Background

Jasmin is an occupational therapist (OT) who works in an outpatient neurorehabilitation program. She has been working with Mr. Brodie, a client who is recovering from brain aneurysm surgery and was recently discharged home from the hospital. Mr. Brodie presents with headaches, decreased balance, and cognitive and communication changes. He works as a business executive and wants to recover and return to work as soon as possible. During one of the treatment sessions, the client reveals that his family has hired a private OT who will start coming to his home to provide additional therapy. His family is hoping the extra therapy will help speed up his recovery.

Jasmin wonders how this will affect her role and the implications for client care if there are two OTs treating the client at the same time. She confirms with her manager that there are no hospital policies that prevent her from providing outpatient therapy for a client who has private health services at home.

Considerations

Jasmin decides to reach out to COTO’s Practice Resource Service. She learns that while there are no specific rules about two OTs providing concurrent care, there are considerations that both OTs should be aware of.

• From the client's perspective, it is important to ensure that the client understands each OT’s role and who has accountability and responsibility for parts of the intervention plan. The Competencies for Occupational Therapists in Canada (Domain B Communication and Collaboration) speak about using effective communication and collaborative approaches for safe, ethical and effective practice.
• Clarifying roles and establishing clear expectations will enable the client to make informed decisions about their occupational therapy service. To be able to share necessary health information, both OTs must ensure they have obtained the appropriate client consents.
• OTs are expected to consider whether there are any risks to the client regarding the frequency and duration of the concurrent OT services and if having both OTs services are appropriate. OTs should respect a client’s wishes for additional service provision, but they are expected to proactively establish how concerns and risks will be addressed and managed in advance.
• Both clinicians will need to consider how they will manage any differing professional opinions should they arise during concurrent interventions. Establishing communication and documentation processes between all parties at the start of the process will facilitate timely decisions and actions should concerns arise.

Outcome

• With Mr. Brodie’s consent, Jasmin arranges a meeting for the client and both OTs to discuss each clinician’s roles and responsibilities.
• Jasmin expresses her concerns about Mr. Brodie’s headaches, fatigue level and his ability to tolerate an increased therapy schedule. The client is reminded that he is still receiving other interdisciplinary services such as physiotherapy and speech language pathology while in the outpatient program. She explains the risks associated with overdoing it and the impact on his recovery.
• The private OT is concerned that she may not have access to all the necessary health information as she does not have access to the client’s hospital records.
• A plan was established to help Mr. Brodie make an informed decision about concurrent OT treatment. The plan clarifies each OT’s role in helping the client achieve his goal of returning to work. To address safety concerns and risks, they plan to build up the frequency and duration of sessions, having each OT focus on different aspects of care, and will re-evaluate regularly. They establish a communication and documentation plan to ensure both OTs have any necessary information in a timely manner to provide safe and effective service. 

Conclusion

OTs are expected to respect client autonomy and their wishes for the additional service provision (if appropriate) and assist clients to understand the potential impact of concurrent services on their health outcomes. It is important for OTs to use collaborative approaches to establish safe and effective processes, mitigate risks and manage differing professional opinions.  

Contact

If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1-800-890-6570/416-214-1177 x240 or [email protected].

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