ASSESSMENT TOOLS FEATURE care and education to score the relative abilities and difficulties of a patient in four domains of impairment , activity , participation and wellbeing , in order to monitor changes over time .
Carer wellbeing can also be measured , which is pertinent to working under the Care Act ( 2014 ), which seeks to enable wellbeing .
Training In May to November 2019 , Sharon and Chris Smith initiated a service-wide project to implement TOMs . The aim was to train the whole service of 25 staff in the use of TOMs . This involved two training sessions for each practitioner , firstly an introduction to TOMs , and practice scoring exercises . Then practitioners were asked to score 10 cases from their own caseload .
In the second session , we checked inter-rater reliability through scoring each other ’ s cases , to within one point on the ordinal scale . Certificates of completion for CPD were issued . Feedback of the training sessions from staff was gathered , including comments such as : ‘ By participating this has cemented my understanding ’; ‘ provision of two sessions was useful ’; and that the most useful part of learning was ‘ discussion of case scoring ’.
Staff also noted time pressures in undertaking recording , potentially adding to busy workloads .
Therapy Outcome Measure process TOMs is a quick and easy measure to use . The tool is based on the International Classification of Functioning , Disability and Health ( World Health Organisation 2001 ). The practitioner selects a condition-specific adapted scale , for example neurological disorders , musculoskeletal , or dementia , to record the client ’ s four domains to measure progress at initial assessment and following intervention .
The four domains of impairment , activity , participation and wellbeing / carer wellbeing are scored on an 11-point ordinal scale . Scoring ranges from nought ( profound ) up to five ( normal ) for age and gender without disability . Occupational therapists , physiotherapists and other allied health professionals have been involved in developing further adapted scales appropriate for their services .
TOMs recording practice All practitioners were enabled to practise recording the domains on a TOMs document on our social care recording system Liquid Logic ( www . liquidlogic . co . uk /) between January and March 2020 .
Following this , in April 2020 we were able to make the TOMs electronic recording a mandatory part of our ADLs , moving and handling , seating , and bed safety assessment . Also , practitioners could continue to use the standalone TOMs record , both available on liquid logic .
Positive impact All occupational therapy practitioners have responded to using TOMs ; it is well supported in the service and across the trust . As a service we are now able to demonstrate the effectiveness of our interventions . The use of TOMs data is also part of our integration agenda in the trust ; bringing adult social care in line with other allied health profession services across the trust who are also using this outcome measure .
A recent survey ( November 2020 ) of practitioners , to evaluate TOMs use in the service showed that 100 per cent of staff said they feel confident using TOMs now on ADL and other assessments . In addition , 100 per cent of staff stated they have received enough peer support in using TOMs .
The launch of TOMs during the pandemic has been a success ; plus , it has demonstrated the resilience of the team to take on this change to working practices during uncertainty caused in a pandemic .
Future plans include training for new staff , an audit , according to trust policy , and potentially to look at use of the TOMs adapted scales with a larger cohort to determine specific outcomes for particular client groups .
References
Enderby P and John A ( 2015 ) Therapy Outcome Measure for Rehabilitation Professionals ( 3rd Ed ). J & R Publishing Services Ltd Guildford
Sharon Davenport , experienced occupational therapist , Wirral Health and Care Community NHS Foundation Trust and MSc student Advanced Occupational Therapy at University of Derby , and Chris Smith , occupational therapy advanced practitioner , Wirral Health and Care Community NHS Foundation Trust
Acknowledgements : Pamela Enderby Professor Emeritus , University of Sheffield School of Health and Related Research Innovations Building Sheffield ; Alison Kerr , programme leader MSc Advanced Occupational Therapy , College of Health , Psychology and Social Care , University of Derby ; Sharon has also been supported in her MSc study through funding from the Elizabeth Casson Trust :
https :// elizabethcasson . org . uk
OTnews July 2021 49