Community based assessment Flashcards
who is community based physiotherapy offered to?
- offered to people who can benefit from treatment in their own environment e.g., housebound or those with a long- term condition
what are the different capacities that physiotherapists can work in?
- single handed domiciliary
- part of a multiagency ICT
what do community based assessments depend on?
- local funding and management
where can community based assessments take place?
- privately owned housing
- rented accommodation
- council or housing association accommodation
- caravan
what should the assessment and subsequent treatment always be?
- should be functional, goal- focused and appropriate to the patient and their home environment
what should you take careful consideration of?
patients:
- choice
- culture
- privacy
- dignity
- confidentiality
what should you never do with a patient?
- should never leave messages on their answer phone without the patient’s permission
what is essential to carry out in a house visit? why?
- risk assessment
- ensures safe interaction
- thorough assessment over several visits
what can act as limitations to home visits? (3)
- concentration span
- exercise tolerance
- mental state
what are functional goals related to? who else may be involved?
- related to the patient’s specific needs and their environment
- if appropriate this can involve family members or carers to ensure maximal info obtained
what is required for a family member or carer to be involved in functional goals?
- consent is required for this involvement
what issues may the physiotherapist encounter? what should the physiotherapist do?
- issues around the patient being a vulnerable adult
- these need to be identified and addressed appropriately
what needs to be addressed appropriately? what could be encountered?
- potential protection of vulnerable adults
- abuse could be encountered e.g., neglect, physical, emotional, psychological, financial
what do community based physiotherapists need to be aware of? - give some examples
- need to be aware of other services available in the area
e.g., voluntary organisations, charities and self- help groups
where do referrals originate from?
- can be primary, secondary or tertiary care, social services, voluntary sector or in some instances self- referral
what should the reasons be in the referral?
- reasons made clear, realistic and agreed on by the patient
what should be included in the referral?
- social history of the patient
- access to the property
- any known risk to staff
what can GP supply to the community based physiotherapist?
- can supply other medical records which can include medical history, details of next of kin, name of preferred contact, current medication as well as any previous interventions
what should you confirm in acute episodes of care?
- confirm the relevant dates for fracture healing time or precautions following joint replacement surgery
what should the referrals solely do?
- should satisfy the patient (or their carers)
what can be frustrating for both the physiotherapist and the patient?
- if the proposed goals are not realistic
what could some of the patients done before the referral? is this important for the physiotherapist to know and why?
- may have previously been seen by other services
- important to be aware of the previous treatment approaches and outcome
- may be possible to use the info for intervention
what may some patients do regarding the intervention? how should you respond?
- some patients may chose not to engage with the intervention
- this must be respected, documented and reported back to the referrer
if the patient is unwilling to continue with the proposed intervention what should you do?
- the decision must be explored further with the patient
- potential issues that may arise must be clearly outlined to them
- content and agreed outcomes documented
what should you develop regarding culture?
- develop an awareness of cultural requirements of patients to ensure the treatment is appropriate for lifestyle
will the proposed task and the way an individual carries it out always be the same?
- no
- choice of individual to carry out a task in a specific way that might not be in accordance with the therapy plan must be acknowledged
what shouldn’t you make? what should you ask instead?
- shouldn’t make assumptions
- ask patients about their preference for treatment that is appropriate to their culture and lifestyle
what choices of the patient should you respect? - give some examples
- respect wish for privacy and lifestyle choices
e.g., close curtains, allow patients control over presence of others during treatment
what should be communicated clearly to the patient?
- communicate assessment details clearly
what other patient factor should you respect at all times?
- respect patients dignity
- may be more relaxed in known surroundings but may also need more time to complete tasks
what does the risk assessment cover?
- covers personal safety, lone working, moving/ handling, environmental and other risks
what should you familiarise yourself with for safety?
- familiarise yourself with local policies and procedures for safety
what should you confirm for lone working?
- confirm details with patients ahead of visits e.g., address, access, safety
what should you access before lone working?
- access electronic community records to see any notes concerns
what contact should you have with the patient before a home visit?
- telephone patient prior to visiting to confirm address, any parking restrictions, access to the property and whether the patient will have anyone present
what is moving and handling?
- statutory training provided annually by employers/ universities to cover basic legal requirements for safety
what should you use following safety training?
- use appropriate techniques and equipment
what should be addressed in moving and handling? what if an agreement isn’t met?
- address any unsafe handling techniques by patients or careers
- if agreement isn’t met then it is essential to record this> never put yourself at risk of harm
what are the 4 main things to check for in the environment?
