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 Handout

Patient Education Handouts• Provide consistent instruction

• Ease documentation

• Provide talking points

• Leave room for patient specifics

Measurement Form

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

Documentation

• Formats

• Check off boxes

• “Wall of Shame”

• Countersignature

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

Preparatory care

• Aquaplast AFO splints–clubfoot

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

Teaching Methods

• Ask open ended questions

• Don’t give the answers

• Repetition

Thank You