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Clinical Management of the Catastrophic Claim
by
Eric F. Patten, RN, BSN
Regional Clinical Specialist
One Call Care Management
www.onecallcm.com
www.onecallcm.com
Objectives
• Identify equipment and supply needs of the injured worker based on
the level of function
• Recognize medication management issues and how they affect the
injures worker’s level of function
• Comprehend the home health care needs for the injured worker
based on level of function
• Discuss how all of the above factors affect the progression of
recovery and the handling of the work comp claim
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Matching Product & Service
Parameters with Disability Concerns
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Quadriplegia
Paraplegia
Amputee
Double Amputee
TBI/ABI
Burns
Multiple Fractures
Complex Injuries
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Seating Concerns
Positioning Concerns
Mobility Base Considerations
Future Considerations
Home Accessibility
Soft Goods
Home Health
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Levels of Paralysis
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Quadriplegia High Level Spinal Cord
Injury to Upper Cervical Spine
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C-3 & Above = Probable Ventilator Dependent
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C-4 = Possible Ventilator Dependent
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Absent to Limited Shoulder Shrug
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Absent Upper Extremity Function
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Absent to Impaired Sensation
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Dependent ADL’s & Weight Shifts
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Absent Trunk Balance
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Spinal Fixation
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At Risk for Pressure Sores, Pelvic Obliquity
& Scoliosis
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Paraplegia Spinal Cord Injury to
Thoracic or Lumbar Spine
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Good Upper Extremity & Hand Function
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Absent to Impaired Sensation Below the Injury Level
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Minimal Assistance to Independent with ADL’s
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At Risk for Pressure Sores, Pelvic Obliquity & Scoliosis
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Spinal Fixation
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Probable Independent Weight Shift
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Extremely Active Wheelchair Users
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ASIA Scale Classifications
ASIA - Neurological Classification to categorize motor and sensory
impairment of a spinal cord injury
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A
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Quadplegia Low Level Spinal Cord
Injury to Lower Cervical Spine
• Limited Upper Extremity Function
• Absent to Limited Hand Function
• Absent to Impaired Sensation Below the Injury Level
• Dependent to Maximum Assistance with ADL’s
• Absent Trunk Balance
• Spinal Fixation
• Can do Limited Weight Shift with Maximum Effort
• At Risk for Pressure Sores, Pelvic Obliquity & Scoliosis
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Amputees
• Amputation is the removal of a body
extremity, or part by trauma, prolonged
constriction, or surgery.
-Bilateral extremity amputation
-Digit amputation
-Partial amputation (foot)
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Prosthetic Devices
C-Leg Prosthesis
Transtibial Prostheses (BKA)
Foot Prostheses
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Prosthetic Devices Continue
Two-Load Hook
In cable-activated prostheses, a
hook, as opposed to a prosthetic
hand, is used as the terminal
device. The prosthesis is activated
by pulling a cable and closes
automatically under spring or
rubber tension.
The unique design of the two load hook
allows users to easily switch between two
spring tension settings for different
activities
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Myoelectric
The Myoelectric prosthesis use a
battery powered hand and the
signals the patient can generate
from muscle contractions in the
remaining limb to have the device
open and close through the use of
sensors in the prosthesis
Myoelectrically controlled arm prostheses
are powered by batteries contained
within the prosthesis. Sensors from within
the prosthesis detect when the user's arm
muscles contract . These sensors then
convert the body's electric signal into
electric power which then moves a motor
in the hand, wrist or elbow.
