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Appendix 2 - Suggested MDT shadowing activities

The EPAs for the novice are to be signed at level 4 – once competent, they can practice unsupervised but it is not expected that they supervise others.

Example discussion points and activities for each profession:

Physiotherapy

  • Mechanical ventilation, ETTs and traches
  • Indication for trachy / extubation
  • Tracheostomy weaning
  • Minute volume on ventilator, how does this differ with different modes and where is this documented.
  • Experience CPAP via face mask or discuss with patient who has received CPAP to understand how it feels  
  • Experience High Flow Nasal Cannula or discuss with patient who has received this to understand how it feels and how the flow may affect their oral intake?
  • Attend and shadow joint session with PT / OT and discuss rehabilitation and process of goal setting

Dietetics

  • How to identify patients who are malnourished
  • Feeding routes and indications for each
  • Causes for poor nutrition delivery in critical care
  • Impact of suboptimal nutrition delivery
  • How nutrition provision targets change throughout metabolic phases of critical illness (acute, stabilisation and recovery)
  • Enteral feeding and oral intake – does NG feeding have an impact on appetite?
  • First line and practical methods of improving oral nutritional intake

Occupational Therapy

  • Functional assessments / interventions and how these may benefit critically ill patients
  • Cognitive assessments / interventions and indications in critically ill patients
  • Attend and shadow joint session with OT / PT and discuss rehabilitation and process of goal setting

Speech and Language Therapy

  • How critical illness can impact swallow function and signs and symptoms of dysphagia to be alert for in the critically ill patient
  • Shadow swallow assessment, including instrumental assessments if possible
  • The SLT role in tracheostomy weaning to assess laryngeal function and to support swallowing and communication
  • Shadow communication assessment including provision of AAC if possible
  • Shadow joint SLT/PT tracheostomy wean session

Nurse

  • Shift patterns and different roles within the nursing team
  • Level of care is this patient requiring and allocation of patient
  • What observations are being kept for this patient and why they are important
  • Fluid balance goals, what is contributing to intake and output and what aids with achieving fluid balance goals
  • Observe a patient on renal replacement therapy and discuss indication, filtration process, fluid removal  
  • Observe NGT insertion, location confirmation, GRV checking

Handover Ward Round

  • Observe medical team handover  
  • Discuss with your supervisor what are the benefits of attending handover meetings  
  • Reflect on the experience of attending the handover WR