- hazards
- accessibility
- suitability
- physical safety
what hazards would you look for in the environment?
- unsafe areas
- pets
- trip hazards (rugs, cables)
- clutter
- inadequate heating/ lighting
- wet floor (continence issues)
what accessibility factors would you look for in the environment?
- safe parking
- communal entrances
- entry phone
- key safe
- can patient open door independently
what should the environment be suitable for?
- should be suitable for treatment equipment
how can you be mindful of physical safety during home visits?
- height of furniture (affects moving & handling)
- how is equipment delivered in this area
what always needs to be verified for safety?
- always verify the reliability of information
what should you do if feeling anxious or concerned?
- you shouldn’t visit a patient alone if feeling anxious or concerned
what should you do if you feel threatened? what should be planned?
- end intervention immediately if you feel threatened
- always have a planned exit strategy
what time should new assessments be completed?
- new assessments should be done during working hours, not at the end of the day
what should the parking areas be? what should you avoid?
- parking areas should be well- lit
- avoid isolated underground parking
what assessment processes are common in home visits? what can they be supplemented by?
- joint health and social services assessments are common
- supplemented by MDT assessments
how do you contextualise the assessment?
- contextualise as a snapshot in time
what should be focused on in the assessment?
- reason for referral
- long- term issues
- current management before addressing new issues
when should patients consent be obtained?
- must be obtained at assessment for sharing information
what notes are valuable? who should these be accessed by?
- patient hold notes are valuable
- should only be accessed by those the patient consents to
where should you leave written information?
- in a location agreed by the patient to maintain confidentiality
what adjustment should you make for non- English speaking patients? what needs to be ensured?
- use professional translator rather than family for communication
- ensure accuracy and dignity
when do you have to adjust communication?
- adjusted for patients with sensory impairments or low literacy
what does the subjective assessment follow?
- follows the biopsychosocial model
what information is available in patient- held records ?
- demographic information
- medical history
- medication details
what should community physiotherapists utilise as an advantage?
- should take time to gather in depth information that might have been missed by others due to time restrictions
what should you do in the subjective assessment regarding drug history?
- ensure regular medication reviews
- check patient compliance with their regime
how can you manage polypharmacy?
- managed via compliance aids
e.g., blister packs or dossette box to increase adherence
what should you check to see if formal carers can administer medication?
- check local policies to see if formal carers are trained to administer medication
what are the two main factors you should assess regarding pain?
- assess how pain affects daily living
- coordinate with medication schedules
what shouldn’t be exceeded in any 24- hour period?
- maximum dose shouldn’t be exceeded
what assessments would be completed in the objective assessment during a home visit? (2)
- ROM
- strength
what helps to guide, inform and influence goal setting?
- limitations and restrictions on preferred activity level
why would exercise tolerance be reduced? what can you help to improve?
- due to respiratory/ cardiac issues (less injury)
- gradual deconditioning may be improved by progressive exercise
what adaptations should be made in the objective assessment? why?
- environment
- simple adjustments of furniture can increase independence
what should you assess regarding mobility of the patient?
- assess if the patient can access all areas of their home
what is important after a fall? why?
- timely assessments after a fall are crucial to reduce the risk of further incidences
what should you review and update in regards to mobility?
- review and update the need for mobility aids based on patient’s condition
what function can be considered in rehabilitation plan regarding mobility?
- high level function related to outdoor mobility and the use of public and private transport can be considered
what else needs to be considered after a fall?
- podiatry referral
- footwear reviews
what mental health conditions should you consider? - give an example
- depression, anxiety and cognitive impairments e.g., dementia can affect patient engagement in rehab
what do you need to do with the patient’s presentation?
- differentiation of the patient’s presentation is needed e.g., acute confusion can be associated with an infection that is treatable e.g., UTI
what should you evaluate when looking at patient’s activities of daily living?
- evaluate how patients organise their routines and if they can manage essential tasks
what are the essential tasks that the patient should be able to do?
- access the toilet
- sleep in a bed
- restricted movement
what should you consider regarding activities of daily living?
- consider if any improvements can be made to existing support services/ equipment’s
what should you do with outcome measure results? why?
- should be documented for consistency
what should treatment aim to improve?
- should aim to improve quality of life e.g., manage personal hygiene
what should be provided in treatment?
- recommendations provided for emotional changes to help increase independence and safety
what should the goals of treatment be? who should be involved?
- should be negotiated with the patient for realistic treatment plans - treatment process should involve careers
what consideration should be apart of the assessment?
- consideration as to whether the patient needs to be managed in a lesser/ greater intensity of service
