Reflection on outreach with the occupational therapist

I shadowed the occupational therapist (OT) on one of his session to assess a patient in my placement ward. A 91 years old male who came into hospital presenting vomiting and unsteadiness on feet. The patient mobilised with a Zimmer frame with minimal supervision. Before the patient’s assessment began, the OT introduced himself and maintained privacy and dignity all through and gained his consent. The OT began his assessment by asking the patient a couple of questions(background assessment- basically to gain understanding of patients baseline, environment and how patient have been managing before admission). Patient reported that he was responsible for his day to day care as he cooked for himself, did his own laundry, shopping and manages his own. He reported that he only had a cleaner coming in once a week to help. Patient reported to be feeling a little bit wobbly walking. The OT assessed patient functionally by telling him to mobilise to the toilet(toilet transfer) and also getting in and out of bed(bed transfer) so he can observe him. This was aimed to determine how much help patient will require when discharged back home and in other to ensure safe discharge. The OT explained to the patient that this assessment is necessary to determine the need for a package of care. Patient was asked if he would like carers helping him with his shopping, laundry and some basic needs and he responded affirmatively, he reported that he does not know how he was going to manage when he returns home, hence will probably need help till he gets better on his feet. The OT explained to him that he can have up to a maximum of four visits a day but patient said he will only require three visits daily. OT also recommended red cross referral for shopping when patient reported that he was worried about how he is going to do his shopping, patient consented for OT to send a red cross referral. OT advised that patient will be issued a frame to assist him with his mobility and also community therapy referral will be sent aiming at progressing him back to his mobility baseline. Patient reported happy with OT for his help. OT gained patient’s consent to send referral for POC, patient consented for POC. OT advised that patient will be discharged as soon as POC is confirmed

Practice Supervisor’s comments:

 

Rita has shown thorough understanding for the need of an occupational therapy assessment for patients having problems with their mobility. She understands that these assessments ensures a personalised treatment for patients taking into account their exact needs with the aim of promoting their overall wellbeing.

CIWA assessment reflection

A 52 years old male was admitted in my ward presenting acute confusion from GHB drug withdrawal, had a fall at home resulting in humeral fracture. Before rendering care to him, I introduced myself, gained consent and maintained privacy and dignity all through. The patient appeared agitated and unsettled when the shift started, and was assigned enhanced care where he had one to one care. Patient was presenting symptoms of confusion, hallucination and was sweaty and tremulous. Patient was on an hourly CIWA score to assess and manage his withdrawal symptoms. During the CIWA assessment, factors such as the patients anxiety, nausea and tremors were evaluated to guide treatments of his undergoing drug detoxification. Patient had a prescription of diazepam with a start dose of 10mg. In the morning he was administered with 10mg dosage of diazepam. Under supervision, on one of the hourly rounds of his CIWA assessments, I asked patient if he was aware of his environment. He seemed confused at that point as he was not sure of his environment. I asked patient if he knew the date and day, his response was negative as he gave me a wrong date and day. Patients mouth appeared dry so I offered him water but he seemed drowsy and unresponsive. The staff nurse and I started calling out his name loudly with no response. The emergency bell was immediately pressed to alert doctors and all staff members. Patient was put on a high flow oxygen 10L via non-rebreathe mask and he was saturating at 100%. I quickly observed his vital signs and monitored it. Patients vital were within range. I undertook patients blood glucose levels and it read 5.7mmol/L which was within patients range. Patient became responsive, alert and started talking. Patients observations were rechecked fifteen minutes after and were within range. Patient was assessed and reviewed by doctors and the DASS team. ECG was done and results reported to the doctor.

I understood the CIWA assessment tool as I was able to evaluate the patient by assessing the severity of GHB withdrawal symptoms. I learnt that a patient scoring between 0-8 meant minimal to no withdrawal, 9-15 meant mild withdrawal and close monitoring will be needed. Scoring between 16-21 meant moderate withdrawal and interventions and referral may be required. Scoring above 21 meant severe withdrawal and medical intervention will be needed. Understanding the scoring scale help to know what interventions to give patients in managing the addictions.

Practice Supervisor’s comments:

 

Rita understand the CIWAS tool and was able to alert as soon as the patient was not responding. She was able to manage the situation professionally as well as very proactive.