Occupational Therapy EPA4 Functional assessment and basic treatment 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

Impaired power

Impaired sensation

Biomechanical changes

Impaired coordination

Subluxations

Oedema

Pain

Tonal changes

Impaired proprioception

Nerve issues: eg. brachial plexus injuries

Skin

To have an awareness of formal upper limb assessments (if/when appropriate). Consider: Chedoke, ARMA etc. *unit specific

Awareness of suitable upper limb outcome measures, *unit specific: CAHAI/ Chedoke; MTHAS; Fugl- Meyer

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

To complete Risk Assessment prior to assessment based on admission and presenting conditions

Assesses passive range of movement: Goniometry or Neutral- O method

Uses subluxation measurements

Active range of movement: Oxford Scale (OS)

Cylindrical

Spherical

Palmer

Hook

Lateral

Tiper/Pincer

Tripod

Demonstrates use of Modified Ashworth Scale (MAS) - Rigidity vs spasticity?

To be aware of the impact that spasticity has on function, both positive and negative.

Dermatome knowledge and awareness. Patient reporting- sharpness, numbness, dull aches, pins and needles - patterns

Demsontrates assessment of light touch

Demsontrates assessment of deep touch

Demsontrates assessment of temperature

Demsontrates assessment of distinction

Demsontrates assessment of discrimination

Assess proprioception using thumb

Assess proprioception using arm positioning matching

Assess proprioception using joint position sense

Assesses coordination using 9 hole peg test

Assesses coordination using finger nose test

Assesses coordination using digit tapping

Assesses coordination using DDK

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

Demonstrate awareness of the factors that can contribute or cause delirium in an Critical Care

Be able to discuss predisposing factors (gender, pre-existing cognitive impairment, age, auditory/visual impairment, alcohol/drug abuse, severe illness etc.)

Show awareness of precipitating factors (analgesia, benzodiazepines, sepsis, pain, ventilation, hypoxia etc.)

Describe how to recognise/diagnose delirium, including the common subtypes

Be able to describe typical presentations of hyperactive delirium, hypoactive and mixed delirium

Demonstrate basic knowledge of pharmalogical impacts on delirium

Identifying typical medication forms that may impact such as benzodiazepines/antipsychotics and subsequent imbalances caused

Demonstrate awareness of the ABCDEF Liberation Delirium bundle or PADIS guidelines

Demonstrates the knowledge of early mobilisation, nutrition, activity engagement, sleep and family input in delirium management

Demonstrate knowledge of the RASS scores

To be able to complete a CAM-ICU independently

Demonstrate how to feedback on results of assessment and recommendations to MDT, patient and family

Demonstrate typical OT intervention and treatments of delirium

Be able to complete a detailed social history capturing the wider needs of the patient including hobbies, likes/dislikes, occupations, personality, family dynamics etc.

Complete and recommend daily orientation with delirious patient; to include use of orientation boards, pictures or verbal orientation strategies, use ‘framing’ to aid hallucinations/understanding of reality, insight building, education.

Assess, commence and recommend early mobilisation, rehabilitation, routine and bed mobility

Complete environment assessment and recommendations within scope of practice and skills. Consider light/ dark, windows, sounds and stimulation and work with MDT to support

Sleep cycle – introduction of sleep hygiene strategies i.e. masks, reduce caffeine intake, exercise (if appropriate) or environmental changes to support sleep/wake cycle etc.

Functional/cognitive activities alongside normal daily routine

Partake in family, friend engagement/education of delirium and how they may participate in delirium management. Provide family/ friend education on delirium management

MDT education on delirium and therapeutic role of activity

Demonstrate awareness of Maslows Hierarchy of needs and how this applies to the critically ill patient

To identify appropriate treatment interventions to support engagement in leisure interests

Complete personal history Questionnaire. Consider Interest Checklist.

To be able to discuss leisure with patients, appropriately in Critical Care

Detailed understanding of Goal Setting and the impact on rehabilitation in Critical Care

Demonstrate ability to develop SMART patient-centred goals with a patient/MDT (or in a patient's best interests when required), in order to meaningfully direct rehabilitation

Understand the impact on volition on task performance

Interest Checklist

Be able to obtain information on a patient's meaningful occupations, roles, responsibilities and preferences, and use creativity to apply this in an appropriately graded way to the critical care setting

Establish or implement a bed side 'This is me' or 'Getting to know me' provision.

To identify how many hours sleep a patient is getting over a 24-hour period

To discuss barriers to sleep with patients

To make non-pharmacological recommendations to support sleep

Make recommendations to support sleep hygiene

Recognise the value and importance of eating and drinking functionally/ holistically

Understand the modified risk and eating/ drinking needs in CCU i.e. modified diets, swallow needs etc.

Complete a feeding assessment

Complete a drinking assessment

Provide recommendations on feeding and drinking skills (graded and/ or adaptive)

Having an awareness of when a personal care assessment is required/ appropriate and within remit of your skills and the patients' capabilities

To discuss hygiene preferences with patients and cultural preferences for hygiene completion. To identify personal care tasks regularly completed by the patient

Complete toileting assessment and management

Grooming task assessment i.e. shaving, tweezing etc.

Oral hygiene assessment- yankeur use, toothbrush, mouthwash

Support patient to access leisure activities within personal care i.e. nail painting, haircuts and attempt to access support networks for this

To be aware of how people can communicate via media and technologies whilst on critical care i.e. phone, iPad

Awareness of how patient can communicate and raise concerns.

Support patient in referring for or accessing alternative low- tech or familiar communication devices

Complete call bell assessment

To identify presence of artificial airway impacting verbal communication

To identify limitations in communication due to weakness, neurological change, impairment or pharmacology

To identify if patients have access to communication aids

Be aware of low tech and high-tech communication solutions

To identify if a patient can make their needs known

To identify strategies to support patients to make their needs known in liaison with MDT colleagues

To liaise with MDT colleagues to support patient communication

To complete a written communication assessment

Demonstrate an understanding of how the critical care environment can impact on a person's basic human needs

Demonstrate environmental awareness and use of critical care equipment (creativity) to support in rehabilitation i.e. chairs, bed mechanism, weights

Make reasonable recommendations for environmental changes to access functional activities

Create an adaptive and supportive environment for staff and patient to engage in rehabilitation or a familiar environment i.e. pictures, routines, timetables

To identify when specialist seating is required

To recognise scope of practice and when additional support required (seating or postural assessments)

To identify if a patient can/ cannot complete seating or transfer due to equipment provision and lack of. How to escalate any of these concerns

To complete a complex Seating Risk Assessment

To be able to recommend a transfer method to get to/from seating

To identify appropriate seating within the Critical Care setting (*unit specific)

To recognise when assistive devices are needed (e.g., splints, braces, etc)

To be able to identify presence of assistive devices (e.g., splints, brace etc)

To recognise scope of practice and when additional support required

To request support for prescription of assistive devices