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Burns the rule of nine
The rule of nines is a standardized method used to quickly assess how much
body surface area (BSA) has been burned on a patient. This rule is only applied
to partial thickness (2nd degree) and full thickness (3rd degree) burns
(April 27, 2014 by EMTResource.com 2 Comments )
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Discharge Planning
Discharge Planning Starts at the Initial Date of Injury
 Communication Is Key in the Discharge Process
Early referral notification
Team Care planning
Adjuster involvement
Case Management
 Have a goal for the injured worker and a plan that you
can execute
 You always need to expect the unexpected
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Equipment Considerations
• Wheelchairs
– Quickie 2 with Tapered Front End
– Titanium Wheelchairs
– A4 GPS
• Power Wheelchairs
– Front Wheel
– Rear Wheel
– Mid Wheel
– Tilt & Recline vs. Standard Seating
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Equipment Considerations
• Wheelchair Cushions
– Essential
– Roho 2”, 3”, 4”
– Jay Seat & Back
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Equipment Considerations
• Wheelchair Accessories
– Head Rests
– Lateral Supports
– Cloth Guards
– Seat Belts
– Leg Straps
– Back Packs
– Seat Packs
– Otto Bok Arms
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Equipment Considerations
• Hospital Beds
– Full Electric
– Bed Rails & Trapeze
– Over Bed Table
• Adjustable Beds
– Standard vs. Full
– Queen vs. King
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Equipment Considerations
• Air Beds
– Low Air Loss for Pressure Relief
– Overlay Mattress
Low Air Loss Alternating Pressure Relief
Overlay Mattress
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Equipment Considerations
• Bath Aids
– Standard Commode vs. Drop Arm
Commode
– Transfer Bench vs. Shower Chair
– Elevated Toilet Seat
– Rolling Rehab Shower Chair or Commode
Chair
– Hand Held Shower Unit with Diverter Valve
– Long Handled Sponge
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Equipment Considerations
• Wheelchair Lifts
– Car Lifts
– Truck Lifts
– Van Lifts
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Equipment Considerations
• Custom Wheelchair Vans
– Raised Roof
– Lowered Floor
– Auto-Open Options
– Lift / Ramp for Access
– Seating Lock-Down vs. Transfer to Captain Chair
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Home Modifications &
Accommodations
• Bathroom Modifications
– Roll Under Sink
– Roll In Shower
– Door Widening
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Home Modifications &
Accommodations
• Ramping Systems
– Cement  Permanent
– Aluminum  Portable
– Wood  Portable vs. Permanent
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Home Modifications &
Accommodations
• Elevators
– Inside vs. Outside
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Coordinating Home Health Care
Needs
• Nursing Care
– RN vs. LPN
• Home Health Aid
– Daily vs. Hourly
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Physical or Occupational Therapy
Care for Children
Infusion Therapy
Wound Care Needs
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Know the Injured Claimant’s
Needs:
• Wound Care Supplies
• Ostomy Supplies
• Soft Goods/Supplies- KY Jelly, Gloves, Catheters,
under pads, Drainage Bags etc.
 Set Par Count + 15-20 extra x 3 months Return to
monthly needs and re-evaluate every 6 Months
(avoids overstock)
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Medication Management
Considerations
• Short vs. Long Term Control
– Pain Control Medications
• Oxycontin
• Percocet
• Hydrocodone
– Anti-inflammatory
• Naprosyn
• Motrin
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Medication Management
Considerations
• Bowel Preps
– Suppositories
– Theravac
– Enemas
– Magic Bullets
Bladder
- Pyridium
- Cypro
• Spasticity
– Baclofen
– Valium
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Medication Management
Considerations
• Psychological Medications
– Elavil
– Ambien
• Prophylactic Antibiotics
– Bactrim
• Vitamins and Over-the-Counter Meds
– Vitamin C
– B-12
– Cranberry Pills
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Discharge Planning
Discharge Planning Starts at the Initial Date of Injury
Communication Is Key in the Discharge Process
•
•
•
•
Early referral notification
Team Care planning
Adjuster involvement
Case Management
 Have a goal for the injured worker and a plan that you can
execute
 You always need to expect the unexpected
www.onecallcm.com
Learn to Expect the Unexpected
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THANK YOU !
Eric F. Patten, RN, BSN
Regional Clinical Director
[email protected]
Cell: 781-733-1242
www.onecallcm.com