am applying for the SPARC scholarship from Ensign Therapy. From my experiences, my hope is that you can see my desire to use any financial assistance with the gratitude and humility worthy of such generosity. While such generosity is not intended for repayment, if I am selected, you can be sure I would pay it forward. For this reason, I believe I would make an excellent candidate for your scholarship program, as my vision and action to reduce health disparities in the Milwaukee community are already being enacted in my education as a physical therapy student at Marquette University, and as I actively live out service
in the Pro Bono Clinic and at the Milwaukee Rescue Mission.

In this way, I do not have the opportunity, but rather the responsibility to use my education to be a spark for the communities of Milwaukee. This is why I chose my profession. It gives me the chance to be a light in the community I call my own. My passion for leadership and service centers on my belief in the power of education to help those who need it most, and my learning has been supported and guided by the power of a calling found and a goal pursued. This is the legacy and strength of the many leaders who have come before me, and they continue to teach me how to translate potential into selflessness Indeed, it is the first spark that brings the light.

“If I have been able to see further, it is because I have stood on the shoulders of giants.” ~ Isaac Newton

 

Congratulations April Westbrook, OT SPARC Winner!

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April Westbrook, OT
Keiser University, Ft. Lauderdale, FL — Grad Date: 12/31/20
Fidelity is a core value of Occupational Therapy. Through trust and loyalty, this value can “spark” others toward healing. In order for patients to open up and allow a therapist to truly impact their lives, they must gather a sense of loyalty and empathy first. This value is paramount in OT and is one that I had to refine within myself prior to jumping into the field. I had to truly trust my passion, dedication, and commitment to learning before making such an immense life change.

I fell in love with Occupational Therapy when a friend of mine introduced me to the field. As I read through the qualities and qualifications of an occupational therapist, I knew that OT would provide me with a unique opportunity to make a difference in the lives of others. It was a pivotal time in my life when I made this career change; I was a mother with three young children who had just undergone a divorce from a ten-year marriage, and I was working as a small business owner where I was unable to make an impact on the lives of others the way I knew that I could. Although it was certainly not an easy time to follow this “spark,” it is one of the most rewarding decisions that I have ever made. Through this decision, I have modeled for my children that you can follow your dreams and make the necessary changes in your life at any point. Through fidelity and dedication, anything is possible.

Upon beginning my career as a COTA, schooling became my full-time job. I would care for my three children in the mornings and evenings, study until midnight, and work my part-time job on the weekends. This dedication afforded me the opportunity to serve the most endearing of people and made me stronger than I ever thought possible. I have practiced the perseverance that I encourage in others and have gained a true insight for empathy.

After working as a COTA for six years, I began to consider making another life change to provide the best possible opportunities for myself, my children, and my future patients. I began to consider becoming an OTR through a bridge over program through Keiser University. I understood that gaining more knowledge in this field would provide opportunities to make a greater impact in my community, one individual at a time. Becoming an OTR meant that I would be able to create goals for my patients that would allow them to become their most successful and independent selves. I sought the opportunity to dedicate myself to my patients through the entire OT process, from evaluation, to creating goals, bonding through treatment sessions, all the way through discharge. This wasn’t within my scope as a
COTA, and I knew that it is what I needed to do to feel fully fulfilled in my career.

The most rewarding opportunity in the field of OT is to become the agent of change in one’s life. It is incredibly humbling to connect with those who are sick or disabled and provide a means to aid in their healing and create change. When an individual looks you in the eyes and says, “thank you for understanding, encouraging me to heal, and getting me to where I am today,” it makes every sacrifice worthwhile.

I have endured many obstacles, and at times, thought the tribulations were too great to persevere through. However, those obstacles became the pivotal points to leading me into this field. I look back at these obstacles and use them as a springboard to provide the most meaningful conversations with my patients. Conversations are driven by empathy, compassion, encouragement, and a “spark” for change in the lives of others. When we fight to endure challenges, dedicate every ounce of ourselves, and then overcome these adversities, it provides a platform to help others through truly understanding by way of empathy and perseverance. Occupational Therapy provides a perfect balance between technical knowledge and compassion through our code of ethics, core values, and standards of practice, all of which come together to empower others.

