Support fitting

Question 1

Different applications for assistive equipment:

Answer 1

Positioning:
Soft wedges or adjustable beds.

Sitting:
Riser recliner chairs.

Bathing:
Hand rails, bath seats, hoists.

Mobility:
Walking sticks, walking frames, crutches, ramps, motorised scooters, wheelchairs (manual and electric).

Other activities:
Special cutlery, adapted can openers, tap attachments, bed table, adapted shoe horns.

Question 2

The type of assistive equipment prescribed will depend upon:

Answer 2

The client’s needs and abilities;
The environment in which it is to be used;
The client’s condition and prognosis;
The cost and availability of the equipment;
Whether a carer is present when the equipment is used.

The Allied Health Professional will also consider the client’s motivation to comply with using the equipment.

Question 3

Steps involved in making the arrangements for the equipment (once AHP has prescribed):

Answer 3

1) Preparing for the fitting of the assistive equipment.
2) Fitting the assistive equipment.
3) Supporting client to use the assistive equipment.
4) Completing basic equipment construction and modification.
5) Complying with supervisory requirements.
6) Cleaning and storing assistive equipment after use.
7) Reporting and documenting information about the process.

Question 4

Preparation before the fitting session:

Answer 4

The Allied Health Professional will have assessed the client and provided information (either written or verbal) about the prescription.

ACCESS:
The Allied Health Assistant firstly needs to access this background information and confirm that the assistive equipment details and fitting requirements are understood.

CONFIRM:
Verbal confirmation with the Allied Health Professional is helpful to avoid any potential for misunderstanding.

CLARIFY:
Clarification about the prescribed information should be sought from the Allied Health Professional before proceeding, to ensure that all relevant information is accurately understood.

CHECK:
The Allied Health Assistant should also carefully check that the features of the assistive equipment exactly meet the prescribed information provided by the AHP. This is to ensure that the correct equipment is to be fitted for the individual client. Features may include size, style, product code, brand name and type.

Question 5

Factors that may impact upon the needs and abilities of the client:

Answer 5

Function:
How the client currently goes about completing the activity for which the equipment is being prescribed.

Environment:
The place where the client usually completes the activity as this is where the equipment will be used.

Medical condition:
The impact of current symptoms and the prognosis for the client’s ability to complete the activity in the future.

Cost and availability:
Whether the client can afford the equipment and how readily available the equipment is.

Carer availability:
Whether or not the client has a carer to help with using the equipment.

Motivation:
How motivated the client is to use the equipment for the activity.

These factors will not only affect the type of assistive equipment which is prescribed, but also the likelihood of the equipment being successful for the client. They may also impact upon the way in which the equipment should be fitted.

When preparing for the fitting of the assistive equipment, the AHA should ensure that they confirm the specific needs and abilities of the individual client with the AHP.

Reviewing the current care plan and client file will also provide details of the client’s needs and abilities. This information will provide them with an understanding of the client which will be useful during the fitting session.

Question 6

If there are steps involved in a client’s fitting requirements which AHA is not trained to complete or not authorised to carry out:

Answer 6

You MUST discuss it with the Allied Health Professional before making any attempt to fit the equipment.

The AHP may need to be present for the fitting session or may make alternative arrangements for the assistive equipment to be fitted safely.

Proceeding with fitting equipment outside the scope of your work role may put the client at risk of harm and place you, the AHA, at risk of formal disciplinary action.

Question 7

Things to consider when contacting the client (to book fitting session):

Answer 7

Available times in work schedule;
Availability of the workspace to be used;
The amount of time likely to be required for the planned fitting session;
The individual needs of the client, including any special needs which might affect appointment length.

Question 8

Preparing equipment for fitting session:

Answer 8

gather the assistive equipment and also any equipment required for fitting.

Certain assistive equipment may be kept in stock in the Therapy Department, while others may need to be ordered.
In some cases, the client may need to purchase the equipment before it is fitted and the Allied Health Assistant would discuss the details of this with the client, providing the necessary information and support required for the equipment to be obtained.

