Occupational Therapy News OTnews April 2019 | Page 34

FEATURE ASSESSMENT TOOLS
Standardising assessments
to improve services
Sarah Clifford, community therapy team lead at South Tees Hospitals NHS Foundation Trust,
talks about standardising assessment tools for occupational therapists across the trust,
and how training has improved their skills, knowledge and confidence
O
ccupational Therapists work with
individuals to overcome the barriers that
restrict their participation in meaningful
occupations, whatever the reason.
Through holistic assessment and interventions,
occupational therapists play a key role in promoting
independence and active participation in the everyday
activities that are important to a person.
This may be to achieve safe and sustainable
discharges from hospital, or to maximise occupational
performance in the community.
Where patients have an underlying cognitive
impairment this brings additional challenges, due to
the variable information received from patients and
carers, and the assessment not always being a true
representation of a person’s occupational performance
if they are in hospital, because of the unfamiliar
environment and their potential acute confusional
state, or delirium.
Within South Tees Hospitals NHS Foundation
Trust, occupational therapy assessment has largely
been undertaken through the use of a variety of tools,
by occupational therapists who have varying skills,
knowledge and experience of working with patients
with a cognitive impairment.
The tools used were predominantly non-
standardised and were able to inform the
occupational therapy assessment, however it was
acknowledged that there was a need to introduce a
more standardised way of assessing and supporting
patients living with a cognitive impairment.
An individual’s ‘rehabilitation potential’ is
frequently discussed on rehabilitation wards by the
multidisciplinary team to identify the most appropriate
services they should be referred to in the community,
the level of support they may require after discharge,
or indeed, if they would benefit from remaining in
hospital to further promote their recovery.
This is in line with the current agenda for patients to
see the right therapist at the right place and the right
time.
34 OTnews April 2019
Assumptions should never be made about a
person’s inability to participate in their rehabilitation
goals fully, due to them having a cognitive impairment.
The Cognitive Disabilities Model and associated
Large Allen Cognitive Levels Screening Tool (LACLS-5)
can be used by occupational therapists in mental
health, elderly care and physical rehabilitation settings
to establish person-centred goals to improve or
maintain an individual’s occupational performance
(Allen et al 2007).
By assessing a patient’s functional cognition,
occupational therapists are able to demonstrate what
changes are required in the approach of professionals,
the activity itself or the immediate environment,
to achieve the ‘just right’ challenge and focus on
remaining skills, identifying rehabilitation potential and
promoting function.
The liaison psychiatry occupational therapists
in the acute hospital had been using the LACLS-5
for a number of years, however, it was recognised
that there were still gaps in the knowledge of the
occupational therapists working for the trust that
needed addressing.
South Tees Hospitals NHS Foundation Trust
Integrated Therapies introduced the Cognitive
Disabilities Model, screening tools and Routine Task
Inventory-Expanded (Katz 2006) to occupational
therapists working in elderly care settings across the
acute hospital elderly care wards, primary care hospitals
and community therapy teams, in addition to the
reablement units in the community, in November 2017.
These services were selected to attempt to mirror a
patient’s potential pathway and to promote improved
communication and more consistent approaches by
the occupational therapists.
It was hoped that it would standardise cognitive
assessments and bring a common terminology to the
occupational therapists working in the hospitals and
community across both the acute and mental health
teams, to improve services for older people living with
a cognitive impairment.
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