Policy. Consulted With Individual / Body Date Philip Burns General Manager November 2009 John Tobin Divisional Manager November 2009 Debbie Snell,

Transcription

1 Physiotherapy and Occupational Therapy Clinical Operational Policy Policy Register No: Status: Public Developed in response to: Service Development Contributes to CQC: Outcome 4 Consulted With Individual / Body Date Philip Burns General Manager November 2009 John Tobin Divisional Manager November 2009 Debbie Snell, Lead Therapists Lisa Curtis, Professionally Approved By Lynda Lovelock Lead Therapist November 2009 Version Number 1.0 Issuing Directorate Emergency Care Ratified by: Margaret Blackett, Chief Operating Officer Ratified on: 23rd April 2010 Trust Executive Board Date n/a Implementation Date 23rd April 2010 Next Review Date March 2011 Author / Contact for Information Lynda Lovelock / Debbie Snell / Lisa Curtis Policy to be followed by (target staff) All Staff Distribution Method Intranet & Website Related Trust Policies (to be read in conjunction with) Infection Prevention Policies Mandatory Training Policy Manual Handling Policy Fire Safety Policy IT Policies Clinical Record Keeping Policy Document Review History Review No Reviewed by Review Date It is the personal responsibility of the individual referring to this document to ensure that they are viewing the latest version which will be the document on the intranet 1

2 Index 1. Purpose of Document 2. Aims of the Service 3. Scope of the Service 4. Work Flows 5. Key Relationships 6. Staffing 7. Equipment Requirements 8. Infection Prevention 9. Equality and Diversity 10. Contingency 11. Auditing this Policy 12. Responsibilities 13. References Appendix 1 - Emergency Work Flows Appendix 2 - Elective Pre-assessment Flows Appendix 3 - Outpatient Work Flows Appendix 4 - Therapy Services Staffing Profile 2

3 1. Purpose of Document 1.1 To define the Occupational Therapy and Physiotherapy service provision within MEHT. 2. Aims of the Service 2.1 To provide a high quality, patient centred Therapy service for the population of Mid Essex (approx 360,000), delivering both acute inpatient and outpatient activity. 2.2 The service overall is governed by and aims to comply with the Trusts policies and procedures and applicable National Service Frameworks. Professional staff are responsible to the Health Professions Council and are governed by the Codes of Conduct of the British Association of Occupational Therapy or the Chartered Society of Physiotherapy. 3. Scope of the Service 3.1 The combined Occupational Therapy and Physiotherapy service is provided by autonomous professionals who assess, plan and carry out treatments, provide advice, equipment and information, and assist in timely discharge planning within a framework of individualised patient goal setting. In addition to the provision of direct patient care, Therapists engage in multi-disciplinary decision making, education, and the future planning of service provision. 3.2 We provide our patient services primarily via face to face contact, involving the patients in shared goals setting and treatment planning. We also work with the multi disciplinary team, engaging with the patient s supporters and liaising with a variety of other services including; Primary Care, Community Services, Social Services, Voluntary Groups, other Hospitals and Community based Therapy Services to ensure the most effective and appropriate care for each patient. 3.3 Provision of acute assessment, therapy goal setting, acute rehabilitation, and facilitation of discharge for patients admitted within Broomfield and the non Mental Health areas of St John s Hospital. Therapies provide input within almost all of the clinical specialties 3.4 The service provides Occupational Therapy and Physiotherapy to patients in the following areas. Accident & Emergency Emergency Short Stay The Emergency Assessment Unit does not have dedicated staff but ad hoc acute interventions are provided. Support is provided to the Therapist working within the Elderly Assessment Team. Outpatient Physiotherapy for Orthopaedic, Rheumatology, Pain and Neurology Consultant referrals 3

4 Out patient Physiotherapy for tertiary referrals requiring specialist physiotherapy treatment, particularly upper limb rehabilitation for movement disorders Outpatient Occupational Therapy for Rheumatology Consultant referrals for hand problems Maternity; inclusive of Antenatal and Postnatal clinics Gynaecology Outpatients Paediatrics Outpatient treatments (Women s Health) ENT ward Specialist Orthopaedic Physiotherapist input to Outpatient clinics in Shoulder, Spinal, and Hip / Knee clinics Acute Knee Injury service 3.5 Staff Groups State Registered Occupational Therapists Chartered / State Registered Physiotherapists Therapy Assistants Admin Support staff 3.6 Activity Data Data collection for the Occupational and Physiotherapy Service is unavailable at this time. Data collection is currently being formalised to ensure that robust data is available to update this policy. 3.7 Operational Hours Core hours for inpatient and outpatient services are Monday to Friday 08:00 16: Services are provided for weekend, Bank Holiday and out of hours emergency care Physiotherapy service for patients with chest conditions at risk of deterioration without daily therapy Weekend and Bank Holiday cover is provided to Orthopaedic services, for patients whose discharge would be significantly delayed in the absence of daily therapy. This is primarily relevant to elective surgery patients. 3.8 Inclusion Criteria The service includes the provision of Occupational Therapy visits to the homes of current inpatients in order to facilitate timely and appropriate discharges where there 4

