Manual handling
Feature
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ccupational therapists at University Hospitals Bristol and Weston ( UHBW ) assess patients ’ needs to enable a safe discharge from our large , acute hospital . As part of these assessments , the patients ’ manual handling needs and home environment is considered .
We have patients who require a hoist on discharge to manage all of their transfers safely . In some circumstances , family or informal carers will complete the hoisting on discharge and therefore need to have the hoist demonstrated to them and deemed competent to complete a safe hoist transfer .
Occupational therapists are best placed to facilitate discharges where the needs of the patient , the home environment and the task needs are to be considered .
Within UHBW there was no formal documentation or guidance for hospital occupational therapists to safely assess and provide a mobile hoist . Therefore , making safe recommendations for carers and family completing the hoisting at home was a challenge .
On discussion , it was found that there was no consistent approach across the teams for hoist provision , with variations in documentation , outcome of assessments , recommendations and information provided to carers and family .
These inconsistencies in approach led to variable standards of care and were dependent on the level of experience of the occupational therapist in hoist assessment and provision . The lack of process highlighted the learning needs of junior staff members , as they were dependent on senior support at every stage of the process .
It was also apparent that a better problem-solving approach was required to allow for any potential problems to be anticipated as part of the assessment process , rather than at the point of follow up .
Furthermore , there was a considerable impact on the overall occupational therapy service efficiency , due to the demands on clinical time of all occupational therapists .
As a result , the need for a clear process was identified and agreed to support staff ’ s learning , with the ultimate aim of benefiting the patients using our service .
Identifying and exploring the challenges
A scoping meeting was completed with the UHBW occupational therapy team leads to identify team processes and explore the challenges associated to the provision of hoists .
The frequency of hoist prescription and provision on discharge varied across teams . This difference in exposure impacted on occupational therapists ’ understanding of requirements and risks associated with hoists in a patient ’ s own home , particularly for less experienced clinicians .
A literature search was completed to identify the current evidence base relating to hoist provision . Following this , a review of UHBW policies was completed , in which the manual handling team was approached to gather any information it had on risk assessments , hoist training and recommended resources .
It was found that trust documentation focused on the inpatient setting , to ensure staff were fully trained in ward-based hoist use .
Local occupational therapy services were contacted to share their approach to risk assessments and documentation for community hoist provision . Their service manager was most supportive of improving and gaining consistency of care for patients transitioning from the inpatient setting to the community setting . The local equipment provider was also approached to clarify its processes when providing equipment .
Development of the process
We produced a series of flow charts to illustrate a new consistent approach for the provision of hoist for discharge .
With the hoist process in place there is potential for patients to have a reduced length of stay in hospital , as ward occupational therapists know what is expected for the discharge .”
January 2022 OTnews 47