Great point of discussion Brent. I think doubling/dovetailing can be used ethically, but I also think it can be used unethically. I have seen some rehab departments use doubling/dovetailing quite well that was actually therapeutic psychosocially as well. I have also seen rehab departments that have become machines in which the same type of exercises are used for no apparent reason except to capture time. This might be an unspoken truth in the therapy world, but I guarantee that most of us have seen this happen at one time or another.
To me personally I have a hard time with doubling because it takes away my therapeutic sense at that moment. Usually when I am doubling I am thinking about the activity that will occupy the individuals without truly focusing on the individual that I am trying to help. When I am one on one I can give my all to that individual to focus on the key areas that they are dealing with. So to me personally it could be argued that I would be violating principle 1 in the area of the client's well being. I am sure that there are individuals who can overcome this, perhaps it takes much practice. But in the eight years that I have been practicing I continue to struggle with it, so I try to avoid it. Chris Nahrwold MS, OTR -----Original Message----- From: Brent Cheyne <[EMAIL PROTECTED]> To: otlist@otnow.com Sent: Thu, 6 Nov 2008 6:51 pm Subject: Re: [OTlist] doubling patient in acute rehab To Ron, Chris and the List, or the sake of continuing the doubling/dovetailing conversation, I'd like to alk about ethics...the labels of "ethical and unethical" situations get reely tossed around a lot in talk about the OT world. To say that something is unethical" because it is against the rules means if you follow the rules your re supposedly"ethical". However, truly ethical conduct goes beyond the mere act of following the rules', and is far more complicated. As we have already observed one clinical etting (acute rehab) may have different "rules" than another (SNF, Peds etc.). nd often the rules are hard to find, pin down, verify, or subject to multiple nterpretations. Rules change frequently...does that mean our ethics are lso constantly in flux based on corporate,medicare, or insurance provider olicies? he AOTA has a Code of Ethics (2005) with 7 principles as components: rinciple 1.demonstrate a concern for the safety and well-being of the ecipients of their services. (BENEFICENCE) rinciple 2. take measures to ensure a recipientʼs safety and avoid imposing or nflicting harm. (NONMALEFICENCE) rinciple 3 respect recipients to assure their rights. (AUTONOMY, ONFIDENTIALITY) rinciple 4. achieve and continually maintain high standards of competence. DUTY). rinciple 5.comply with laws and Association policies guiding the profession of ccupational therapy. (PROCEDURAL JUSTICE) rinciple 6. provide accurate information when representing the profession. VERACITY) rinciple 7. treat colleagues and other professionals with respect, fairness, iscretion, and integrity. (FIDELITY) According to the AOTA these are the ethical principles we follow to determine f a situation or even a rule is ethical. Additionally these ethical principles re held in conjuction with the OT Core Values (AOTA 1993): Altruism, Equality, reedom, Justice, Truth and Prudence. o...Based on AOTA Ethical Principles and Core Values, we take a look back at oubling/dovetailing patients for treatment and we know there are certain rules o follow in a variety of contexts of clinical practice, Questions Come p: Should doubling/dovetailing (DB/DT) always be considered "unethical" egardless of the clinical setting ? If DBDT is allowed by rule is it still nethical? If it is generally unethical by what ethical principle? Is DBDT nly unethical because it is harder (or easier) work for the therapist, or can t be proven to be less (or more) efficient in providing the most effective reatment to the most people for the least cost? think all these questions should have good answers before we go to our olleagues, managers, and administrators to talk about the ethics of practices nd policies such as DBDTing. ny other thoughts or responses? rent, an OT -- On Thu, 11/6/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> ubject: OTlist Digest, Vol 44, Issue 7 o: otlist@otnow.com ate: Thursday, November 6, 2008, 3:00 PM Send OTlist mailing list submissions to otlist@otnow.com To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com r, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific han "Re: Contents of OTlist digest..." oday's Topics: 1. Re: doubling patient in acute rehab ([EMAIL PROTECTED]) --------------------------------------------------------------------- Message: 1 ate: Wed, 05 Nov 2008 19:05:30 -0500 rom: [EMAIL PROTECTED] ubject: Re: [OTlist] doubling patient in acute rehab o: OTlist@OTnow.com essage-ID: <[EMAIL PROTECTED]> ontent-Type: text/plain; charset="us-ascii" I think doubling and dovetailing in unethical in acute rehab, since it is a ule from medicare.? I have not read the rules for SNFs. ----Original Message----- rom: Brent Cheyne <[EMAIL PROTECTED]> o: Ron Carson <otlist@otnow.com> ent: Tue, 4 Nov 2008 6:16 pm ubject: Re: [OTlist] doubling patient in acute rehab Hello everyone and good topic, ??? I've worked in SNF rehab geriatrics for the better part of 15 years nd oubling/dovetailing has often been part and parcel of business as usual specially since the PPS RUGs category system was put into place. Coupled with his? RUGs phenomena is a fairly high productivity standard which usually etween 85% to 95% in companies I've known or worked for.?( 8 hour day eans 08min?or 6.8 hours?to 456 min or 7.6 hours of therapy contact and 24-72 inutes?to do everything else including meetings, and documentation). ??? As Jennifer Mc Laughlin OT/L?has said "MCR has changed and allows Med to e treated concurrently and billed for the minutes engaged in tx as this is a inutes billing vs a modality treatment billing." The MCR B atients?I've seen ave always been one-on-one. ???? There seem to? be a lot of different interpretations of the? Medicare ules and Regs and different? Rehab companies and many?therapists/managers are ften convinced that they have it all straight.?Curiously, this?doesn't xplain he vastly different ranges of accepted practices and?policies?amongst? ifferent settings and companies. ??? As a therapist who has done a fair share of doubling/dovetailing...I am eenly aware of the advantages and limitations of it's use. And yes--there re imes when it is completely inappropriate for conducting skilled intervention elated to occupations.However, there are times when it is appropriate to ouble p patient?when? it is selectively used to conduct treatment efficiently and ree up more time to work one-on-one with a more involved patient in the same aseload. This takes good treatment?planning,time management,?and? clinical udgement ?? The real problem is when the dovetailing/doubling becomes an everyday-all ay practice in which no 1:1 time is available at any time for anybody. Then aseloads simply become a? corporate billing mechanism but not skilled service. ?? The question I have is (as I play devil's advocate)....Is doublling eally nethical in all circumstances?, or which circumstances? And if it is please xplain what is meant by unethical, in what manner is doubling unethical...that assertion is?one worth specifically articulating. 'd be interested in hearing from any of you, espectfully, rent the OT - ptions? ww.otnow.com/mailman/options/otlist_otnow.com Archive? ww.mail-archive.com/otlist@otnow.com ------------------------------ -- nsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Help? [EMAIL PROTECTED] End of OTlist Digest, Vol 44, Issue 7 ************************************ - ptions? ww.otnow.com/mailman/options/otlist_otnow.com Archive? ww.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