5 is no other way to confirm any necessary adaptations required or that the patient will be able to cope in their chosen environment The service includes outpatient Physiotherapy for patients referred from areas beyond Mid Essex, Tertiary Consultant referrals for specialist musculoskeletal physiotherapy assessment, management and treatment also to all MEHT members of staff with musculoskeletal problems in association with Occupational Health Department. 3.9 Exclusion Criteria Plastics & Burns patients have their own Occupational Therapists and Physiotherapists GP outpatients except by special arrangement Community based therapy interventions. 4. Work Flows 4.1 Emergency Flows Emergency referrals are received into the Physiotherapy and Occupational Therapy Services via several routes. Please refer to appendix 1 for detailed emergency pathways. 4.2 Elective Flows Elective referrals are received into the Physiotherapy and Occupational Therapy Service via several routes; please refer to appendix 2 & 3 for the detailed elective pathways. 5. Key Relationships 5.1 Key Operational Requirements Therapy Department Treatment cubicles Treatment room Hand therapy treatment area Hydrotherapy pool with associated changing facilities, showers, toilet, store room, plant room Gym Store rooms ADL rooms: kitchen x2, bedroom, bathroom (wheelchair access) Offices: Lead Therapists, inpatient staff office, quiet room for confidential meetings / phone calls Writing up areas Reception and waiting room inc. patient toilet Disabled access toilet Meeting / training rooms Staff change / toilets 5

6 Staff room Sluice area Ward areas Assessment area Treatment / quiet areas Access to stairs Storage space for equipment Writing up area Access to computer / printer Access to patient information systems Equipment Many items of therapy equipment are large and unwieldy. Some are static; others need to be transported to other areas of the hospital in response to patient needs. Hydrotherapy pool hoist, patient chairs, changing facilities, pool equipment, emergency equipment; Outpatient department treatment couches, electrotherapy equipment, exercise equipment, gym equipment, emergency equipment; Equipment for provision to patients short or long term; Walking aids crutches, frames, sticks, specialist items for demonstration IT telephone, computer access, IT support; Information management therapy patient treatment records, access to patient information systems, data collection systems. 5.2 Key Relationship with other Departments / Services Accident & Emergency; Emergency Short Stay; Emergency Assessment Unit and Elderly Assessment Team Therapists who provide cover for this area; Outpatient Physiotherapy for Orthopaedic, Rheumatology, Pain and Neurology Consultant referrals; Out patient Physiotherapy for tertiary referrals requiring specialist physiotherapy treatment, particularly upper limb rehabilitation for movement disorders; Outpatient Occupational Therapy for Rheumatology Consultant referrals for hand problems; Maternity; Gynaecology; Paediatrics Antenatal and postnatal clinics; Outpatient treatments (Women s Health); ENT ward; 6

7 Specialist Orthopaedic Physiotherapist input to Outpatient clinics in Shoulder, Spinal, and Hip/Knee clinics Acute Knee Injury service Self help groups who use the Hydrotherapy Pool Cardiac Rehabilitation who use the Gym facilities Chronic Fatigue Service who use some assessment rooms St Andrews and The Linden Centre where we share a Band 5 rotation for Physiotherapist and Occupational Therapists respectively; Medical staff Ward nursing staff Specialist nurses Discharge Liaison Team Speech and Language Dietetics Surgical Appliances Plaster room Social Services Radiography / Radiology Pharmacy Mental Health Services Clinical Psychologists & Counselling service Occupational Health ELMS Training & Development External Agencies Charitable organisations Volunteers service Community Therapy Services Intermediate Care Services Other Community Services 5.3 Key Requirements for Facilities Management (F.M.) Support required from: Domestic staff Porters Security Estates and Facilities EBME Supplies / Goods Receiving; Transport Hard FM: SLE with EBME; general maintenance of fixtures and fittings, specific checks for Hydrotherapy service Soft FM: Cleaning provision as schedule, laundry service, and waste management. 7

