http://www.kirklees.nhs.uk/uploads/tx_galileodocuments/Acute_occupational_therapy_guidelines__2_

Acute Occupational Therapy Service Guidelines For Good Practice Prepared by:

Caitlin Edwards

Responsible Area: Approval Information:

Occupational Therapy Date Approved: COMMITTEE:Robert Flack

15 August 2007 PEC

Version No. Approved:

Number (2)

Review Date:

August 2008

Lead Director:

Reference to Standards for Better Health Domain Core/Development standard Performance indicators

History of Document

First domain Safety Second domain Clinical and cost effectiveness Third domain:Governance Fourth domain Patient focused Core Standard C4(b) C5(b)(C) C8(b) C13B

1. Number of inappropriate referrals 2. Average time from referral to assessment Version 1: 2002 Version 2: August 2004

Page 1 of 19

CONTENTS Section No.

Page No’s

1.

Introduction (statement)

1

2.

Sources of referral

2

3.

Initial Interview/Assessment

3

4.

Documentation of Patients Treatment

5.

Treatment/Intervention

7

6.

Kitchen Assessment

8

7.

Guidelines For Conducting A Home visit/Safety policy

8.

Taxi Guidelines

12

9.

Wheelchair Provision

13

10.

Minimum Standards For Splinting

11.

Supervision Guidelines

4-6

9-11

14-16 17

NICE Guidance Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgement. However, NICE Guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.

GUIDELINES ON REFERRALS

STATEMENT: In accordance with “Code of Ethics and Professional Conduct “(2005) and “Professional Standards for Occupational Therapy Practice” (July 2003) – which all Occupational Therapists should read

"Occupational Therapists shall undertake treatment either when the consumer has been referred by a medical practitioner or where Occupational Therapists have access to the consumer's doctor".

If the referral is not medically initiated, e.g. self-referral, Macmillan, the name, address and telephone of the G.P. or Consultant must be given and recorded.

SOURCES OF REFERRAL a)

For Inpatients: Doctors, Nursing Staff, other Therapists and self

b)

For Outpatients: Consultant Medical Staff, other Therapists, patients still under the care of Medical Consultants, self, Nurse Consultants and Macmillan Nurses

c)

For Rehabilitation (ward 21) Medical and Nursing Staff, G.Ps and other Therapists A doctor’s referral is required for Ward 21

d)

For out of area patients, refer to protocol of particular clinical area

METHOD OF REFERRAL Verbal or written referrals are accepted.

1

ON RECEIPT OF THE REFERRAL 1. The Occupational Therapist should determine the suitability of the referral.

Additional information from other sources may be collected e.g. the individual's case notes previous Occupational Therapy case notes the referral source other members of the Multi Disciplinary Team 2. If the referral is appropriate, the Occupational Therapist should undertake an initial assessment of the individual.

3. If the referral is inappropriate, the Occupational Therapist should advise the referral source and document decision not to assess in Nursing Kardex and medical notes.

Alternatives may be recommended where possible.

4. Referral should be recorded in the Occupational Therapy notes.

TIME SCALE Response to the referral should be made within: 1) 2)

For Inpatients For Outpatients

two working days five working days

2

INITIAL INTERVIEW / ASSESSMENT STATEMENT:Referred Inpatients/Outpatients are assessed according to their level of function and the completion of Initial Interview and subsequent identification of the nature of intervention will be carried out after discussion with the patient.

STRUCTURE:1

Initial Interview shall be carried out by State Registered Occupational Therapists.

2

The assessment is to be carried out in accordance with policy for referral on Inpatients/Outpatients/ (on previous page), after undertaking a risk assessment to ensure patient is fit and that the therapist’s safety is not compromised.

3

The purpose of the assessment explained to the patient and consent obtained and recorded in the Occupational Therapy record; Occupational Therapy leaflet is issued to patient.

4

A record of initial assessment is to be documented in the Nursing Kardex and medical notes on the same day, including time and location. An Occupational Therapy sticker must be affixed to medical notes

5

Initial assessment is to be recorded in Occupational Therapy records on the same day as the interview is carried out.

6

The Occupational Therapist will analyse and interpret the data collected to determine the patient's current functional status and to develop an appropriate treatment plan, with goals after discussion with patient/carer.

7

Ensure appropriate communication methods are used with patient/carer.

