Occupational Therapy EPA2 Assesses upper limb oedema of the critically ill patient

Able to demonstrate knowledge of general infection control prevention and control including hand hygiene, aprons, masks and aseptic non-touch technique

Has completed Basic Life Support Training as per local trust policy

Describes how they would summon help in an emergency and locate crash bells

Describes how to call a medical emergency call via switch

Describes own role and expected contribution in medical emergency eg. Basic Life Support, providing assistance to MDT as able

Demonstrates positive patient identification and awareness of allergies

Demonstrates how to monitor vital signs (Temp, HR, SpO2, RR, blood pressure, MAP)

Interprets observations in an ICU setting, considering trends and normal ranges for all (Temp, HR, SpO2, RR, blood pressure)

Able to troubleshoot difficulties with taking vital signs eg. poor trace on pulse oximeter, missing ECG leads, positional sensitivity of arterial line

Awareness of who to escalate concerns to in relation to patient safety with recognition of different levels of urgency and reporting to different staff members dependent on situation

Can describe the bed numbering, storage location of safety equipment, location of offices and other key areas within the critical care unit

Can describe the shift patterns and handover process of other MDT members

Able to identify key MDT members by their role, including critical care nurses, nurse in charge, consultant on call

Demonstrates how to locate the local protocols and guidelines relevant to own role

Has an awareness of key ICU meetings relevant to role e.g. MDT meetings, handovers, safety briefings, teaching sessions.

Can identify standard ICU bedspace equipment and location of equipment necessary for role

Describe barriers to communication in ICU including those associated with PPE, illness and ICU interventions.

Awareness of communication aids with patients to overcome communication barriers i.e. PPE + oral intubation

Describe the support services available to help liaise with family including family support nurses, PALS, psychology services as appropriate.

Describe barriers to communication with family and methods to improve this

Knows importance of confidentiality and consent to share information with friends and family

Awareness of peer support and psychological support

Demonstrates how to access and document in patient records using local IT systems

Demonstrates how to view results and imaging on local IT systems

Awareness of Falls prevention and who to escalate to if concerned regarding falls risks

Compliant with Manual Handling training as per local trust policy.

Demonstrate working in an MDT by building and maintaining relationships with other professions

Aware of the roles and responsibilities of other members of the MDT

Clarifies, accepts and executes tasks delegated by the team leader

Explains the importance of highlighting safety issues / concerns to a member of your team in a prompt manner

Uses appropriate level of assertiveness for the clinical situation

Demonstrates a logical and systematic handover using local format

Outline how to escalate and to whom if there are patient / safety concerns

Identify and respond to patient / staff safety issues appropriately

Demonstrate ways to open up airway using simple manoeuvres (inc. repositioning, head tilt chin lift, jaw thrust)

Demonstrates how to deliver manual ventilation using two person bag-valve-mask (BVM) technique

Recognise and escalate airway compromise in a tracheostomised patient

Demonstrates how to perform and document oral hygiene

Knows the types of oxygen delivery system and their limitations (including reservoir mask, simple face mask, venturi system and nasal cannulae)

Demonstrates how to deliver oxygen urgently (including reservoir mask, simple face mask, venturi system and nasal cannulae)

Describe how to escalate or de-escalate oxygen therapy in a step wise manner eg. nasal cannulae to face mask.

Recognise different lines and their location relevant to local population (eg arterial lines, central line, vas-cath)

Identify enteral feeding tube in situ, whether it is connected to feed and whether the feed pump is running

Knows to discuss plans with nursing staff prior to moving or reposition a patient with NG feed running

Aware of events which can displace feeding tubes and to escalate accordingly

Describes how to check enteral feeding length and escalates if tube length has changed

Describe how to recognise dysphagia and an escalation plan including referral to SLT

Demonstrates how to assist patients with eating and drinking

Have an awareness of modified diets or thickened fluids in line with SLT recommendations

Demonstrate how to categorise neurological status using the AVPU scoring

Describe factors that may cause or contribute to delirium

Describes how to recognise delirium

Demonstrates how to complete a CAM-ICU score

Demonstrates an understanding of non-pharmacological management of delirium

Demonstrates knowledge of the Mental Capacity Act, when capacity assessment is indicated, how to assess capacity and when specialist communication support is required eg. referral to SLT

Demonstrates how to use pain faces or a similar visual analog scale

Demonstrates an understanding on the impact of pain on patient presentation eg. agitation

Demonstrates an understanding of the impact of pain medication on patient presentation eg. sedative effect

Demonstrates an understanding of RASS (or alternative sedation) scoring system

Able to access and read using ICU drug charts

Demonstrates an awareness of common ICU sedative medications

Demonstrates a basic knowledge of common ICU medications and their role e.g. sedatives, vasopressors, inotropes

To be able to feedback assessment to senior OT to implement appropriate intervention

To be able to escalate any concerns regarding pain, skin, necrosis etc. to MDT

Assess pain using Pain Scale (VAS, Numerical Pain scale and Clinical Pain Observation Tool)

Assess pain using verbal pain descriptions i.e. sharp, numbness, tingling, pins/ needles, dull, old/ new pain

Stretched, taut, shiny, dry, cracked, weeping, pale, red, erythema (rash) bruised, temperature, healed. Necrosis and TVN advise adherence

Assessing Impact on ROM in function.

Teeth brushing

Drinking/ Feeding tasks

Oral care

Putting on glasses

Using a phone

An understanding of the pathophysiology of oedema

An understanding of the impact of oedema on function, kinesiology, pain and disability

An awareness of the OT role in oedema management (assessment and treatment)

Pitting

Non pitting

Mixed

Local

Global

Uni/bilateral

Peripheral

Liases with MDT and reviews medical notes to consider:

• Sodium retention;
• Fluid balances (+ or -);
• Trauma to location;
• DVT;
• Line positioning

To recognise limitations and/ or risk assessment associated with oedema i.e. DVT, cardiac, fluid balances, RRT

An awareness of medical intervention leading to causation of oedema

Information Gathering and Admission History

• PMH (e.g. congestion heart disease, lymphedema, other conditions that may increase risk e.g. kidney problems, lung and liver diseases);
• Medication;
• Risk factors: smoker, family history, obesity, hypertension,
• Local trauma or DVT present

Assessing figure of 8. Consider: Figure of 8 demonstration video

Assessing Grade/Depth and Rebound time. Consider: Pitting Edema Scale infographic

Assessing Measurements-circumference (bicep/forearm). Consider: Pitting Edema Scale infographic