Occupational Therapy
The following describes the skills required for a novice occupational therapist to be able to work competently and confidently in critical care. Workforce planning should ensure that the below are included in the training and development of staff to ensure we have the necessary skills and knowledge amongst occupational therapists to provide safe and high-quality patient care. Attainment of the Shared AHP Competencies, Occupational Therapy Core Competencies and EPA sign off will ensure the clinical caseload is managed by a sufficiently skilled therapist who can work independently.
It is recommended that critical care occupational therapists (especially those working in isolation) consider membership to intensive care societies such as the RCOT critical care specialist group.
Some of the domains within this document can be better understood by engaging with those outside your profession (ie asking a bedside nurse to explain the lines and wires, learning from the medical team regarding shift handovers, discussing with the nurse in charge which MDT meetings are most relevant for your role and contribution). See Appendix 2 for suggested MDT shadowing experiences which will aid the completion of both shared and occupational therapy domains of the C3Framework.
EPA quick access
Occupational Therapy Entrustable Professional Activities (EPAs)
Occupational Therapy EPA 1 : Assess the upper limbs of the critically ill patient
- Specifications and Limitations
The Novice Critical Care Occupational Therapist will be able to assess the function, ability and kinesiology of a critically ill patients upper limbs:
- Fully assess a critically ill persons upper limb and identify any risk and/ or injury to function and kinesiology.
- Recognise dysfunction, impairment and disability of an upper limb on critical care.
- Advise on further assessments and or scope of investigations for upper limb management
Limitations
- Intervention/ Treatment of upper limb impairments or rehabilitation is not within the scope of this novice competency.
- This does not include assessment of patients intubated and sedated or are clinically unstable as per the Medical Team.
- This document does not include condition/ diagnostic specifics assessments relating to injuries commonly seen on critical care. This is a generic upper limb assessment.
- Required knowledge
- C3Framework Shared AHP Competencies
- C3Framework OT Domains:
- Upper Limb Assessment
To demonstrate a competent understanding of the upper limb (kinesiology and function), critical care complications or risks for a persons upper limb on critical care. How to identify impairments and report on said impairments for treatment. They will have a sound awareness/ knowledge of upper limb function and its potential disability.
- Information to assess progression
- Verbal and/ or written feedback on knowledge obtained from learning(self-directed or senior directed) to supervisor for sign-off
- Senior supervision (informal)
- Observational sessions with senior support (2-3 sessions)
- Demonstration of skills session with senior (2-3 sessions)
- Clinical supervision
- Supervision
- Entrustment decision made at level 4
- Documentation of self-assessment and senior sign- off through supervision
- Basis for formal entrustment decisions
An entrustment decision should be made by an experienced critical care OT after observing this EPA completed on more than one patient.
Use the EPA Completion Template (PDF, 88KB) for this.
Occupational Therapy EPA 2 : Assesses upper limb oedema of the critically ill patient
- Specifications and Limitations
The Novice Critical Care Occupational Therapist will recognise, discuss and assess patients with upper limb oedema.
- Understand and demonstrate an awareness of oedema and its pathophysiology,
- Identify oedema and its subtypes,
- Identify associated factors contributing to oedema,
- Acknowledge complications causing oedema such as medical interventions, fluid balances etc. that may contribute to oedema
- Demonstrate an awareness of secondary complications associated with oedema
- Be able to assess the appropriate patients for oedema and thereafter liaise with senior support to assist with treatment modalities for oedema management.
Limitations
- Intervention/ Treatment of oedema is not within the scope of this novice competency
- This does not include assessment of patients intubated and sedated or are clinically unstable as per the Medical Team.
- This does not include lower limb oedema
- Renal replacement therapy patients are not considered within this competency (advanced)
- See Core Skills for risk assessment
- Required knowledge
- C3Framework Shared AHP Competencies
- C3Framework OT Domains:
- Oedema
The Novice OT will require a sound understanding of the pathophysiology of oedema, critical care complications or risks for oedema and the overall knowledge of its impact on upper limb function and disability.
- Information to assess progression
- Verbal and/ or written feedback on knowledge obtained from learning (self-directed or senior directed) to supervisor for sign- off
- Senior supervision (informal)
- Observational sessions with senior support (2 sessions)
- Demonstration of skills session with senior (2 sessions)
- Clinical supervision
- Supervision
- Entrustment decision made at level 4
- Documentation of self-assessment and senior sign- off through supervision
- Basis for formal entrustment decisions
An entrustment decision should be made by an experienced critical care OT after observing this EPA completed on more than one patient.
