Occupational Therapy News July 2020 | Page 31

REHABILITATION FEATURE discharged home at a time when community services were unable to offer rehab. This was also difficult for staff to come to terms with. As a team we quickly adapted our ways of working, minimising paperwork and maximising efficiency. Our focus became discharge planning and we became creative around how to do this, completing ‘virtual’ access visits via WhatsApp video calls. We all suddenly had to become more confident with our grasp of technology – working from home if self-isolating or shielding, using conference calls and video for patient review meetings, completing family education sessions via video link, and supporting patients to keep in contact with family using a variety of platforms. Usually all patients are assessed face-to-face prior to admission, but this was no longer possible. In-depth telephone assessments were completed with ward staff, but some key pieces of information were not handed over. Combined with the pressure on acute hospitals to discharge patients, this resulted in some safety concerns on transfer. In particular, one patient arrived with MRSA, which we had not been made aware of, and another patient was transferred with a PICC line in situ, which the transferring hospital denied was in place. As such, we innovated further and set up a pre-admission video call with the patient to answer their questions and observe part of a therapy session. As part of our response to the pandemic, we set up a twice-weekly conference call with social services and the CCGs. This allowed us to build closer working relationships and to ensure close liaison between partners. As a relatively new service, this increased communication allowed us to demonstrate our expertise and efficacy to the commissioners. It also appeared to speed up the referral process and allowed the responsibility around admission decisions to be shared between the group. Within the service, working relationships developed and grew. Each new admission required careful negotiation between safe staffing, constraints on housekeeping, not overwhelming the team, and the ever present pressure to relieve beds in the acute sector. Although it only amounted to a handful of beds, everyone was aware that our extra work was playing a small, but important part in a much bigger effort to manage the virus. This allowed us to keep going when we were exhausted, to put our own anxieties aside and to cope with the disappointment of not being able to provide as much input as we would like. As with the government advice, the situation was changing by the hour, and all staff had to be flexible in adapting to this. The team had to pull together and began to support each other much more readily, putting team priorities above individual workload. As a relatively new team this had been the goal for some time. The pandemic proved to be the catalyst we needed to develop as a team. Seeing rainbows and ‘thank you key worker’ signs on the drive to and from work, alongside the weekly clap for carers, kept us going when we were drained and exhausted. Everyone in the team needed to step up and go beyond their usual roles. Due to sickness impacting on our nursing team, our senior occupational therapist, who had previously worked in an extended practice role, was assessed as competent to administer medications and cover elements of the nursing role. The rehabilitation service lead provided support in completing the majority of admission paperwork and GP ward rounds © GettyImages/traffic_analyzer via video link. As part of our contingency plans, all staff were advised that they may need to assist with personal hygiene if we were particularly short staffed. This type of cross-cover pushed staff out of their comfort zones, but will ultimately lead to closer interdisciplinary team working moving forward. Patients admitted during this period, and their families, were incredibly accommodating and understanding of the limitations on the service. This made our work easier, as did their thanks and appreciation. Seeing rainbows and ‘thank you key worker’ signs on the drive to and from work, alongside the weekly clap for carers, kept us going when we were drained and exhausted. As the dust starts to settle we are beginning to be able to re-charge our batteries, reflect on the last few months and review how recent experiences will impact on the service moving forward. Lasting changes will include: the ability to use technology more readily throughout our practice; closer working relationships within the unit and increased appreciation of each other’s roles; broadening of staff skills and experience, resulting in increased confidence; and strengthened partnership with commissioners. Our block contract with the CCGs has recently been extended for a further 12-week pilot. Their feedback has been overwhelmingly positive around our reduced length of stay while maintaining good patient outcomes and in relation to how quickly we have adapted our ways of working. Like us, they recognise the benefits of our closer working relationship and the trust that has quickly developed between us. Clare Cole, Therapies and Rehabilitation Service Lead, Sue Ryder – The Chantry. Email: [email protected] OTnews July 2020 31