Equipment required for fitting assistive equipment varies greatly and may include simple items such as scissors for trimming, or more specialised tools.
In some situations, it may be necessary to book these items in advance, if they are generally shared by other therapy staff. Availability of this equipment should be checked prior to making the appointment for the fitting session and the equipment should then be gathered prior to the client’s arrival so that it is ready for use.

Question 9

Preparing the environment for the fitting session:

Answer 9

Ensure that the room is accessible for the client, that the furniture is set up in such a way that the Allied Health Assistant will be able to reach as needed to fit the equipment, and that the work surfaces / equipment are adjusted to the correct height and position.
Note:
The comfort and privacy of the client should also be taken into account when preparing the room.

In some cases, assistive equipment may be fitted in the client’s home, workplace or other environment, depending upon the location where the equipment is to be used.
In these situations, the same preparation principles apply to the session – despite the fact that some of the preparations would need to be made at the location, rather than at the health care facility.

Question 10

Obtaining informed consent before beginning fitment:

Answer 10

This involves the client being made fully aware of the details of planned procedure (including risks, benefits and alternatives) and freely giving consent to it.
Important:
The client must be competent to give consent and it must be specific to the planned procedure. The fitting session can then go ahead.

Question 11

Reviewing the assistive equipment at the start of the fitting session:

Answer 11

to ensure that it will perform the job for which it has been prescribed.

Does the equipment fit the client well?
Is the equipment the correct size for the client?
Does the equipment work as intended for the client?

The manufacturer’s guidelines should also be reviewed to confirm that the equipment is working in the way that it has been designed to work.

It is also essential to make sure that the equipment is clean and in safe working order. If the equipment is re-usable and has been used by another client previously, it should be thoroughly disinfected to infection control standards in accordance with the organisation’s policies. All parts should then be carefully checked to make sure that they are in good order and that there is no damage to the equipment. For example, a wheelchair check should make sure:
the chair is sturdy
the brakes work effectively
the wheels are adequately inflated
the footplates are securely attached.

Checking over the equipment before the fitting session ensures that the equipment is safe to use and eliminates the risk of harming the client when they start using it.

At this time, the Allied Health Assistant should also think about the environment in which the assistive equipment is to be used as there may be environmental factors such as temperature, light, or physical barriers which could impact safety.

Question 12

Examples of why equipment may be suitable in one environment but not another:

Answer 12

Examples:
A grab rail beside three steps may be used safely by the client in a hospital setting. However the same type of grab rail beside three steps leading to the clothesline in the client’s home may become extremely hot due to sun exposure. This places the client at risk of a burn and makes the grab rail unsafe for the client to use at certain times of the day.

A walking aid that is suitable whilst being used in the wide hallways of a rehabilitation facility, may be unsafe for use in the home if there are obstacles such as furniture or loose mats in the trafficways of the house, that the walking aid may become caught upon.

Question 13

Making adjustments to assistive equipment:

Answer 13

Generally adjustments would be made by the AHP, particularly if they are of a complex nature.
However, if the adjustments are straightforward, the AHA may be responsible for obtaining relevant measurements and data.

Note:
The key issue when taking any such measurements is ACCURACY.
It may be necessary to check and re-check measurements to ensure that they are correct, always keeping in mind the range of situations and positions that the client may use the equipment in and making allowances for elements such as temperature which may impact upon the amount of adjustment that is required.
Example:
A hand splint that fits well in a cool air conditioned treatment room may be too tight once the client spends time outside on a hot day. This is because their hand is likely to become more swollen due to the heat.

Question 14

If a fault with equipment is identified during fitting:

Answer 14

If the fault is one which could impact upon the safe use of the equipment, the fitting session may need to be suspended until replacement equipment can be arranged.

In such a situation, the AHA needs to explain the reasoning to the client and report promptly back to the AHP so that appropriate follow up action can be taken.

It is possible that not having the assistive equipment fitted could impact upon the client’s safety to complete certain activities of daily living and the AHP will need to make appropriate arrangements for this to be managed.

They may direct the AHA to be involved in these arrangements, depending upon the individual situation. The details of the fault, the impact upon the fitting session, and the alternative arrangements should all be documented in the client’s file.

