OTnews January 2020 | Page 33

To establish the occupational therapy role on critical care it was important for us to observe and understand the different types of patient journey , based on their reasons for admission .
We found that patients travelled from all over the country for cardiac surgery , ECMO or transplants . Some of these patients spent time on the critical care unit prior to their procedure , but often they were admitted after surgery .
Large numbers of post-surgical patients required acute , but not always prolonged treatment on critical care , therefore the window of opportunity for occupational therapy input with these patients was limited .
We spent time observing the needs and difficulties of the patients on critical care to guide our focus for assessments and interventions . The areas we identified for assessment included :
• cognition : delirium , attention , memory ;
• upper limb : range of movement , sensation , tone , oedema management and positioning ;
• psychological : anxiety , stress and mood management ;
• self-management : sleep hygiene , daily routine , mindfulness and energy conservation ;
• functional task re-training : grooming , toileting , washing and dressing ; and
• goal setting : rapport building , person-centred short- and longterm goals . The interventions used were varied and it was important to ensure they were person centred . We found that in the specialist environment of a cardiothoracic hospital , strategies to reduce anxiety , daily orientation , individualised activity programmes and education around management of conditions , were the main focus of our practice .
Our opportunity to explore the use of different interventions and outcome measures was limited by the short length of stay that
CRITICAL CARE FEATURE
most patients experienced , but this is definitely an area for further practice development .
Once medically stable enough to leave critical care , patients were either transferred to one of the wards , or to their nearest district general hospital , depending on the level of care required .
At this point the patient was verbally handed over to the appropriate occupational therapist at their transfer destination . We identified that a method of follow up for all critical care patients that have had occupational therapy involvement would be beneficial , to offer continuity of care for the patient and to be able to monitor the effectiveness of our practice .
On reflection , the role of an occupational therapist in critical care is both rewarding , yet challenging . Our experience of working on critical care at the Royal Papworth Hospital has enabled us to identify the following areas for future service and professional development :
• a clear referral criteria and pathway needs to be established ;
• education should be provided to the multidisciplinary team on the role of occupational therapists in critical care ;
• further experience of occupational therapy interventions in the critical care environment ;
• develop specific critical care documentation for occupational therapists ;
• establish how patients will be followed up after discharge from critical care ;
• continued monitoring of the benefits of early occupational therapy intervention including the impact on patient length of stay ;
• develop or identify appropriate outcome measures that are sensitive to the progression of the patients on critical care and evidence the value of our occupational therapy intervention ; and
• continue to develop and maintain links with other critical care occupational therapists . We are very grateful to the staff at the Royal Papworth Hospital , who supported and guided us through our three-month secondment on critical care . We hope that collaborative working will be used to continue to further develop the occupational therapy workforce , as it is an invaluable tool to share knowledge and experience .
References
Intensive Care Society ( 2019 ) Guidelines for the provision of intensive care services . Available online at : www . ficm . ac . uk / sites / default / files / gpics-v2 . pdf [ accessed 30 September 2020 ]
Royal College of Occupational Therapists ( 2020 ) A quick guide for occupational therapists : Rehabilitation for people recovering from COVID-19 . Available online at : www . rcot . co . uk / sites / default / files / Quick % 20guide % 20for % 20OTs % 20People % 20recovering % 20from % 20 COVID-19 . pdf [ accessed 30 September 2020 ]
Catrina Wigmore , senior occupational therapist in the Surgical Therapy Team at West Suffolk NHS Foundation Trust , email : c . wigmore @ nhs . net , and Sophie Graves , senior occupational therapist in the Critical Care Therapy Team at Peterborough City Hospital , North West Anglia NHS Foundation Trust , email : sophie . graves @ nhs . net
© GettyImages / Mohammed Haneefa Nizamudeen
OTnews January 2021 33