PROCESS:Collection of personal and domestic details, including vocation, roles, environment and lifestyle. Document carer’s needs and abilities and make appropriate referrals as required.

OUTCOME:Database/Personal profile completed Outcome of Initial Interview recorded Relevant aims and objectives written on Assessment Sheet

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DOCUMENTATION OF PATIENT’S TREATMENT Aims 1. To provide a systematic and ongoing record of the patient's condition and the course of Occupational Therapy intervention.

2. To provide a legal record of the patient's treatment by the Occupational Therapy Service.

3. To provide the basis of material required for effective communication with other professionals contributing to the patient's care.

4. To provide data for use in treatment, education, research and quality assurance activities, e.g. peer review, audit of documentation.

5. To provide records and data in line with management requirements.

Basic Elements Required 1. The qualified therapist collects all relevant patient details. Full name, date of birth and unit number should appear on all pages of records.

2. Each entry must be dated and signed (not initialled).

3. All errors must be corrected, then signed and dated.

- no tippex used.

4. All terminology and abbreviations should be understood within relevant service.

Allied Health professional Guidelines should be followed (2005) 5. All entries should be concise, precise and professional.

6. All entries must be legible.

7. Anything written by Technical Instructors or Students must be counter signed by the supervising Occupational Therapist.

4

Contents of Patient Documentation Initial Interviews 1. All patient details on Data Base need to be collected, including name, date of birth, unit number, General Practitioner, Consultant, date of referral, source of referral and the social history on the interview sheet.

2. The outcome of the initial interview needs to be recorded and relevant aims and objectives written on the assessment sheet.

3. All patient contacts to be put onto Epex-3 within 24 hours of seeing patient.

4. All new patients must be registered on the PAS system on a weekly basis.

5. An Occupational Therapy sticker much be put in the medical notes at the initial contact with a patient.

Assessment and Treatment 1. The outcome of any assessments should be recorded, naming any special tests used and identifying problem areas to be incorporated into the treatment plan.

2. A brief treatment plan outlining the goals for the patient and the clinical reasoning should be included using the assessment sheet.

3. A record of all treatment activities undertaken and their outcomes should be kept.

4. Any progress should be recorded at appropriate intervals. It is also important to identify when the patient is not progressing, with possible reasons and solutions.

5. Modification of treatment plan should be made as appropriate.

6. A record of all equipment assessments and a list of items provided must be made, ensuring equipment is fitted in line with manufacturers’ instructions.

Head Occupational Therapist to ensure all staff are trained and competent to fit all core equipment in line with department/COT guidelines.

7. Copies of all communication relating to an individual patient must be kept (including telephone).

5

Follow-up and Discharge 1. Evidence of outcome recorded in patient’s notes.

2. For In-patients, a record of intended follow-up visits and assessments must be made, with details of the outcomes.

3. Where an In-patient is requested to attend, brief note needs to be made that the case notes are to be passed to the occupational therapist.

4. Record that patient has been discharged from Occupational Therapy treatment.

5. Patients remain the responsibility of the named Occupational Therapist for a period of four weeks post discharge for minor equipment.

6. A discharge letter is sent to the Consultant Rheumatologist.

6

TREATMENT/INTERVENTION

1 The Occupational Therapist will develop and document an intervention plan that takes into account factors established from the Initial Interview/Assessment, based upon goals that have been identified and negotiated with user/carer.

2 Intervention may be of the following: • • • • • •

Direct treatment Advice to patient and/or carers Provision of equipment Referral to other agencies with patient's consent Home Visit/Follow-up at home Discharge

3 The Occupational Therapist must document all intervention, including location, date and time,persons present and results, indicating methods/techniques used in Nursing Kardex and medical notes if appropriate.

4 The Occupational Therapist will identify aims and objectives and methods of intervention in conjunction with the wishes and expectations of the patients and/or their carers.

5 Intervention/treatment should be continually reviewed and evaluated/ altered to meet the patient's specific needs and must be evidence based to ensure best practice.

6 Patient intervention will only be delegated to another member of staff if they are deemed competent.

7 The Occupational Therapist will maintain or seek current information on resources relevant to the patient's needs, this can be demonstrated by contacting appropriate persons/agencies and documenting in Occupational Therapy records.

8 Patient consent should be sought and recorded at all stages of intervention/treatment. Consent should be written in the Occupational Therapy records in full indicating intervention to be carried out.