Question 15

Client familiarity and comfort with the assistive equipment:

Answer 15

When a client first starts using assistive equipment, it may take time for them to become familiar and comfortable with it.

If there are any concerns about the client being able to safely use the equipment, it may be appropriate to restrict the equipment functions during the initial period.
Example:
The AHA may need to instruct the client to use the equipment only for certain basic tasks or under particular circumstances until the Allied Health Assistant is assured that the client can use the equipment safely. (eg. scooter only on side streets, not main roads, for first wk/until reassessment)

Question 16

Documenting fitting session:

Answer 16

At conclusion of the fitting session, the AHA needs to document the details of the process and the outcomes in the client’s file as per the documentation guidelines for their organisation.

Key points to include:
NAME/Size
The name of the assistive equipment fitted (and the size where relevant).
LOCATION
The location where the fitting session took place.
ADJUSTMENTS
Details of any adjustments/alterations which were required or which need to be followed up, including relevant measurements.
RESTRICTIONS
Details of any restrictions placed upon the use of the equipment and the rationale for these.
OUTCOME
The outcome of the fitting session, including whether the original goals for the session were met and any barriers to achieving them.

In addition to documenting these details, the AHA should also give a verbal report to the AHP. This enables the AHP to review the client’s treatment plan, incorporating any changes that may be appropriate after the fitting session. For example, if fitting session was unsuccessful, they will need to schedule a review assessment to identify an alternative treatment plan. Providing detailed feedback ensures that the Allied Health Professional is made aware of any necessary follow up actions so that these can be addressed.

Question 17

Discussing maintenance requirements:

Answer 17

The type of maintenance required will vary greatly, depending upon the type of equipment. Maintenance may range from simple cleaning procedures to be carried out by the client/carer to formal servicing by a qualified mechanic.

The AHA should confirm maintenance requirements for the particular equipment item by consulting the manufacturer’s instructions. These are often provided with the equipment when it is new, or can be accessed via contact with the manufacturer over the phone or internet.

The AHA needs to provide details (preferably both verbal and written) of these maintenance requirements to the client/carer and confirm that they understand them.

A useful way of making sure that the client/carer understands the maintenance requirements is to ask them to describe them back to you. You can then gauge their level of understanding and provide any extra explanation that may be required. In some instances, it may be necessary to demonstrate maintenance tasks, if explanation alone is insufficient.

When documenting the fitting session, details of the maintenance schedule and the client’s awareness of same should be included.

Question 18

How to provide information on the use of assistive equipment:

Answer 18

When explaining information about the use of the assistive equipment, it is important to consider the way in which this information is delivered.

The AHA should think about the manner which the client is most likely to understand (verbal, written, or demonstrative).

Verbally giving information allows for questions to be addressed at the time and often helps promote client rapport.

Written information can be beneficial for clients who have difficulty understanding the spoken word (due to language issues, for example). It can also acts as a reminder to take away and refer back to after the session. Written material can also be read by family members or carers who may not be able to be present for the fitting session

Demonstration provides a means for giving information in a practical manner, providing a visual application of the information being conveyed.

The best approach to presenting information to a client is to include aspects of all three methods of delivery – by doing so you’re most likely to utilise at least one method that the individual client can effectively relate to.

Question 19

Ensuring client understanding of information:

Answer 19

Consider the pace and level of delivery which is appropriate for each client.
Some clients may have the ability to receive and understand complex information without difficulty, while others may require more explanation or time to process what is being said.

Give thought to these issues and tailor the way in which information is given, to suit each individual client.

Once the necessary information has been explained, the AHA needs to confirm that the client understands it. DO NOT ASSUME that the client has grasped all the details which have been explained. There are many factors which may impact upon their ability to do so.

For example, a client with hearing difficulties may be embarrassed by their lack of understanding and nod in agreement to the AHA’s explanation, despite missing important details.

Need to ask questions which confirm that the client has grasped the key points of information and also provide the opportunity for the client to ask any questions which they may have.

It is often beneficial to have a family member or carer present for the fitting session to ensure that the information given is understood.

Family member/carer can then reinforce the information given during the fitting session after the session is completed.