8 Consumables are supplied via the Commercial Services Department via pre agreed stock proforma 5.4 Environmental Requirements Flooring Non slip Level surfaces Even colour Carpeted waiting area and staff room Heating Thermostatic control for office and staff room areas Regulated to appropriate 21 O C for patient treatment areas, including gym Ventilation and cooling systems Lighting Natural lighting Appropriate lighting for office and reception areas to suit working at computers Central controls to adapt lighting to suit patient requirements Privacy Sound retarding surfaces to improve patient privacy and maintain respect for dignity Screening: fixed and mobile for patient areas Treatment rooms Solid doors for privacy Sound retarding Emergency call system 5.5 Way finding Directional signage Clear signage to the department at each point of entry to the hospital Inclusion on hospital maps Additional signage at lifts, corridor junctions Identification at department entrance 5.6 Security Requirements Data Security The service will be delivered in accordance with and compliance to the Trust s IT Policies Information sharing agreements will be drawn up to cover all data sharing outside the Trust in accordance with the Trust data sharing policy 8

9 Hospital information/patient data will only be downloaded onto devices provided by the Trust which are encrypted Databases will be registered on the Trust database of databases A data mapping form will be completed for all routine data flows leaving the Trust Patient identifiable information will only be sent out of the Trust from an nhs.net account or other secure route (never from an nhs.uk account) Security for Patients The service will be delivered in accordance with and compliance to the Trust s Patient Safety Policies Security for Staff The service will be delivered in accordance with and compliance to the Trust s Lone Worker and Security/Risk Management Policies Medical Records Security All patients medical records will be managed confidentially at all times Medical Records for outpatients are held within the department. In the event of medical records being required within the department, all movement of patient records will be accurately tracked in accordance with the Trust's Case note Tracking Policy 5.7 Manual Handling The service will be delivered in accordance with and compliance to the Trust s Manual Handing Policies. 5.8 Fire Safety The service will be compliant with the Trust s Fire Safety Policy, Fire Evacuation Policy and other local fire plans and procedures The detail of these items will then be developed as part of the separate Fire Safety Work Programme, as led by the Trust s Fire Officer.) 5.9 ICT Requirements Telephones, internal and external; Computers; Printers; Photocopiers / scanner Mobile phone for home visits and on call staff; Access to internet, intranet, PAS, Extramed, Infoflex, Impax, IT support 9

10 6. Staffing 6.1 Staffing Profile Please refer to appendix 4 for detailed staffing profile. 6.2 Training and Education All staff within the department will comply with the Trust s mandatory training programmes and NHSLA requirement. In addition they will have: Access to clinical courses to support specialist knowledge and skills. These will be determined at appraisal in response to individual and service needs; Access to personal and professional development programmes in leadership, communication, stress management etc as identified at appraisal in response to personal and service needs; Access to in-service training programmes within Therapy Department and across the Trust. 6.3 Facilities Staff refreshments restaurant; League of Friends / WRVS coffee shops. Hospital shop Occupational Health 7. Equipment Requirements 7.1 Equipment requiring specific environments Hydrotherapy pool and supporting clinical and changing areas; Assessment kitchens and bathroom, with a range of equipment to adapt the areas so that the abilities and equipment needs of patients with disabilities can be assessed; Assessment stairs, adjustable rails and varied step height; Access to controllable outside environment including kerbs, even and uneven pavement and not paved surfaces. 7.2 Emergency Resuscitation trolley and equipment; O2 cylinders with safe storage; First aid. 7.3 Aids to mobility and independence and suitable storage Walking aids; Parallel bars; 10

11 Pneumatic post amputation mobility aids; Transfer boards; Wheelchairs; Loan equipment to facilitate activities of daily living. 7.4 Manual handling Hoists Patient Assisted Transfer Slides (pat slides) transfer sheets etc 7.5 Seating and treatment surfaces Chairs for waiting and clinical areas, variety of designs and heights; Treatment couches, hydraulic; Mats and mobile storage rack; Standing frames; Small tables. 7.6 Patient assessment Measuring devices; Equipment for practicing activities of daily living; Technology based assessment devices. 7.7 Treatment and rehabilitation Electrotherapy; Wax bath; Range of movement e.g. continuous passive movement machines; CV training e.g. static cycles, cross trainer, treadmill (inc un-weighting system), trampette, steps; Power training, e.g. resistance equipment; Balance / co-ordination training e.g. wobble boards, Wii, small equipment; Respiratory treatment and support equipment and disposables with suitable storage; Taping and dressings etc. 7.8 Personal and people development IT, including laptop, projector and screen; Flip chart supports; Sufficient seating and tables; Anatomical models and charts; Equipment for hands on training including exemplars and inactivated small equipment; Storage for copious reference materials. 7.9 Cleaning Equipment for cleaning the environment and clinical equipment 11

