Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0

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1 Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0 January 2014

2 Table of Contents 1. Introduction Purpose of this Policy/Procedure Scope Ownership and Responsibilities Role of the Clinical Lead OT ED Role of the Therapies Senior Management Team (SMT) Role of the Therapies Inpatient Manager Role of Individual Staff Standards and Practice Types of Intervention When the service is available How to refer Dissemination and Implementation Monitoring compliance and effectiveness Updating and Review Equality and Diversity Equality Impact Assessment... 5 Appendix 1. Governance Information... 6 Appendix 2. Initial Equality Impact Assessment Form... 8 Appendix 3.Checklist for Annual Audit Page 2 of 10

3 1. Introduction 1.1. The Occupational Therapy (OT) Emergency Department (ED) team provides an intervention by assessing any patient in ED referred because there is concern about discharge and to help avoid an admission. The objective of the OT service in ED is to support the decision making process for safe discharge This version supersedes any previous versions of this document. 2. Purpose of this Policy/Procedure 2.1. The purpose of this policy document is to describe the types of intervention provided and how/when a referral can be made. 3. Scope 3.1. This policy applies to all staff referring to or working in - the OT ED Service. 4. Ownership and Responsibilities 4.1. The roles responsible for the development, management and implementation of the policy are shown below Role of the Clinical Lead OT ED The Clinical Lead OT ED is responsible for the development and communication of this policy and monitoring compliance with it 4.3. Role of the Therapies Senior Management Team (SMT) The Therapies SMT is responsible for the approval of this policy 4.4. Role of the Therapies Inpatient Manager The Therapies Inpatient Manager is responsible managing the OT ED Service 4.5. Role of Individual Staff All staff members (eg referrers and members of the OT ED Service) are responsible for: adhering to any requirements described within this policy and documents described in the standards and practice section. 5. Standards and Practice 5.1. Types of Intervention Physical: e.g. identifying risks by the assessment of mobility, balance, control and sensation, risk of falling and of the patient/family/carers ability to manage their problems. Using community liaison to establish the patient s usual functional level compared with current presentation in ED and the needs for a safe discharge. Providing a practical, problem solving and can do approach to admission avoidance Cognitive and perceptual: community services and carer liaison, assessment of memory, orientation and confidence, comparing usual level with current presentation and identifying problems/solutions for a safe discharge Establishing a support network in the community to facilitate a sustainable discharge by linking with the county wide community resources for: Page 3 of 10

4 requesting a care plan for the patient to be supported at home identifying the possibility of an alternative place of safety for the patient when returning home is not appropriate but an acute admission is not required, e.g. community beds for a patient referred to OT or a temporary placement in a care home Orthotics: brace fitting and advice as appropriate according to staff experience Providing the patient and carers a contact number and information about how to access more help after discharge if required Providing a follow up appointment if deemed appropriate by the OT Continuing OT intervention where started in ED and patient is admitted to a ward When the service is available Monday Friday , unless in exceptional circumstances Saturday, Sunday and Bank Holidays This is a voluntary service and cannot be guaranteed How to refer Bleep Verbal if you see an OT in ED Out of hours : complete a referral form found in the green OT box which is in the ED trolley bay doctors office. Leave the form in the box, an OT will collect it the next day and make a follow up phone call if the patient is already discharged home. 6. Dissemination and Implementation 6.1. This policy will be made available on the RCHT Documents Library and a copy will be ed to Emergency Department staff The policy will be presented initially at the ED meeting and regularly at ED Rotating Staff Induction training sessions 7. Monitoring compliance and effectiveness Element to be Appropriateness of referrals monitored Lead Clinical Lead, OT ED Team Tool Simple checklist based on criteria outlined above (copy at Appendix 3) Frequency Annually Reporting Report to: Therapy Inpatient Manager and Therapy Clinical arrangements Governance Forum Acting on Clinical Lead, OT ED Service will undertake subsequent recommendations recommendations and action planning for any or all deficiencies and Lead(s) and recommendations within reasonable timeframes. Required actions will be identified and completed in a specified Change in practice and lessons to be shared timeframe Required changes to practice will be identified and actioned within one month. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders Page 4 of 10

5 8. Updating and Review 8.1. This policy will be reviewed at least every three years. 9. Equality and Diversity 9.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 5 of 10

6 Appendix 1. Governance Information Document Title Date Issued/Approved: 24/01/14 Date Valid From: 01/02/14 Date Valid To: 31/01/17 Directorate / Department responsible (author/owner): Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital Maggie Wee-Lean, Clinical Lead, Occupational Therapy ED Team, Therapies, Clinical Support Services & Cancer Division Contact details: (Bleep 2169) Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes The purpose of this policy document is to describe the types of intervention provided by the OT ED Service and how/when a referral can be made Occupational Therapy, Emergency Department RCHT PCH CFT KCCG Medical Director New Document New Document Therapies Clinical Governance Forum Therapies Senior Management Team Sally Rowe, AHP Lead & Divisional Director Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards N/A Related Documents: Training Need Identified? Not required {Original Copy Signed} Internet & Intranet Clinical\Occupational Therapy N/A No Intranet only Page 6 of 10

7 Version Control Table Date Version No 24/01/14 V1.0 Initial Issue Summary of Changes Changes Made by (Name and Job Title) Maggie Wee-Lean, Clinical Lead, Occupational Therapy ED Team All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 7 of 10

8 Appendix 2. Initial Equality Impact Assessment Form Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital Directorate and service area: Clinical Support Services & Cancer Division, AHP Therapies Name of individual completing assessment: Maggie Wee-Lean 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? Is this a new or existing Policy? New Telephone: (Bleep 2169) To describe the types of intervention provided by the OT ED Service and how/when a referral can be made 2. Policy Objectives* Ensure appropriate referral of patients to the OT ED Service resulting in safe discharge 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. Referrers to the service understand how and when to refer to the OT ED Service and the types of intervention available Audit of appropriateness of referrals (see Appendix 3) Patients Yes Yes Divisional Director, Medicine & ED Division 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age Page 8 of 10

9 Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. There are no areas of differential impact. All service users are included within this clinical policy Signature of policy developer / lead manager / director Maggie Wee-Lean, Clinical Lead Occupational Therapist Date of completion and submission 16/10/2013 Names and signatures of members carrying out the Screening Assessment 1. Maggie Wee-Lean 2. Janet Gardner, Divisional Governance Lead Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 9 of 10

10 Appendix 3.Checklist for Annual Audit Monitoring compliance and effectiveness with OT Service in ED Policy Method, time and date Yes No of referral to OT by ED Reason for referral Yes No Presenting complaint Yes No of patient to ED Appropriate referral Yes No Follow up appointment/ Phone call Type of O.T. intervention: Physical Psychological Orthotics Social Equipment Patient/carer information pack Yes No Outcome of OT intervention: Discharge from ED same day Discharge from RCHT within 48 hours Page 10 of 10

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