7

KITCHEN ASSESSMENT

Prior to considering a Kitchen Assessment a thorough initial assessment of the patient’s needs and abilities must be carried out to ascertain if this is the appropriate treatment media.

Aims: (a)

To assess ability to prepare basic drinks, snacks and meals

(b)

To identify problem areas and/or provide appropriate equipment or advice

1. The State Registered Occupational Therapist explains to the patient the purpose of the assessment.

2. The therapist asks what the patient would prefer to prepare, within treatment goals/reason.

3. The therapist makes a mutually convenient arrangement for the assessment and advises the Ward Staff.

4. The therapist prepares the kitchen for the assessment and ensures that all necessary ingredients and equipment are available.

5. The therapist asks the patient to perform the chosen task in their usual way, taking into consideration, their current functional level and observing any relevant precautions. Difficulties are noted.

6. If the patient encounters any problems the therapist offers appropriate advice or equipment and arranges for further practice if necessary.

7. The therapist reports the outcome of the assessment and subsequent practice to all relevant disciplines and carers. Further practice could be carried out by Technical Instructors under guidance of qualified Occupational Therapists.

8. The therapist documents the outcome of the assessment in the Nursing Kardex and in the Occupational Therapy notes.

9. Where necessary, the therapist carries out a kitchen assessment in the patient's home.

8

GUIDELINES FOR CONDUCTING HOME VISITS WITH HOSPITAL IN-PATIENTS

2. A patient must be assessed by an Occupational Therapist prior to consideration of a Home Visit.

3. If a Home Visit is deemed to be inappropriate or unnecessary by the Occupational Therapist, the decision should be discussed with the referrer and recorded accordingly.

4. The Occupational Therapist should ensure that the patient is medically fit to undertake the Home Visit. Occupational Therapist to contact relevant doctor to gain medical clearance, if there are concerns.

5. The nature of the assessment should be explained to the patient and any family/carer that the patient wishes to be involved.

6. The date and time of the visit should be relayed to the patient, identified family/carers, Ward Staff and appropriate Multi Disciplinary Team members.

Home Visit leaflet issued to the patient.

7. Availability of keys or means of access should be established by the Occupational Therapist. (Follow Protocol for entering a patients house without patient 2006) 8. The Home Visit should be undertaken by at least one qualified Occupational Therapist. A second member of staff should also be present (from Occupational Therapy or another discipline).

9. The patient should be informed as to who will be present and their role.

10. A self-discharge form should be taken on the visit if there is any risk of the patient refusing to return.

11. Transport should be arranged prior to the Home Visit and relevant paperwork completed by the Occupational Therapist.

12. Small change or a mobile phone should be carried by the Occupational Therapist.

13. The Occupational Therapist should ensure that the patient is appropriately dressed for the visit. (Some wards have a supply of day clothes for patient use).

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14. The patient's address and telephone number should be recorded in the Home Visit Recording Sheet, and an expected time of return (ETR) written clearly on the staff location board.

15. The Occupational Therapist should ring the department if there is an expected delay in the in their return (in accordance with the Occupational Therapy Safety Policy).

16. If a patient refuses to return to hospital the Occupational Therapist should attempt to persuade the patient to change his/her mind. If unsuccessful the Occupational Therapist should contact the Ward, alert any relevant Services/ Agencies and ask the patient to sign the self-discharge form.

17. In the event of any serious accident, injury or illness the ambulance should be called. On return to hospital a clinical incident form must be filled out and Head Occupational Therapist informed.

18. In the event of a violent or aggressive threat the Occupational Therapist should act in accordance with the Occupational Therapy Safety Policy. See attached Policy.

Reporting 19. On return to the hospital a verbal report should be given to the relevant Ward Staff, a brief written summary provided in the Nursing Kardex and medical notes.

20. A full written report should be typed and distributed to appropriate disciplines within three working days.

Discharge Home Visits:It is the policy of the Acute Occupational Therapy Department not to conduct Discharge Home Visits but we are looking at this with a view to implementing them in the future.

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SAFETY POLICY FOR HOME VISITING 1 All staff should ensure that there is a record of the visit, including names and addresses of patients or locations; expected time of return to base must be included. Record information on the Home Visiting Record Sheet and expected return time on the white board.

