Physiotherapy

The following describes the skills required for a novice physiotherapists 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 to provide safe and high-quality patient care.
Attainment of the Shared AHP Competencies, Physiotherapy 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 physiotherapists (especially those working in isolation) consider membership to intensive care societies such as the ACPRC critical care specialist group.

The following are useful resources in progression towards EPA sign off:

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 physiotherapy domains of the C3Framework.

Physiotherapy Entrustable Professional Activities (EPAs)

Physiotherapy EPA 1 : Assessment of patients admitted to Critical Care with Respiratory failure
Description

The novice physiotherapist will be able to complete a comprehensive assessment of patients admitted to Critical Care with Respiratory failure.

A structured A-E assessment of the critically unwell adult to ascertain a problem list and identify risks and considerations which may impact on a treatment plan.

Limited to adult patients admitted with Respiratory failure and those at risk of developing Respiratory failure e.g post operative patients.

Excludes patients admitted with Poly-Trauma including brain injury, burns, smoke inhalation, spinal cord injury and progressive neuromuscular conditions.

Excludes patients on ECMO or nitric oxide.

Required knowledge

Competencies Required:

  • C3Framework Shared AHP Competencies
  • C3Framework Core Competencies:
    • Competency 1 Assessment
    • Competency 3 Tracheostomy Management
    • Competency 4 High Flow Oxygen devices, CPAP and NIV
    • Competency 5 Positioning and Rehabilitation
Required KSA
  • Basic Life support
  • Manual handling
  • Infection Control
  • Information Governance
Information to assess progression
  • Clinical supervision
  • Nonclinical supervision
  • Notes Audit
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care physiotherapist after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Physiotherapy EPA 2 : Develop and deliver a respiratory treatment plan
Description

The novice physiotherapist will be able to risk assess the use of the following chest clearance treatment techniques and monitor their effectiveness.

ACBT, Manual techniques, Suction (Via NP, ETT, Trache), Manual assisted cough, IPPB, cough augmentation device (e.g NIPPY Clearway) manual hyperinflation, ventilator hyperinflation.

Limited to adult patients admitted with Respiratory failure and those at risk of developing Respiratory failure.

Required knowledge

Competencies Required:

  • C3Framework Shared AHP Competencies
  • C3Framework Core Competencies:
    • Competency 1 Assessment
    • Competency 2 Treatment
    • Competency 3 Tracheostomy management
    • Competency 4 High flow oxygen devices, CPAP and NIV
    • Competency 5 Positioning and rehabilitation

Acute Respiratory / On Call Physiotherapy Self-evaluation of Competence Questionnaire On Call Project Team S Thomas MA Broad J Cross B Harden M Quint P Ritson

Required KSA
  • Basic Life support
  • Manual handling
  • Infection Control
  • Information Governance
Information to assess progression
  • Clinical supervision
  • Nonclinical supervision
  • Notes Audit
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care physiotherapist after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Physiotherapy EPA 3 : Tracheostomy Management
Description

The novice physiotherapist will be able to complete a comprehensive assessment of a self-ventilating tracheostomised patients, assess their readiness to commence weaning and as part of the MDT progress them through the following steps:

  • Cuff deflation
  • One way valve use / cap/ Swedish nose (as per trust policy)
  • Decannulation

Limited to tracheostomises inserted for respiratory weans.

Excludes tracheostomises inserted for head and neck cancer and for patients for whom the tracheostomy is expected to be permanent.

Excludes Laryngectomies and mini-tracheostomies.

Required knowledge

Competencies Required:

  • C3Framework Shared AHP Competencies
  • C3Framework Core Competencies:
    • Competency 1 Assessment
    • Competency 2 Treatment
    • Competency 3 Tracheostomy management
    • Competency 4 High flow oxygen devices, CPAP and NIV
Required KSA
  • Blocked tracheostomy and emergency algorithm
  • National Tracheostomy Safety Project (NTSP) (2013)
  • Intensive Care Society Tracheostomy Guidance (2020)
  • NCEPOD Report ‘On the Right Trach? A review of the care received by patients who underwent a tracheostomy’ (2014)
Information to assess progression
  • Clinical supervision
  • Nonclinical supervision
  • Notes Audit
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care physiotherapist after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Physiotherapy EPA 4 : High flow oxygen devices, CPAP and Non-Invasive Ventilation
Description

The novice physiotherapist will be able to complete a comprehensive respiratory assessment and blood gas analysis and make recommendations for initiation of the below:

  • High flow Oxygen Therapy devices (HFOT)
  • Airvo
  • CPAP
  • NIV (BiPAP)

They will have awareness of locally available interfaces and if appropriate be competent in the setup of the device.

Excludes patients on NIV or CPAP for OSA/ OHVS and sleep related disorders.

Required knowledge

Competencies Required:

  • C3Framework Shared AHP Competencies
  • C3Framework Core Competencies:
    • Competency 1 Assessment
    • Competency 2 Treatment
    • Competency 3 Tracheostomy management
    • Competency 4 High flow oxygen devices, CPAP and NIV
Suggested reading

BTS Guideline: Non-invasive ventilation in acute respiratory failure

Information to assess progression
  • Clinical supervision
  • Nonclinical supervision
  • Notes Audit
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care physiotherapist after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Physiotherapy EPA 5 : Positioning and Rehabilitation
Description

The novice physiotherapist will be able to complete a musculoskeletal assessment including range of movement, sensation and a strength assessment and determine the risk of developing physical morbidity.

The novice physiotherapist will be able to implement a rehabilitation plan meets the needs of the patient and their goals.

Required knowledge

Competencies Required:

  • C3Framework Shared AHP Competencies
  • C3Framework Core Competencies:
    • Competency 1 Assessment
    • Competency 5 Positioning and Rehabilitation
Suggested reading
  • NICE CG83: Rehabilitation after critical illness in adults (2009)
  • The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy - March 2013 (Vol. 99, Issue 1, Pages 33-41, DOI: 10.1016/j.physio.2012.01.003) E.J. Corner, H. Wood, C. Englebretsen, A. Thomas, R.L. Grant, D. Nikoletou, N. Soni
Information to assess progression
  • Clinical supervision
  • Nonclinical supervision
  • Notes Audit
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care physiotherapist after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.