Use the EPA Completion Template (PDF, 88KB) for this.
Occupational Therapy EPA 3 : Identify, assess and treat patients therapeutically for delirium in critical care
- Specifications and Limitations
This EPA is specific to patients admitted to the critical care units. The novice critical care OT will understand the mechanisms of delirium and its impact on rehabilitation, quality of life and its longer-term affect on recovery.
- Understand and demonstrate an awareness of delirium within CCU
- Understand and discuss the A-F Liberation Bundle and its evidence base
- Identify delirium and its subtypes
- Identify associated factors contributing to delirium i.e. pre-disposing, medications, environment
- Develop skills of assessment of delirium (verbal, non – verbal)
- Acknowledge environmental factors in the causation of delirium
- Demonstrate an awareness of secondary complications associated with delirium
- Implement a strategic delirium treatment plan including early mobilisation, sensory alterations and environmental changes
- Participate with MDT and family members in delirium prevention or treatment
Limitations
- This does not include assessment of patients intubated and sedated or are clinically unstable as per the Medical Team.
- This does not discuss referral/ screening processes for assessment/ treatment
- There will not be an in- depth review of pharmalogical management of delirium
- Required knowledge
- C3Framework Shared AHP Competencies
- C3Framework OT Domains:
- Delirium Assessment and Treatment
Suggested resources:
- ICU steps.org website https://icusteps.org
- Dale Needham (Johns Hopkins University) presentation on Delirium within ICU
- https://www.sccm.org/Clinical-Resources/ICULiberation-Home/ABCDEF-Bundles
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351776/
- https://www.youtube.com/watch?v=2cg1x4pxqcY
- Information to assess progression
- Senior supervision (informal)- verbal/ written feedback on resources review
- Observational sessions of assessment (2 sessions)
- Demonstration of skills session for treatment with senior (2 sessions)
- Clinical supervision
- MDT feedback on application and outcomes
- Supervision
- Full entrustment within 3 months of starting in Critical Care
- Documentation of self-assessment and senior sign- off through supervision
- Basis for formal entrustment decisions
An entrustment decision should be made by an experienced critical care OT after observing this EPA completed on more than one patient.
Use the EPA Completion Template (PDF, 88KB) for this.
Occupational Therapy EPA 4 : Functional assessment and basic treatment of the critically ill patient
- Specifications and Limitations
The Novice Critical Care Occupational Therapist will be able to assess the functional skills and dysfunctional components of the critically ill patients to ascertain occupational losses and provide basic treatment to overcome occupational barriers within reason in critical care.
- The OT will have skills to recognise dysfunction, impairment, occupational deprivation and disability for function in critically ill patients.
- Have an awareness of the cognitive, physical and psychosocial implications on function as a critical care patient and assess said needs.
- Support and treat patients to access leisure and goal orientated occupations as appropriately with Level 2/ 3 patients.
Limitations
- This does not include assessment of patients intubated and sedated or are clinically unstable as per the Medical Team.
- Complex Intervention/ Treatment of function is not included
- Detailed functional, cognitive, motor and psychosocial skills and treatments not within this novice competency
- This does not include or cover the scope of high level functional skills performance
- Required knowledge
- C3Framework Shared AHP Competencies
- C3Framework OT Domains:
- Competency 1; Upper Limb Assessment
- Competency 2; Oedema assessment
- Competency 3; Delirium Assessment and Treatment
- Functional Assessment and basic Treatment additional ‘components/ considerations’
- Therapy Manual Handling skills
- Information to assess progression
- Verbal and/ or written feedback on knowledge obtained from learning to supervisor for sign- off
- Observational sessions with senior support (2 sessions)
- Demonstration of skills session with senior (3 sessions)
- Clinical documentation and notes audit
- Functional reporting- case monitoring and/ or supervision
- Clinical supervision
- Supervision
- Full entrustment (level 4)
- Documentation of self-assessment and senior sign- off through supervision
- Basis for formal entrustment decisions
An entrustment decision should be made by an experienced critical care OT after observing this EPA completed on more than one patient.
UUse the EPA Completion Template (PDF, 88KB) for this.