I am currently working towards completing my degree as a master’s student to become an OTR. It has been a long road, especially while completing my internships in the midst of a global pandemic, but fidelity and perseverance continue to lead the way. Becoming an agent of change for individuals whose voices are not always heard and to physically improve that person’s health, is what makes Occupational Therapy the most rewarding of fields. I plan to address those needs through compassionate service, a holistic approach, creative interventions, local advocacy, and evidence-based practice. I look forward to making a lasting impact in the lives of others by creating a “spark” for healing, hope, and endless opportunities.

I appreciate any support received and am committed to paying it forward through my dedication to serving others through Occupational Therapy

Making Vital Signs Vital

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By Tamala Sammons, M.A., CCC-SLP, Therapy Resource
We have been focused on why it is so important to measure vital signs as part of our clinical practice. Not only does the data help us with early detection of sepsis, identifying patient instability, having comparative baselines during exercise, and knowing when to stop an activity, but it also helps us make better clinical decisions around patient care. Now, therapy teams need to also focus on capturing measured vital signs into our daily documentation practices.

Measuring and documenting vital signs starts at the evaluation to ensure treatment plans are designed to address challenges with varying diagnoses and to ensure we provide interventions accordingly.

Next, vital signs are measured during treatment sessions to support decisions around interventions being provided. The key for us as therapists is to capture the data from vital signs as a guide to what interventions we will provide, or stop providing. In other words, we need to do more than simply take and record vitals. We need to use vital sign data as tools to make clinical decisions.

For example:

● Mr. Smith has O2 weaning as a goal. OT is documenting patient is SOB during activity; however, no vitals were recorded at evaluation or in TENs. Data was only entered into PCC. Here is why capturing vitals in our clinical documentation is also needed: Documentation is further enhanced when the OT documents how many liters the patient is on and levels of O2 before the activity, five minutes into the activity, and after the activity. This documentation is specific to the therapy session and needs to be recorded in the TENs as it supports what physical activity the patient can tolerate as part of decisions around O2 weaning and overall improvement with ADLs.

● Mr. Jones has precautions with BP risk identified on the PT evaluation. However, upon review of daily TENs, BP is not captured in the documentation pre-, five minutes into, and post-exercise. BP was entered into PCC, which is great for simply recording data. However, using the data in a meaningful way in our TENs supports the clinical judgment of a therapist (i.e., what decisions during treatment were made based on BP readings?) and further supports medical necessity for care.

● Mr. Romero had a CHF exacerbation and the hospital record noted he has 45% ejection fraction and he has SOB with walking greater than 75 feet. Documented vitals are paramount to ensure that his treatment with functional activities or prescribed exercise are keeping his HR between 25-35% of his target HR.

Other Examples:

● Pt. “V” has SOB and needs to rest frequently. What do the vital signs tell us and do we change direction in treatment due to those measures?

● Pt. “I” is on 2L O2. PT is working on ther ex and gait. Does O2 change with exercise? How long does it take to get them to recover?

● Pt. “T” is medically complex and post-septic. What do we know about pts who have been septic? How are we ensuring we are monitoring for s/s of sepsis while in therapy? What vitals are recorded in our documentation to support our clinical treatment decisions?

● Pt. “A” is doing breathing exercises with SLP due to COPD. What is the patient’s respiratory rate pre-, during, and post-breathing exercises? What are the O2 levels? How do we know the interventions are working?

● Pt. “L” is a cardiac patient. How are vitals documented during treatment sessions to support exercise prescription? How do we know our plan is working?

Please continue to work with your teams to not only measure vitals, but more importantly, integrate the data into evaluation and treatment documentation to support skilled intervention decisions, capture clinical judgement, and demonstrate medical necessity of our services.