Case Study: Amputation Part 2
Mr. Rivera was discharged to a rehabilitation hospital a couple of days later, after treatment for his infection was started. At the rehabilitation center, he is assigned to a standard team that consists of a nurse, a physician, a physical therapist, an occupational therapist, a pharmacist, and a social worker. Other healthcare professionals are often included in the team as needed. In the case of Mr. Rivera, an endocrinologist nurse practitioner and a dietician were added to the team to assist with controlling his diabetes and weight. An orthotist-prosthetist will join the team once Mr. Rivera is ready for a prosthetist. When the patient is admitted to the rehabilitation center, the team meets to discuss treatment goals and develop a plan. In the case of Mr. Rivera, the team decides the nurse and physician will take the lead regarding the general health of the patient, including caring for the incision and stump. The physical therapist will work on strengthening the leg that was operated on and improving his balance. Once he is ready to work on the prosthetic foot, the orthotist-prosthetist will make a prosthetic foot for him, and the occupational therapist will teach him to put on, use, and care for the prosthesis. The pharmacist will manage his medications (with the physician and nurse), and the social worker will coordinate several aspects of Mr. Rivera’s care, including interacting with Mr. Rivera’s family, health insurance, and referrals to outpatient services once he is ready for discharge. Once the plan is in place, the team operates asynchronously; however, the team meets periodically to review the progress and make course corrections to the plan.
A week after admission, the physician and the nurse agree the incision is not healing as fast and well as expected. A chart review reveals that although his blood sugar level has improved, the insulin coverage order has not fully controlled the diabetes. The nurse noted she has talked with the patient several times about asking his wife to bring him sweets, but he evades the conversation, making a joke of it; he has also been seen getting candy from the vending machines in the rehabilitation center. The physical therapist and occupational therapist reported that Mr. Rivera does not like to move because the stump hurts, and it takes a lot for him to perform the exercises prescribed by the physical therapist. After a quick conference call, the team decides to refer Mr. Rivera to the health psychologist for behavior modification and include his wife and adult daughter to help them better support Mr. Rivera. The psychologist sees Mr. Rivera individually once per week and daily in a support group with other patients in an amputee support group. After a couple of weeks, Mr. Rivera and his family become more compliant with his treatment, and the physical therapist and occupational therapist can proceed with fitting the prosthesis and teaching him to live with it.
Discussion Questions
- What are some of the advantages and disadvantages of having such a large interprofessional team?
- Is it better to have a smaller team? Explain your answer.
- Are all the healthcare professionals on the team necessary? Why or why not?
- Which strategies worked and which did not work in this case study? Explain in terms of the appropriate Core Competencies and specific Sub-competencies involved in your rationale.
- How could introducing patient-centered care from the beginning have improved the unfolding of this case?