Question 20

(7) key points of information to convey to the client during the fitting session:

Answer 20

The purpose of using the equipment;
The manner in which the equipment is designed to be safely used;
The safety features of the equipment;
How to safely transport and maintain the equipment;
Any possible ways the environment it is used in may affect the equipment;
What steps client should take if the equipment malfunctions/becomes unsafe, relevant contact details;
Details of any follow up arrangements

Question 21

Fitting assistive equipment in the client environment:

Answer 21

Whenever possible, fitting sessions should take place in the environment where the equipment will be used by the client.

This enables assessment of the environment at the time of fitting, and removing or minimising any potential hazards that may be present.

Eg: fitting a wheeled walking frame for the client to use when mobilising around their home.
AHA might identify that a piece of furniture needs to be relocated to allow access for the wheeled walker in the hallway, or may observe a sliding door lip which will present a safety risk when using the walking frame. Action can then be taken to address any such issues so that they do not pose a safety risk to the client.

During the initial fitting session, the AHA may need to provide some physical support to enable the client to use the assistive equipment. Using the above example of fitting a wheeled walking frame, the client may initially have difficulty adjusting to pushing the frame whilst mobilising at the same time.
AHA may need to assist with pushing and steering the frame while the client walks with it until they get used to it and are able to use it independently.

Important:
Any physical assistance given should be in keeping with maintaining the safety of the client and the AHA, and should reflect best practice manual handling prinicples so that neither is injured during the session.

Question 22

Constructive feedback:

Answer 22

Telling the client specifically what they are doing correctly and what needs improvement in relation to using assistive equipment.
This type of feedback is clear and objective. The feedback is aimed at helping the client to learn to use the equipment safely and effectively.

The feedback may need to be combined with additional demonstration. The AHA may also need to provide encouragement if the client shows any anxiety about using the equipment.

Question 23

Client distress:

Answer 23

The AHA should pay close attention to the client at all stages of the fitting session so that they can be alert to any signs of becoming distressed or being in pain, or the client communicating a desire to slow down or stop the session.

If such problems do arise, the AHA should pause the session and explore the concerns of the client whilst they are positioned safely.

Question 24

Steps to take if a client shows distress:

Answer 24

1) Pause the session (while client is safely seated) and ask them about their concerns
2) Reassure and encourage client.
3) Calmly explain and demonstrate again
4) If not in pain, continue the session

If the AHA were to continue the session without stopping to address client’s concerns, the client may panic further. In their distress, they may injure themselves whilst attempting to complete the transfer. They may also be traumatised by the experience.

As a result, the fitting session would not achieve the intended purpose.

Question 25

Points to consider towards the end of the fitting session:

Answer 25

Once the client education and fitting has been completed, they may start using the equipment. When they do so, the AHA needs to evaluate the effectiveness of it:

Is the equipment working as intended?
Is the client able to use the equipment safely?
Is the equipment compatible with the environment in which it is to be used?
Is the equipment assisting the client to do the activity for which it was prescribed?
Are there any adverse effects relating to the client using the equipment?

Information from the fitting session should be reported back to the AHP promptly so that appropriate follow up arrangements can be made.
Follow up arrangements may include a review appointment to monitor the effectiveness of the equipment or consideration of alternatives if the equipment has been deemed unsuccessful.

Question 26

Complete basic equipment construction and modification:

Answer 26

When given this task, the initial priority is to obtain equipment construction or modification specifications from the AHP. Generally, this would involve verbal discussion but may also include written or demonstrated instructions.

In obtaining specifications, the AHA should ensure that they fully understand the requirements of the tasks and the instructions. They should confirm these instructions before attempting the construction or modification.

If the Allied Health Assistant has any doubts regarding the specifications, they should not proceed until these have been fully resolved and they are certain that they have all information they need to complete the task.

Next step for the AHA is to gather the materials needed to carry out the construction or modification.
Gather not only the obvious materials, but also ensure ready access to any other materials that may be required depending upon the way the session progresses. For example, if a hand splint is to be fitted, it would be useful to also have the splinting scissors ready for the session in case trimming of the straps etc. is required.

If the work is to be carried out in the presence of the client, all materials and preparation should be completed beforehand in order to reduce the length of the appointment.

