Scope of Care, Treatment and Services

I. POLICY:

A. Statement: The Inpatient Rehabilitation Unit is designed to provide 24 hour comprehensive inpatient rehabilitation services for individuals who have experienced illness or injury resulting in a loss of function ability and/or self-care skills. The Inpatient Rehabilitation Unit consists of a total of 22 private rooms designed to accommodate patients with limited functional ability. Potential patients are screened prior to admission with regards to pre-hospital function, diagnosis and current medical condition, patient needs, patient goals/expectations, potential benefit(s) of service and expected return to the community. Licensed personnel assess patient needs upon admission and a plan of care is developed under the directions of the physiatrist. Care is implemented accordingly and is reevaluated at least every week with changes made as necessary until discharged.

Interdisciplinary services are goal-directed and designed to restore/maximize functional independence and to return the patient to their family/community while preventing further impairment. Psychosocial aspects of adjusting to disability are addressed in addition to the physical aspects of illness or injury. All services are provided in accordance with applicable licensing laws and Codes of Ethics under the provided concurrent medical care during the rehabilitation process and other consultants are utilized on an ongoing basis as determined by the needs of the patient.

B. Purpose: The unit cares for an adult/geriatric population that fall within the scope of admission-discharge criteria of the Inpatient Rehabilitation Unit. At least 60% of the unit’s population is admitted with the following conditions, including, but not limited to:

1. Stroke
2. Spinal Cord Injury or Dysfunction
3. Hip Fracture or Joint Replacement
4. Amputation of Lower Extremity
5. Major Multiple Trauma
6. Single / Bilateral Knees
7. Traumatic Brain Injury and Non Traumatic Brain Injury
8. Neurological disorders, including Multiple Sclerosis, Motor Neuron Disease, Polyneuropathy, Muscular Dystrophy, Guillain Barre, Parkinson’s disease among others.
9. Osteoarthritis
10. Congenital Deformity

The Stroke Specialty Program focuses on treatment and improvement of quality of life to maximize functional independence as patient transitions back to community. Education is provided to all Stroke patients in the form of a class available for family members as well prior to discharge from the unit. The program treats all types of strokes including ischemic, hemorrhagic, and subarachnoid hemorrhage.

II. PROCEDURE: Special Procedures Performed in the Unit:

1. Cortisone Injections
2. Electrical Stimulation
3. Deep Pharyngeal Neuromuscular Stimulation
4. Lee Silverman Voice Treatment

Frequency of services: Frequency will be tailored to patient’s needs however all patients are required doing 3 hours of therapy per day, 5 days a week. Attending physician is required to see patients at least 3 times per week, and PT, OT, SLP at least 5 days per week and by nursing daily.

Services and Hours:

1. Rehabilitation nursing is a 24 hour per day, 7 day per week service staffed by the RN shift coordinator, RNs, Rehab Techs and Unit Secretary.
2. The therapy staff is on duty variable hours between 8 a.m. to 5:00 p.m., Monday through Friday, and from 7 a.m. to 5 p.m. on Saturday, if case required Sunday coverage will be provided and is staffed with at least one Physical Therapist, one Occupational Therapist, PTAs, COTAs and Rehab Techs.
3. The Speech/Language Pathologist is on duty from 8 a.m. to 5:00 p.m., Monday through Friday, however, should patient load require a therapist, then one would be scheduled on Saturday and Sunday.
4. Social Service is on duty from 8 a.m. to 5 p.m., Monday through Friday.
5. The RN admission coordinator is on duty from 8 a.m. to 5 p.m., Monday through Friday with coverage on Weekends if needed

III. PRACTICE GUIDELINES: The Inpatient Rehabilitation Nursing Staff adopts the professional statements of the Texas Nurse Practice Act and the Texas Board of Nursing. The Occupational and Physical Therapy Staff adopts the professional statements set forth by the Texas Board of Occupational and Physical Therapy Examiners. The Speech Therapy Staff practices according to the professional statements set by the State Board of Examiners for Speech Language Pathology and Audiology. All staff abides by current Federal / State Laws and Valley Baptist Health Systems Policies and Procedures.

IV. COMMITTEE PARTICIPATION:
The following committees are attended as designated:

• Team Conference is held to formalize the rehabilitation plan and to document the progress of each patient. Team Conference will be held within 7 days of admission and weekly thereafter.
• Utilization Review is a monthly multidisciplinary management team discussion used to maintain / provide quality, affordable, cost-effective physical medicine and rehabilitation services for each patient in the Inpatient Rehabilitation Unit.

V. PERSONNEL SKILL LEVEL: The Inpatient Rehabilitation Unit at Valley Baptist Medical Center—Harlingen provides individualized care to patients through the coordination of licensed RN, Social Worker, Physical Therapist, Occupational Therapist and Speech Therapists. In addition, there is ancillary staff consisting of Rehabilitation Technicians, Physical Therapy Assistants (PTA) and Certified Occupational Therapy Assistants (COTA). Upon hire, each nurse is provided with a comprehensive and individualized orientation to the Inpatient Rehab Unit. Competencies are assessed during orientation and thereafter annually. Each nurse working on the unit is responsible for maintaining the knowledge and clinical skills required to provide comprehensive nursing care. Licensed Therapy Staff receives a “shadowing-hands on” orientation to the rehab unit. All licensed staff is required to have certification in Basic Life Support (BLS). Specialty and Advanced Life Support Certifications are encouraged, as is participation in the Clinical Ladder Program. The unit is also staffed with Rehabilitation Technicians, and a unit secretary who functions in a supportive capacity and is required to have BLS certification.

Payer sources:

The VBMC Inpatient Rehabilitation Unit accepts different funding sources including, but not limited to private commercial insurances, Veteran’s Administration, Medicare Managed Plans, Traditional Medicare, Worker’s Compensation, HMO/PPO plans and private pay. For more information please contact the Admission Coordinator.

Fees: Fee schedules are available upon request thru the Inpatient Rehabilitation Admission Coordinator.
Unfunded cases are reviewed by the Administration Team and if approved only one case a month is provided.

Referral sources: Referrals can be made by Physicians, insurance case managers, hospital case managers, social workers, emergency departments, home health agencies and families. VBMC Inpatient Rehabilitation Unit does not discriminate against individuals of varying race, cultural background, religion or sexual preferences.

VI. STAFFING:
An ongoing review of the nursing staffing mix will be conducted on a regular basis. The staff is currently comprised of the following:
RNs
Rehabilitation Techs
Unit Secretary

The IRU Therapy staff is currently comprised of the following:
Physical Therapists
Physical Therapy Assistants
Occupational Therapists
Certified Occupational Therapy Assistants
Speech Therapists

VII. Policy History:

1. Origin: 09/2018
2. Review Date(s):
3. Revision Date(s):