Physiotherapy EPA1 Assessment of patients admitted to Critical Care with Respiratory failure

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.

Print this EPA

You can print this EPA in a completable template by clicking print below.

If you select any prior completed EPAs via the options below the printable form will automatically mark these as "achieved".

EPA overview information
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.

Previously completed EPAs:
If you have completed any previous EPAs, select them here
to highlight where competencies have already been met.

Shared AHP competencies

Competency description Self assessment Senior assessment


Infection Prevention and Control:

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


Patient Emergency Management:

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


Patient ID:

Demonstrates positive patient identification and awareness of allergies


Monitoring Vital Signs:

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



Communication with patient:

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


Communication with family + friends:

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


Communication with colleagues:

Awareness of peer support and psychological support



Local IT Training:

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


Demonstrates how to view results and imaging on local IT systems


Moving and Handling

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


Compliant with Manual Handling training as per local trust policy.


Non-technical skills


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


Clinical Assessment and Basic Life Support


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


Mouth care:

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.


Lines and attachments:

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


Core competencies

Competency description Self assessment Senior assessment


Explains physiotherapy role to patients and family


Acquires consent for assessment and treatment or understands when to “treat in best interest”


Ascertains the presenting condition and relevant medical and social history to inform assessment and goal setting


Ascertains limitations of treatment (e.g. resuscitation status, End of life pathway)



Identifies type of airway, airway adjuncts and patency

  • Own
  • Naso Pharyngeal (NP)
  • Endo tracheal tube (ETT)
  • Tracheostomy

Awareness of grades of Intubation and measures taken to secure ETT



Identifies the oxygen delivery device, flow rate and FiO2


Ability to interpret vital signs from bedside monitoring equipment including respiratory rate, and saturations


Auscultates patient and describes breath sounds and added sounds


Observes and describes breathing pattern and chest wall movement


Assesses cough and describes effectiveness


Interprets a CXRAY, completing a systematic assessment identifying volume loss, consolidation, pneumothorax, pleural effusions and pulmonary oedema.


Interprets blood gases demonstrating knowledge of parameters appropriate for the patient


Able to identify mucolytics, bronchodilators and antibiotics within a prescription chart


Mechanically Ventilated Patients:


Identifies the mode of ventilation and can interpret set parameters including PEEP, inspiratory support, I to E ratio and fio2


Awareness of spontaneous modes, controlled modes and mixed modes of ventilation.


Able to identify tidal volumes, peak airway pressures and aware of safe limits



Interprets vital signs from bedside monitoring including heart rate and rhythm.


Identifies systolic and diastolic pressure and recognise a poor arterial trace


Interprets cardiac monitoring demonstrating knowledge of parameters appropriate for the patient.


Able to identify commonly used cardiac drugs within a prescription chart



Able to complete an accurate assessment of level of consciousness using AVPU or GCS


Able to understand the RASS scoring system in the sedated patient


Recognises Delirium scoring system and can describe methods to reduce delirium


Able to identify commonly used medications to reduce agitation and ones that may affect level of consciousness



Identifies and explain the indication for Chest drains and comment on their status (swinging/bubbling/on suction)


Identifies and explain the indication for a PCA (Patient controlled analgesic)


Identifies the urinary catheter or filter for Renal replacement therapy



Identifies and explain rationale for NG tube and completes the 4 checks for safety



Identifies abnormal blood results and describes their potential impact on physiotherapy treatment.


HB, Platelets, INR, APTT, K+, CRP, WCC, NA, Urea, Creatinine and Albumin


Clinical Reasoning:

Forms a problem list informed by the holistic patient assessment with and understanding of which problems are amenable to physiotherapy intervention


Tracheostomy Management

Subjective assessment:

Able to demonstrate a basic understanding of the anatomy and physiology of the respiratory system


Objective assessment:

Identifies type of tracheostomy (single or double lumen/cuffed or uncuffed, fenestrated or unfenestrated


Identifies surgical or percutaneous


Identifies presence of stitches


Identifies which oxygen delivery system is in use and how humidification is being delivered


Can establish cuff status (up or down)


Can state appropriate safe cuff pressure with cuff pressure manometer


Can describe when we would consider deflating the cuff and what physiological parameters to use to assess tolerance of this


Can describe the rationale for use of a one way valve.


Can explain the role of SALT in tracheostomy weaning and when to refer.



Can perform open suction using a sterile technique


Can change an inner cannuale and store this safety


Awareness of emergency tracheostomy algorithm


Awareness of contents of emergency tracheostomy box



Can state local requirements for decannulation including any objective measures and requirements


High Flow Oxygen, CPAP and NIV

High Flow Oxygen Devices:

Can discuss the indications for initiation of high flow oxygen therapy and is aware of the precautions


Can explain how to adjust and modify the therapy (flow rate and oxygen) to optimise the patient’s condition


Can recommend next steps if set parameters are not being achieved


Continuous Positive Airway Pressure:

Can discuss the indications for initiation of CPAP and is aware of the precautions


Can explain how to adjust and modify the therapy (PEEP and oxygen) to optimise the patient’s condition


Can recommend next steps if set parameters are not being achieved


Non Invasive Ventilation (NIV):

Can discuss the indications for initiation of NIV and is aware of the precautions


Can explain how to adjust and modify the therapy (PEEP, oxygen and Inspiratory Pressure) to optimise the patient’s condition


Can recommend next steps If set parameters are not being achieved


Positioning and Rehabilitation

Ability to complete a TILE assessment


Can describe the safe use of sliding sheets


Can describe the indications for a pressure relieving mattress and when to escalate tissue viability concerns


Can assess soft tissue length in the sedated patient and move all available limbs through range.


Can reposition an awake or sedated patient into alternate side lying demonstrating awareness of pressure areas in lateral position


Can reposition the awake patient into high sitting using the available functions on the bed


Can direct and assist an awake patient into the prone position with awareness of lines and pressure areas


Can assist with the proning of a sedated patient as part of a team (not required to lead this).