CRITICAL CARE FEATURE
Guidelines for the provision of intensive care services, from
the Intensive Care Society (2019), cite a study that suggests
there should be 0.23 whole time equivalent (WTE) occupational
therapists per bed – about one occupational therapist per five
beds.
It says that occupational therapists on ICU should:
• have the experience to contribute to and develop holistic
rehabilitation plans;
• be skilled in non-pharmacological delirium assessment and
treatment;
• participate in multidisciplinary team meetings, ward rounds and
follow up clinics; and
• have a clearly defined role in the ICU.
But what does this mean for occupational therapists wanting
to build on their experiences of the last few months? How can we
make a case for change and establish occupational therapy in
every ICU? And how do we show our value?
The occupational therapy role on ICU
Occupational therapists are a unique member of the
multidisciplinary team; we are one of the only allied health
professions who work across both physical and mental health
services. We are skilled in functional rehabilitation, cognitive
assessment, delirium management, discharge planning and
much more.
Costigan et al (2019) reviewed over 200 papers to understand
what kind of interventions occupational therapists are carrying out
in ICU. They found that, while interventions were predominantly
around physical rehabilitation, occupational therapists are carrying
out a huge range of activities on ICU, categorised into six areas:
• physical: mobility, activities of daily living, feeding/eating and
splinting and skincare;
• environmental: communication, seating, adaptations and
assistive devices;
• cognitive: delirium prevention and care, cognitive assessment
and cognitive intervention;
• social/emotional: mental health support, goal setting,
psychosocial support and family support;
• sensory: sensory stimulation and music therapy; and
• other: discharge planning, patient diaries, education and sleep.
We are truly holistic in our approach to rehabilitation, looking at
patients’ emotional and psychological needs, as well as engaging
in physical rehabilitation. Having occupational therapists in ICU also
means that discharge planning is started earlier, so patients go
home sooner.
Our input shortens length of stay on ICU by two days, shortens
the overall length of hospital stays, and when patients are
discharged – if they have received occupational therapy while on
ICU – they are more functional and have less care needs (Dinglas
et al 2013; Schweickert et al 2009).
This means that occupational therapy input saves money both
in hospital and in the community – truly improving lives and saving
money.
Critical Care Clinical Forum: www.rcot.co.uk/aboutus/specialist-sections/trauma-and-musculoskeletalrcot-ss/clinical-forums
Recovering from COVID-19: Post viral-fatigue and
conserving energy www.rcot.co.uk/recovering-
RESOURCES
covid-19-post-viral-fatigue-and-conserving-energy
Using our core skills and building a case for change
As any occupational therapist who has ventured onto ICU for
the first time in the the last few weeks will tell you, you do not
need any extra formal training to be an occupational therapist
on ICU.
You certainly need to spend time with the physiotherapists
and nurses who are familiar with the unit and to learn about the
ways of working and machines, what they do and what the noises
mean.
But you don’t need an MSc in critical care to help a patient with
ICU-acquired weakness to wash their face for the first time in six
weeks, set meaningful goals with them, or talk to them about how
they are feeling that day.
We know that being on ICU has a huge psychological impact
on patients and holistic rehabilitation, which occupational
therapists can offer, is key to their recovery (Jackson et al 2012).
Of course, there are areas where some training is needed, such
as splinting or specialist seating, but there is a lot we can do using
skills that we use everyday in other areas.
Our core occupational therapy skills are what we need and
moving to work in a new area is a perfect opportunity to review
these and see how they can be applied in this environment (COT
2016).
Having spent the last weeks and months on ICU, and seeing
the huge impact they can have on patient outcomes, occupational
therapists may now be wanting to make the case for change on
their own ICUs.
It is important to consider both the risks and outcomes of
building a new service, and the table on page 46 highlights some
things that could be considered.
References
Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S and Copland DA
(2015) Effect of early rehabilitation during intensive care unit stay on
functional status: Systematic review and meta-analysis. PLoS ONE,
10(7): e0130722
College of Occupational Therapists (2016) Entry level occupational
therapy core knowledge and practice skills. London: COT. Available
online at: www.rcot.co.uk/sites/default/files/Entry%20level%20OT%20
5.26.17.pdf [accessed 22 June 2020]
Dinglas VD, Colantuoni E, Ciesla N, Mendez-Tellez PA, Shanholtz C and
Needham DM (2013) Occupational therapy for patients with acute lung
injury: factors associated with time to first intervention in the intensive
OTnews July 2020 45