2 If expected time of return to base becomes unrealistic, then contact base with a revised time. Messages should not be left on answer machine, need to speak to someone from Occupational Therapy Department or ask Ward staff to pass on a message. Change to be kept in Home Visit bags.

3 If a member of staff does not return back to base within the expected time, Head Occupational Therapist or Deputy to contact last visit to see if Occupational Therapist is there and contact previous visits to try to locate member of staff. If staff cannot be located, the Manager on call to be contacted through the switchboard. The on call Manager will then decide whether to send security staff to the last appointment to see if staff can be located.

NB

No Home Visits to be carried out on way home. If leaving work early for any reason, make sure Supervisor is aware and it is noted on the white board.

4 Where a potential risk has been identified with a patient or their family, then no member of staff should visit alone. All notes to be marked with a red triangle indicating risk.

5 If, whilst on a Visit, the situation becomes difficult and a member of staff may be in danger, then the member of staff, if at all possible, should leave the situation. The Supervisor must be informed and the incident fully documented in the patient's records and the file marked.

All incidents where there is considered to be a significant risk or persistent verbal abuse over the telephone should be reported in the Incident Book. If there is an incident whilst on a visit contact the bleep holder.

6 Following an incident, staff should be referred to Occupational Health for de-briefing and support. If appropriate, Occupational Health will refer to other Services, e.g., Psychology.

11

TAXI GUIDELINES

1.

The user will use the preferred Taxi Company of the Mid Yorkshire Trust

2.

The user will ring and order a taxi at least half an hour before it is required.

3.

The user will fill in a Taxi Form for each journey and send the green slip to General Office on return.

4.

The user should not keep the Taxi waiting for longer than five minutes.

5.

Ensure wheelchair taxis are booked in advance, preferably the day before the visit. The preferred Taxi company may not always be able to respond to requests made the same day.

6.

At times the user will be asked to fill in a questionnaire regarding the service received, this should be filled in promptly and sent to the Head Occupational Therapist.

7.

Any complaints should be directed towards John Byrne, Portering Service Manager, either by telephone or by a written report.

Please note: this needs to be done as soon as possible following the journey.

As from April 2004 preferred Taxi Company ABBEY CARS Tel: 01924 407777

Note:

Abbey Cars have specific standards to meet as part of their contract.

12

WHEELCHAIR PROVISION Aims (a) To assess, select for the most appropriate wheelchair and/or accessories for a particular client, bearing in mind the main purpose for which the chair will be used. (b) To liase with Wheelchair Services to meet the client's need.

Process 1. The Occupational Therapist will discuss the need for a wheelchair with the patient and/or carers.

2. The Occupational Therapist establishes for what purpose the wheelchair is going to be used, i.e. indoor, outdoor, all day or part of the day.

3. The Occupational Therapist needs to establish the patient’s mode of transfer from and to the wheelchair.

4. The Occupational Therapist compares the size, weight and sitting balance against the dimensions of the wheelchair selected.

5. The Occupational Therapist assesses for accessories and liases with the Wheelchair Service.

6. The Occupational Therapist carries out an assessment of the patient’s home/ work environment prior to selecting a wheelchair for a patient.

7. A written record of the assessment and requisitions should be documented in the Occupational Therapy notes and the patient and/or carer should be informed of the result of this assessment.

8. The Occupational Therapist should liase with the Wheelchair Service if the assessment is unclear or a special provision is required.

9. Before issuing the wheelchair to the patient an inspection is made and faults reported to Wheelchair Services immediately. The footplates, etc should be set to the correct patient height.

10. The Occupational Therapist needs to demonstrate how to use the wheelchair and emphasise safety points to the patient on delivery of the chair, unless delivered to the patient’s home where it is the responsibility of Clarks. A wheelchair should not be left with a patient if it is felt they are at risk.

Preferred Wheelchair Repairer:

Clarks 13

01484 511441

MINIMUM STANDARDS FOR SPLINTING

1. REFERRAL 1.1 The Occupational Therapy Service will accept referrals from (qualified) members of the multidisciplinary team.

1.2 Referrals will only be accepted if deemed to be within the expertise of available staff.

1.3 If a referral is deemed inappropriate the therapist concerned will refer back to the referring agent. Reasons for refusal will be documented in the Occupational Therapy records.