Many clients find it uncomfortable to attend long appointments due to pain or other restrictions. Thorough preparation by the AHA prior to the appointment will help to maximise client comfort. When a client is comfortable, the task and its outcomes are more likely to be successful.

Question 27

Unexpected issues when constructing or modifying equipment:

Answer 27

Client reporting pain or discomfort relating to the equipment;
Client’s environment not compatible with the proposed construction or modification;
Client not satisfied with construction or modification;
Equipment cannot be physically modified as per the specifications of the AHP;
Proposed construction or modification becomes more complex than anticipated and falls outside the scope of the AHA’s experience/responsibilities.

If issues are encountered:
AHAs should seek support from the AHP and then follow their directions. It may be possible to continue with construction/modification once new instructions are received or it may be necessary for the session to be suspended until a formal review can be carried out by the AHP.
AHA should always explain the situation to the client and ensure client consent to any follow up arrangements.

The outcome of the construction and modification should always be reported back and checked with the AHP, even if no barriers or concerns have arisen.
This will ensure that the outcomes planned by AHP have been achieved and will allow for appropriate follow up if this has not been the case.

Details of the construction/modification session should also be documented according to organisational protocols.

Question 28

Ways to develop a clear understanding of your scope of practice:

Answer 28

Be familiar with your position description (usually available through HR);
Be aware of all workplace instructions/guidelines that relate to the task and adhere to them at all times;
Discuss with and learn from the AHP;
Participate in formal documented supervision sessions with a supervising AHP on a regular basis.

Question 29

Clean and store assistive equipment after use:

Answer 29

After client returns equipment, check whether the equipment is reusable or designated for single use only.
Organisational protocols and the manufacturer’s recommendations can be referred to for clarification of whether equipment can be reused.
If reusable, the AHA needs to make sure that the equipment is cleaned appropriately.

The manufacturer’s instructions should again be consulted to determine that the proposed cleaning method and materials are compatible with the equipment. Also follow your organisation’s Infection Control policies and procedures.

After cleaning, store the equipment appropriately as per the organisation’s storage arrangements and in such a way that does not conflict with manufacturer’s recommendations for storage.
For example, certain items of equipment such as pressure cushions should not be stored with heavy items on top of them as this may damage them. Equipment should also be stored securely away from trafficways, so that it doesn’t create the risk of someone tripping over it.

If any equipment faults are noted, they should be reported promptly and the necessary documentation completed so that they can be repaired. In the interim, the item should be clearly marked as ‘not for use – awaiting repair’ so that no harm is caused by a client unknowingly using faulty equipment.

Question 30

Report and document session:

Answer 30

Often the AHP does not attend the fitting session. Thus they will have no knowledge of outcomes unless that information is accurately provided to them by the AHA.

The process of reporting information back to the Allied Health Professional is vital.

Information to include in reports/documentation:
ADJUSTMENTS
Any suggested adjustments to the assistive equipment or follow up plans (include why).
Eg during the session AHA may have made an observation or client may have made a comment which would indicate that an adjustment to the equipment could be beneficial.
This would be important information for the Allied Health Professional to be made aware of.
RESPONSE
Client’s response to the fitting of the equipment.
Eg how well the client tolerated the equipment, whether they experienced any discomfort, their acceptance of the equipment, their understanding about the use.
PROGRESS
Eg whether they are progressing as intended as per care plan, whether client mentioned any issues about progress, whether session was able to be completed.
DIFFICULTIES
Eg any safety risks or concerns noted by the AHA or any that client may have expressed during the session.
VARIATIONS
Any variations to the original specifications which were implemented on the advice of the AHP.
Eg if a client was unable to tolerate the setting of the equipment which the AHP prescribed, the AHA may have phoned the AHP and been advised to adjust the equipment to a lower setting.
The details of this would need to be reported and documented.
OUTCOME
Eg whether the session objectives were achieved, any barriers to the objectives being achieved and the end result of the session.
ADDITIONAL
Any additional information AHP requests be included.

Take care to document all relevant information about the client use of the assistive equipment in accordance with organisational protocols.