OT initial assessment Flashcards
OT initial assessment in hospital setting
Effectiveness of OT in Acute Care
Patients who received OT as part of their rehabilitation program were more likely to be discharged to home environments compared to patients who did not
OT initial assessment
Issues for OT Initial Interviews in Acute Settings
- LOS
Length of Stay (LOS)
- short time and emphasis on discharge ASAP
- referrals may come late in the admission when patient stabilises and can then be discharged
OT initial assessment
Issues for OT Initial Interviews in Acute Settings
- Setting
Setting
- Impact on patient
- Assessment and intervention typically in hospital room or facilities patient may be in bed
OT initial assessment
Issues for OT Initial Interviews in Acute Settings
- Acute nature of the patients illness
The initial interview will depend upon the severity of the patients illness
OT initial assessment
Screening and Safety - BEFORE you assess the client check their current status in regards to their
- transfers and mobility
- cognition and affect
- infection risk
- precautions or protocols
- understand equipment (e.g. tubing, adjusting bed)
OT initial assessment
Screening and Safety - BEFORE you assess the client how do you check their status?
Check status through
Case notes
- initial intake assessment and latest entires
- staff (nurse, allied health)
OT initial assessment
Screening and Safety - BEFORE you ask the person to transfer and mobilise
Work out the situation and risks
- don’t completey rely on mobility ratings by others
- check if patient is feeling okay and can do it
Reinforce any relevant transfer cues
Ensure required equipment is there (walking aid)
Provide standby and monitor transfer and mobilising
- optimal position is on the client’s weaker side if relevant
OT initial assessment
Acute Care: OT Initial Aims
- Establish present and likely issues
- Identify client concerns and priorities
- Identify environmental supports and issues
- Identify needs for further tailored assessment
- Initiate identification of discharge needs and commence planning
OT initial assessment
Acute Care: Decision making
- Further information gathering may be needed on capacity, client aims, future needs and discharge destination
- Consult with team
- Frequent monitoring of recovery and capacity
- Capacity of individual regarding decision making
OT initial assessment
Differences between settings - acute hospital
Focus of assessment on ensuring safe and successful discharge
OT initial assessment
Differences between settings - sub-acute or rehab
Focus on developing initial plan of intervention
OT has longer to work with client and strengthen OP before discharge
Subsequent assessment to review progress
OT initial assessment
Differences between settings - outpatient
Focus of assessment on planning next stages of intervention and monitoring progress
OT initial assessment
Referral
Request for service
Referral may come from various sources
- Agency/Practice policy
- Funders
- Potentially Different Aims & Knowledge
e. g. health professions cp client cp family - Different levels of detail
Blanket Referrals
Key decision is whether suitable for OT
OT initial assessment
Screening
Gathering of preliminary info to guide OT evaluation & intervention
- Does your skills/service match client needs?
- Snapshot of any info about previous & current occupational performance and future needs
- Prioritisation (can they actually be seen?)
- Safety considerations
Tools of screening
- Case Notes or reports
- Brief screening tests
- Brief interview with client or family
- Referral Source
OT initial assessment
Evaluation methods
Interview
Observation
Self-rating Scales
Formal & Standardised Tests
OT initial assessment
Interview
Planned conversation with a purpose in mind
Recognition that the client’s perspective is key
Their historical narrative and priorities
Supports client-centeredness
OT has ability to clarify answers
Quick, efficient (typically) but reliability may be variable
- Particularly in performance questions
- Interpersonal factors
- Some disorders/diseases can mean a fluent and plausible history may be confabulation
OT initial assessment
Observation
Observation of occupational performance is key for OT
Can be used to qualify or validate specific info from an interview
Can point to why problem exists in actibities (e.g. performance skills)
Focused observation
Used even when interviewing
Recording observationsa and checklists
Can show effect of others + environment on performance and abilitiy
OT Initial assessment
Comprehensive Occupational Therapy Scale (COTE)
Developed for use in acute, short term psychiatric settings
Rates 26 observable behaviours broadly categorises into
- General Behaviours
- Interpersonal Behaviours
- Task Behaviours
OT initial assessment
Common Areas for Standardised Tests in OT
Developmental
Grip Strength
Upper Limb Function
Work Skills
Perceptual/cognitive
OT intial assessment
Evaluation (OTPF)
Occupational Profile (history, clients concerns and priorities)
Analysis of occupational performace (using assessment tools + observation)
OT initial assessment
Analysing Occupation Performance
Using assessment tools and observation to gather info on skills and performance
Focus guided by the Occupational Profile
Examine how contexts and environments may assist or limit or influence performance
OT initial assessment
Occupational Profiles
Work out through interview and some self-rating tools
OTPF about client
- who
- why
- what areas of occupation are successful/problematic
- occupational history
- client goals
OT initial assessment
Occupational History
Previous patterns of engagement in action and daily life
What pattern reveals about person’s values and interests
OT initial assessment
Analysing Occupational Performance
Using assessment tools and observation to gather info on skills and performance
Focus guided by the Occupational Profile
Examine how contexts and environments may assist or limit or influence performance
OT initial assessment
Importance of OT assessment in hospital settings
- skill of anticipating the potential impact of changed capacity for OP
The OTs ‘prognostic reasoning’ is the basis for helping the client (and others) anticipate and effectively plan for changed OP after discharge
OT initial assessment
Time frame
Evaluation may be one off or over a longer period
Depends on setting and clients needs
OT initial assessment
Evaluation: Key outcome
Leads to identification of goals with the client
Guides development of intervention including methods, duration, frequency
OT intial assessment
Initial interview structure
Preparation
Intro
Warm up/convo
Exploration
Wrap up
OT intial assessment
Initial assessment competencies
- Gathering relevant data
- 1 Conducting interview:
- Introduce self, outline OT role and purpose of initial assessment and obtain consent to conduct assessment.
- Establish pre-admission occupational performance (self-care, household ADL, work, leisure).
- Discuss home environment including access, existing equipment etc. - 2 Consultation/ Planning
- 3 Goal Setting
- Documentation
- Documentation follows departmental guidelines and includes occupational goals, timeline and plan for further assessment / intervention
OT initial assessment
Initial interview content
Proforma used for assessment and write up
Interview driven with some observation and direct performance as required
OT initial assessment
Documentation
Communication between Multi-d team
Provides detail on where client is at re medical issues and discharge
