Occupational Therapy News OTnews May 2020 | Page 29

COVID-19 FEATURE prioritised patients into three groups: those who were ‘at risk’ and needed face-to-face contact; those at ‘medium risk’ who could be managed with telephone follow ups; and the ‘low risk’ category that could be put on hold for intervention. The ‘at risk’ group includes those who, if left, would have a higher risk of a negative outcome compared with not visiting the hospital for input. This includes acute urgent trauma that cannot be safely immobilised by cast, such as tendon repairs if immobilisation is not appropriate for the necessary four-week immobilisation period. We also included as a priority on our waiting list new arthrogryposis patients that require splinting and can then be sent home with the relevant information to continue until the pressures and concerns of COVID-19 reduce. Infection control and new ways of working The therapy department was shut down to prevent the spread of the virus. This meant that there was no waiting area and no direct access to the reception. Patients identified as still needing a face-to-face review went through a rigorous screening process, both before their appointment and on the day of the appointment, to ensure they were not presenting with symptoms. Patients that were seen face to face were expected to only bring one member of their family with them. Infection control measures were implemented throughout each consultation to protect both patient and therapist. This included the use of appropriate personal protection equipment (PPE) which made interaction with our patients, in particular smaller children, very different as a visible barrier was now in place between patient and professional; something we try hard to break down when treating patients. Patients that could be managed over the telephone were contacted, screened and if appropriate offered advice. This included trauma patients coming to the end of their therapy programme and congenital patients with on-going regular input with regards to routine splint checks, due an imminent review, for example known arthrogryposis patients, radial hemimelia and known cerebral palsy patients. Telephone check-ups were centred around their progress and to advise on things such as home exercise programmes and splint weaning. This provided parents with the opportunity to discuss any concerns they might have without having to enter the hospital environment and allowing patients and their families to abide to government self-isolation stipulations. Home exercise programmes were sent out by post, where necessary, with photographs and videos used as needed, if possible. Finally, other patients were identified as non urgent and could be seen in six months’ time or discharged. This cohort of patients included congenital patients already on a longstanding and established therapy programme that are low risk from reduced face-to-face occupational therapy intervention. RCOT Specialist Section – Children, Young People and Families We promote high standards of professional practice within children's occupational therapy and, together with our members, continue to develop an evidence base for the profession. Our specialist section represents occupational therapists working with children, young people and their families in a wide range of settings including: • Acute hospitals • Child and Adolescent Mental Heath Services (CAMHS) • Children's centres • Community services • Education/schools • Independent practice • Learning disability services • Local authority health and social care • Wheelchair services • The voluntary sector For general enquiries please email: [email protected] or visit: www.rcot.co.uk/about-us/specialist-sections/ children-young-people-and-families-rcot-ss New congenital patient reviews for activities of daily living, where possible, were transferring to local community services to reduce the impact on the hospital service once normal protocol is re- instated. Hand therapy relies heavily on face to face, tactile assessments of the hand. As occupational therapists our clinical reasoning and skills were stretched to adapt to new way of working. Patients and their parents were understanding towards the limitations now placed on our service and were helpful in providing us with verbal feedback on patient progress, as well as the patient themselves. As a result of this global pandemic, a department we have been able to reflect on how our service is run and the changes we can carry forward from this new way of working. It has helped us to streamline our service as a whole and review our waiting list in order to make the service more efficient and available to the patients that need it the most. It has also helped us as autonomous practitioners redefine how we help our patients to show that no matter what, we are still here for them and to provide them with reassurance and guidance when still needed. Despite the face-to-face restriction, the Hand and Upper Limb Service still endeavoured to work as a team, exploring new ways of virtual consultations, email, telephone and WhatsApp groups, to remain in communication with one another, while trying to protect both patients and staff from the spread of the virus. Kristabel Ewers, senior occupational therapist, and Kiri Irani, advanced occupational therapists, Hand and Upper Limb Service, Birmingham Children’s Hospital, email: [email protected] OTnews May 2020 29