Patient refusals can be very frustrating!
What do we do? There are supervisors to appease, RUG levels to adhere to, patients to help and ethical dilemmas to resolve.
Here are a few tips to help ease the woes of patient refusals.
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1. Split Your Minutes
If you are an occupational therapist working in a SNF, sometimes having minute minimums are daunting. Maybe seeing the patient a few times during the day helps the patient be more compliant.
Example would be to see the patient right away in the morning for grooming and hygiene at sinkside with their FWW. Next, see them at noon for instruction in use of a new piece of adaptive equipment for self feeding. Lastly, have them participate in some prepatory NDT techniques prior to a short chair yoga session.
Many times, the idea of a long treatment session is just too much and they would rather refuse than participate for that long.
I have worked with many patients that help develop goals during their evaluation, then refuse therapy treatment sessions. Sometimes it is as simple (depending on cognitive level of course!) as reviewing goals with the patient and explaining that OT and the patient are a team to achieve these goals.
Also using your therapeutic use of self to determine the best approach to review these goals. Does the patient respond to a friendly conversation or more of a direct talk. Each patient is individual, so our approach needs to be individualized as well
3. Tag Team Treatments
Are you in an environment where you could provide part of the treatment and have another OT or COTA provide the last session? This builds on the above suggestion of splitting your minutes.
Sometimes, a fresh face is all you need to get your treatment session in. Again, it can be an issue of being overwhelmed by how long you will be working with them versus what you are actually doing.
4. Do Not Overwhelm
Instead of talking about EVERYTHING you would like to do during that session, try breaking it down and explain 1 task before moving on to the next. Or even more specifically, 1 portion of the task - crack out those activity analysis skills!
If you have a patient that is in bed and does not want to participate, I have said, "let's just start by sitting at the edge of the bed and see how you feel." After they get there and are comfortable, proceed with suggesting the next task or portion of the task and go from there.
It is one of my favorite tactics and seems to work well (in general - not every time of course :).
5. Be Flexible
Sometimes a patient simply does not want to go down to the therapy room for a treatment session. What can you do in their room to accomplish the same goal or possibly work on towards another goal?
It's a great time to work on our occupation based goals!
For 10 more tips, check out this great article from Monica at Mind-Start.com explaining 10 Tips for Successful Therapy for the Dementia Patient Who Refuses.
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What is your best tip to get patients to comply?
If you are looking for other tips when working with the geriatric population, check out the post OTs Reveal Their 35 Top Tips When Working in Geriatrics.