Occupational Therapy News OTnews April 2019 | Page 18

FEATURE CRITICAL CARE
outpatient physiotherapy, outpatient hand therapy, falls
clinic, memory clinic and social services.
Patients report that the clinic is beneficial and
particularly helps with normalising their experience.
The inpatient clinical teams have also been educated
by their experiences observing the clinic. This has a
direct impact on practice within critical care, and the
individual patient stories from clinic are relayed back to
the staff on the unit.
The clinics have also highlighted the lack of
awareness of PICS throughout the hospital and
community services.
Occupational therapy role promotion
As recovery becomes more of a focus, funding for
occupational therapy throughout the whole critical care
pathway is essential.
To promote the role of occupational therapy within
critical care a service evaluation of current provision was
completed. This showed that the service is reactive
rather than proactive and has highlighted areas within
current staffing that the service can improve.
To further promote the occupational therapy role,
oral presentations have been completed at the South
London Critical Care Network and the European ICU
recovery network conference, as well as a poster
presentation at the Intensive Care Society conference.
The clinic is also part of the Society of Critical
Care Medicine THRIVE collaborative, which allows
occupational therapy to gain a voice in critical care, not
just within the UK, but globally.
PICS does not discriminate; all ages, all genders and
any diagnosis requiring a critical care stay are at risk.
It is important that all professionals in any specialism
understand the impact of PICS.
With research supporting early rehabilitation in
critical care more studies are needed to look at the
occupational therapy role in this area. A smooth
pathway needs to be facilitated on transition to wards
and at discharge to promote a good recovery and re-
engagement in previous occupations.
References
Corcoran JR, Herbsman JM, Bushnik T, Van Lew S, Stolfi
A, Parkin K, Flanagan SR (2017) Early rehabilitation in
10.1177/0885066617716377
Firshman P, Walmsley N, Slack A, Meyer J and Connolly B
(2018) An evaluation of the provision of occupational
therapy in a post critical care follow-up clinic in the UK.
Journal of the Intensive Care Society, 19(2): Supplement
101-102
Griffiths J, Hatch RA, Bishop J, Morgan K, Jenkinson C,
Cuthbertson BH and Brett S (2013) An exploration of
social and economic outcome and associated health-
related quality of life after critical illness in general
intensive care unit survivors: a 12-month follow-up
study. Critical Care, 17(3): 100
Hopkins RO, Suchyta MR, Kamdar BB, Darowski E,
Jackson JC and Needham DM (2017) Instrumental
activities of daily living after critical illness: A systematic
review. Annals of the American Thoracic Society, 14(8):
1332-1343. doi: 10.1513/AnnalsATS.201701-059SR
Howell D (1999) Neuro-occupation: Linking sensory
deprivation and self-care in the ICU patient.
Occupational Therapy In Health Care, 11(4): 75-85,
doi:10.1080/ J003v11n04_07
National Institute for Health and Care Excellence (2017a)
Development of a multidisciplinary post critical care
clinic at Guy’s and St Thomas’ NHS Foundation Trust.
London: NICE. Available from: https://bit.ly/2CKaeic
[accessed August 2017]
National Institute for Health and Care Excellence (NICE)
(2017b) Quality standards [QS158] Rehabilitation after
critical illness. London: NICE
Myhren H, Ekeberg Ø and Stokland O (2010) Health-related
quality of life and return to work after critical illness in
general intensive care unit patients: A one-year follow-
up study. Critical Care Medicine, 38(7): 1554-1561. doi:
10.1097/CCM.0b013e3181e2c8b1.
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C,
Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M,
Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister
KE, Hall JB and Kress JP (2009) Early physical and
occupational therapy in mechanically ventilated, critically
ill patients: a randomised controlled trial. Lancet, 373:
1874–82
Penelope Firshman, senior specialist occupational
therapist, Guy’s and St. Thomas’ NHS Foundation
Trust. Email: [e-mail]
the medical and surgical intensive care units for patients
with and without mechanical ventilation: An
interprofessional performance improvement project.
Physical Medicine and Rehabilitation. 9(2): 113-119
Connolly BA, Mortimote JL, Douiri A, Rose JW, Hart N and
Berney SC (2017) Low levels of physical activity during
critical illness and weaning: The evidence–reality gap.
Journal of Intensive Care Medicine, 1-10. doi:
18 OTnews April 2019
Acknowledgements: Many thanks to the Critical Care
Recovery Clinic team for the experience of working
within this clinic and gaining a greater understanding
of PICS. Thank you for the support and guidance
of Nicole Walmsley, clinical specialist OT, Rachael
Fergusson, clinical lead OT, Joel Meyer and Andrew
Slack, intensive care consultants