12 7.10 Housekeeping General facilities for staff areas, kitchen, changing, security etc. 8. Infection Prevention 8.1 The service will be delivered in accordance with and compliance to the Trust s Infection Prevention Policies. 9. Equality and Diversity 9.1 The Trust is committed to commit to the provision of a service that is fair, accessible and meets the needs of all individuals. This service is accessible to disabled users. 10. Contingency 10.1 External Major Incident Outpatient therapy department closes. Gym area used as areas for patients awaiting transport away from the hospital. Staff released to assist in other areas as required Internal Major Incident High levels of staff illness, outpatient department closed. Therapists flex to cover emergency activity as priority IT failure Paper copies of appointment diaries for outpatient department. Telephone messages fully recorded for response as soon as system recovers. 11. Auditing this Policy 11.1 Annual review by General Manager in discussion with Head of Therapies / Lead Therapists. Audit information will be shared at the bilateral meeting. 12

13 12. Responsibilities 12.1 The General Manager for Medicine is operationally and financially accountable for service delivery The Therapy team will remain professionally accountable for their actions. They will work in conjunction with the General Manager to ensure that the service is delivered within the confines of the agreed budge and operational requirements Physiotherapists and Occupational Therapists are professionally regulated by the Health Professions Council. They work to professional standards set by the Chartered Society of Physiotherapy and the College of Occupational Therapists. 13. References 13.1 All Trust Polices as mentioned within this document Professional Standards as mentioned within this document. 13

14 Appendix 1 - Emergency Work Flows 14

15 Appendix 2 - Elective Pre-assessment Flows 15

16 Appendix 3 - Outpatient Work Flows 16

17 Appendix 4 - Therapy Services Staffing Profile OUT PATIENT SERVICE TITLE GRADE WTE Acting Lead Therapist Band 8 Full time ESP Physio Band 8 Full time ESP Physio Band 8 Part time 22.5 hours Physiotherapist Band 7 Full time Physiotherapist Band 6 Full time Physiotherapist Band 6 Full time Physiotherapist Band 6 Part time term time only Physiotherapist [rotational] Band 5 Full time Physiotherapist [rotational] Band 5 Full time Assistant Band 3 Part time 23.5 hours Assistant Band 3 Part time 20 hours Head Receptionist Band 3 Part time 26.5 Receptionist Band 2 Full time PA/Secretary Band 3 Part time 26 hours ORTHOPAEDIC SERVICE TITLE GRADE WTE Lead Therapist Band 8 Full time Physiotherapist Band 7 Full time Physiotherapist Band 6 Full time Physiotherapist [rotational] Band 5 Full time Physiotherapist [rotational] Band 5 Full time vacant Occupational Therapist Band 7 Part time 31.5 hours Occupational Therapist [rotational] Band 5 Full time Senior Assistant Band 4 Full time Assistant Band 3 Part time hours Assistant Band 3 Part time 23 hours Assistant Band 3 Part time 20 hours Assistant [weekends] Band 3 Part time 14.5 hours 17

18 SURGICAL AND RESPIRATORY SERVICE TITLE GRADE WTE Lead Therapist Band 8 Full time Physiotherapist Band 7 Part time 18.5 hours Physiotherapist Band 7 Part time 18 hours Physiotherapist Band 6 Part time 15 hours Physiotherapist Band 6 Part time 22.5 hours Physiotherapist [rotational] Band 5 Full time Physiotherapist [rotational] Band 5 Full time Occupational Therapist Band 7 Part time 24.5 hours Occupational Therapist Band 7 Part time 21.5 hours Lead Therapist Band 8 Full time Physiotherapist Band 6 Part time annualised hours Assistant Band 3 Part time 15 hours MEDICAL SERVICE TITLE GRADE WTE Lead Therapist Band 8 Full time Physiotherapist Band 7 Full time Physiotherapist Band 7 Part time 22.5 hours Physiotherapist [also Neuro OP] Band 6 Full time Physiotherapist Band 6 Full time Physiotherapist [rotational] Band 5 Full time Physiotherapist [rotational] Band 5 Full time Physiotherapist [rotational] Band 5 Part time 15 hours Physiotherapist [rotational] Band 5 Part time 22.5 hours Occupational Therapist Band 7 Full time Occupational Therapist [also Rheu OP] Band 7 Part time 34 hours Occupational Therapist Band 6 Full time Occupational Therapist Band 6 Full time Occupational Therapist Band 6 Full time Occupational Therapist [rotational] Band 5 Full time Occupational Therapist [rotational] Band 5 Full time Assistant Band 3 Part time 35 hours ROTATIONAL POSTS ST ANDREWS TITLE GRADE WTE Physiotherapist Band 5 Full time Occupational Therapist Band 5 Full time 18