Calling safe! Before you are ... OUT!

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Renee Kinder
Renee Kinder

It's that time of year again.

The time of year when families are getting their little future big leaguers a shiny new bat, breaking in that leather glove, and proceeding to spend all of their evenings and weekends in the sweltering summer heat.

Every year I enjoy watching the newbies arriving at the ballpark with their strollers and wagons, plenty of sunscreen, and smiles on their faces to watch what they believe will all be fun and games.

It is after just Little League, right?

Wrong.

Not in this neighborhood where there is a history of World Series Champs and a legacy of teaching the rules of baseball, and that means all of the rules of baseball, from a young age.

Batter up! Little Jimmy gets a hit, it rolls past the first baseman and he is off. Go, Jimmy, go! Then as he rounds third base the crowd rises, it's going to be close, the pitcher throws the ball to home and .... SAFE!

Little Jimmy throws his little arms in the air and the celebration begins. Mom has already posted the first home run of his career to her social media when all of the sudden the umpire shouts, “Yoooou'rrre OUT!”

It seems little Jimmy never fully touched home plate.

What do you mean he is out? He is sooo darn cute! He even pulled his tiny new shiny bat around all of the bases in the process.

The umpire doesn't budge. He is, after all, the expert here. And proceeds to call next up to bat.

We see the same phenomenon time after time after time as rehab professionals. And in a culture that calls for more person-centered and person-directed care, we often have to caution our patients to not call themselves “safe,” before they are discharged out of our care.

Take, for example, the following case. Mrs. Jones had a new elective knee replacement. As part of your 48-hour care plan meeting with her daughter present, we initiate discussion of “how long” she plans to remain in our care and she reports, “My ortho doc says I should be good to go in 12 days. He said this knee should be all set by then.”

Day 9 of her stay she is up walking with her physical therapist and makes it all of the way from her room to the dining room for lunch. Day 9 of her stay she also completes her morning dressing, bathing and toileting with her occupational therapist.

When her daughter comes to visit, everyone raves about how well she is doing. Her nursing assistant even tells her, “You will be home in no time.”

Her skilled therapists, however, note her progress but also have a unique eye to see what additional needs are present to not just return home, but to return home safely.

Mrs. Jones, you see, also has COPD, low vision, and unstable diabetes. Upon returning home, she will have three steps to enter her home, will be responsible for preparing two of her meals per day, and managing all of her medications.

So, how do we proceed?

To begin, we have to change the conversation from “how long” to “how safe” our patients need to be before they are out of our care.

Consider initiating the conversation at the 48-hour care plan meetings with, “Mrs. Jones what do you need to be able to do to return home safely?”

There are many considerations for a safe discharge home.

One doesn't just need to be able to use the bathroom. They need to be able to: manage clothes up and down over hips, complete their own toilet hygiene, transfer on and off the toilet, and perhaps bend or reach to clean up any bathroom accidents.

In an individual with COPD or any other form of respiratory diagnoses, they have to complete these steps without becoming overly short of breath and while maintaining appropriate 02 stats.

Medication management includes ability to know when to take medications, understand what the medications are for, realize when to contact the doctor, and comprehend medication side effects.

In an individual with low vision there are additional considerations for reading labels and potential need for greater font size or contrast.

Meal preparation requires the ability to obtain items from the fridge, cook items on a stove, oven or microwave, transfer food from cooking surface to the table, and clean surfaces at the end of the meal.

When an individual has active diabetes, he or she also has to consider any dietary restrictions impacting their health.

Are these conversations with patients easy? Not always. Just like a day at the ball field, it can be hot out there.

Mrs. Jones and her daughter may be calling SAFE! before she has touched all of the bases she needs to be successful at home. They may even start the celebration prematurely.

Just remember, for therapy providers and excited little leaguers, it is not always fun and games.

Just like the umpire, you have a responsibility to teach the rules, share your knowledge of the game and provide all of the care needed to ensure we call safe before our patients are out!

Renee Kinder, MS, CCC-SLP, RAC-CT, is Director of Clinical Education for Encore Rehabilitation and is the Silver Award winner in the 2018 American Society of Business Publishing Editors competition for the Upper Midwest Region in the Service/How To Blogs category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association's (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association's Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).

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Rehab Realities is written by Renee Kinder, MS, CCC-SLP, RAC-CT.  She currently serves as Director of Clinical Education for Encore Rehabilitation and acts as editor of Perspectives on Gerontology, a publication of the American Speech Language Hearing Association.

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