ACUTE CARE FEATURE
In addition to this , PPE also impacts on a person ’ s ability to use lip reading and facial expressions to compensate for the gaps of speech that they miss .
Being in hospital can be an extremely isolating and vulnerable time for patients and poor communication has been associated with poor health outcomes ( Mick , Foley and Lin 2014 ).
We all have a duty of care to adapt our practice so that it maximises patient engagement in therapy assessments and discharge planning . With the above in mind , I have been developing a range of communication resources to support staff within the occupational therapy department to utilise for their assessments , interventions and goal settings . These include :
Occupational therapy initial assessment – prompt cards : written prompt cards that can be used when sitting with the patient to complete face to face initial assessments .
Occupational therapy initial assessment – prompt cards ( aphasia version ): same as above , but with the inclusion of pictures to support with people who have reading difficulties or have aphasia .
Occupational therapy initial assessment – written handout document : a written questionnaire based on the information we would gather during our initial assessment . This written document can be left with a patient to enable them to fill it out in their own time .
Occupational therapy equipment list : this is a document that has pictures of all the main pieces of compensatory equipment we provide to patients to improve safety and independence at home . This can minimise the need for lengthy explanations attempting to describe what equipment a patient currently has in place , has used in the past or what you would recommend the patient trialling .
Written prompt cards and picture board based around supporting basic needs : this includes a list of questions that staff will need to ask the patient regularly throughout the day to ensure patients ’ needs are being met .
Written prompt cards based around assessing cognition : this includes a list of questions based around a patient ’ s orientation and insight .
Written prompt cards based around assessing mobility and transfers : this includes a list of questions and written instructions for these assessments to take place .
These resources have received positive feedback from both staff and patients . One particular example of the documents in use was with a patient who was admitted due to a fall , diagnosed with a hypoactive delirium on a background of a mild cognitive impairment , and also had long-standing anxiety .
In addition to his medical and mental health needs , this patient also had a long-standing hearing deficit .
Normally he would rely upon his bilateral hearing aids , facial cues and lip reading to engage in conversation . However , unfortunately , during his admission one of his hearing aids went missing , and infection control policy meant that face masks were compulsory all times when working with staff .
The prompt cards were utilised by the whole multidisciplinary team during assessments and used to promote the patient ’ s involvement in the discharge planning progress . The basic care prompt sheets were laminated and used by all the ward staff to gain consent to support him with his activities of daily living on the ward and promote independence , for example taking medication , toileting , washing and dressing .
Occupational therapy and physiotherapy staff used the transfer and mobility prompt sheets daily to assess his level of function , ensure this was consistent , and monitor any fluctuations throughout the day .
Occupational therapy used the cognition prompt cards to further assess his recall , orientation , insight , risks at home prior to admission and how these had changed due to his new level of function .
Due to the multidisciplinary team and patient ’ s concerns about safety at home , a meeting was arranged to enable the patient ’ s social worker to complete a face-to-face assessment of his needs and for the team to discuss the outcome of their assessments .
The patient requested that occupational therapy was present during this meeting , as they had been so supportive with his communication needs .
During the meeting , the occupational therapist advocated for the patient to have the majority of the communication in written form , to promote his involvement in the discussion and ensure his wishes were presented .
It was decided that the patient would be transferred into a short-term placement on discharge to monitor his cognition and support needs . The long-term goal was for patient to be discharged home , if appropriate , once his delirium had resolved .
Occupational therapy sent electronic copies of the prompt cards to his social worker so they could be utilised in his placement and continue to support with communication .
As face masks are likely to be common practice for the foreseeable future , if you feel any of the discussed resources could be beneficial for your service and would like to access digital copies , please do get in touch . Any feedback or ideas for how these could be further developed is welcome .
References
Goldin A , Weinstein BE and Shiman N ( 2020 ) How do medical masks degrade speech reception ?, The Hearing Review . Available at : https :// bit . ly / 3tot3jD ( accessed : 12 December 2020 )
Mick P , Foley DM and Lin FR ( 2014 ) Hearing loss is associated with poorer ratings of patient-physician communication and healthcare quality , Journal of American Geriatrics Society , 62 ( 11 ): 2207-2209 . DOI : 10.1111 / jgs . 13113
Lindsey Rigby , senior occupational therapist , works on acute hospital wards at North Tyneside General Hospital , Northumbria Healthcare NHS Foundation Trust . Email : lindseymciver @ hotmail . co . uk
OTnews February 2021 21