1.4 Patients and referring agents will be advised to any time delays relating to splinting intervention.

2. PROFESSIONAL 2.1 The Occupational Therapists will adhere to the British Association of Occupational Therapy’s code of professional conduct (2005) 2.2 Therapists will only fabricate splints with their level of skill and expertise All therapists must recognise their limitations.

2.3 Therapists will use available resources to obtain information prior to making a splint, e.g. Medical notes, x-rays, other professionals, relatives, the patient.

2.4 The Occupational Therapist’s working practice will reflect an understanding of the professional practice of other disciplines and commitment to multidisciplinary working wherever possible.

2.5 On completing of the splint there will be a written record in the Occupational Therapy notes.

2.6 On completion of a splinting regime a splinting report will be submitted to the medical notes and referring agent. Interim reports will be submitted in the case of long-term patients.

2.7 All high priority splints referred to the Occupational Therapy Service will be completed within three working days of receipt of referral.

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2.8 Non-urgent splints referred to the Occupational Therapy Service will be actioned within five working days of receipt of referral.

2.9 The splinting service is provided within the available resources of current staffing levels.

2.10 A prioritisation system will be used where there is heavy demand.

High priority patients are: Those in pain Those who require an immediate post-op splint Those who are at risk if they do not receive a splint 2.11 All patients referred for a splint will have an activities of daily living assessment.

2.12 Any splint provided must be considered to be an integral part of Occupational Therapy intervention.

2.13 Following an Occupational Therapy assessment, the need for a splint will have been identified.

3. PATIENT STANDARDS 3.1 Prior to the manufacture of a splint the following must be explained to the patient and their relative/carer as appropriate.

3.1.1 3.1.2 3.1.3 3.1.4 3.1.5

The need for the splint The type of splint to be made The procedure to be used The requirements of the patient during the procedure The regime to be used

3.2 Verbal and written information on the regime will be provided and the patient’s understanding of and their ability to carry out the regime checked.

3.3 All patient’s questions will be answered clearly and honestly.

3.4 Patient’s dignity and privacy will be respected at all times during the procedure.

3.5 When practical the patient’s wishes on design and materials will be given priority.

3.6 Follow-up appointments will be made for all patients to check the fit and reenforce the regime being used. Timescales will vary depending on the procedures and regime used. The Senior Occupational Therapist will identify the follow-up procedure in each area of service.

15

3.7 Appointments will be negotiated with patient/carers to a mutually satisfactory time and date. Patients who have difficulty attending the Occupational Therapy department may be offered a telephone review if appropriate.

4. PRACTICAL 4.1

Suitable equipment will be available to allow the production of high quality splints. This equipment will be regularly maintained and calibrated as per Trust policy.

4.2

Appropriate levels and ranges of stock will be maintained.

4.3

Splints provided by the Occupational Therapy Service will either be prefabricated or custom-made from low-temperature thermoplastic materials.

4.4

All prefabricated splints will be fitted by a qualified Occupational Therapist.

4.5

The pattern may be drawn onto the material but no trace of biro, ink or other markings should be evident on the completed splint.

4.6

The splint will be cut with appropriate sharp shears so that a neat, smooth edge is achieved.

4.7

Surplus material will be trimmed so that the completed splint has a good cosmetic appearance.

4.8

Straps should be neat and conformable and fitted taking into consideration their effect on the biomechanics of the splint. Colours should be matched wherever possible and the ends of the straps should be rounded off.

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GUIDELINES FOR SUPERVISION

Supervision is a system to ensure that high quality Occupational Therapy is delivered to the Consumer. It is a participative relationship which ensures good standards of practice. It should ensure that individuals are able to do their job effectively and are assisted in their own professional development.

Minimum Standards of Clinical Supervision Staff Grade

Frequency

Senior I Occupational Therapists Senior II Occupational Therapists Basic Grade Occupational Therapists Technical Instructors Clerical Officer

Monthly (as a minimum) Monthly Weekly/fortnightly Monthly Monthly

As per the Clinical Supervision Policy Framework. (Kirklees Primary Care Trust Clinical Supervision Policy Framework.)

Documentation A summary of the discussion along with action points should be written on a supervision sheet. Both the Supervisor and Supervisee should agree what is written and sign. This sheet should be kept in the individuals Professional Development Portfolio. A supervision contract should b signed/agreed prior to supervision commencing.

Documentation All discussion in supervision is confidential and should only be shared with a third party with the consent of both parties.

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