self-service training slides part 2 of 2 · 2a splinting upper limb - score 2 – do not enter...

Self-service Training slides

Part 2 of 2

Versions of therapy dependency tool

General rules for scoring

Descriptions for each item on tool

Scenarios for each Section of tool

2 adult versions Physical –used in rehabilitations units for patients with severe physical impairments

+/- mild-moderate cognitive/behavioural impairment Tool contains both physical and cognitive therapy interventions

Cognitive – used in rehabilitation units for patients with severe cognitive/behavioural impairments +/- mild-moderate physical impairments Tool contains extra items for cognitive/behavioural therapy intervention in addition to

physical items

Use the version most appropriate for your patient population

As a rule of thumb, units use one or other version for all patients

Can choose the alternative option for individual patients if more appropriate

Once a version has been commenced, continue to use the same version throughout the patients stay

The scoring process is the same for both versions

Item descriptions vary in Section A, B & F (these will be explained under the section information that follows)

There are 6 domains on both tools Section A – Physical/handling programme (physical version only) Section A – Medical and risk management (cognitive version only)

Section B – Basic Functions (both versions) Section C – Activities of Daily living (both versions) Section D – Cognitive/Psychosocial/family support (both versions)

Section E – Preparing for discharge (both versions) Section F – Additional Activities (both versions)

Score each item based on the average therapy

intervention during the previous fortnight

Collect fortnightly during the parallel dataset

collection period for Level 1 & 2 specialist

rehabilitation services

Outside of the parallel dataset period units can

decide locally on frequency of data collection

Did the patient receive

therapy for this item

during the last 2 weeks?

Put in a score of 0 and continue to ask

the same question on the next item

Therapy was provided by

the lead discipline only

Score the item 0-3 (possibly 4)

based on the therapy dependency level criteria (see next slide)


1 discipline but not the

lead discipline

Score the item 0-3 (possibly 4) based on the therapy dependency

level (see next slide) and cross out the lead discipline and write

the discipline involved


more than 1 discipline

Write the average amount of therapy hours provided during the

fortnight for all disciplines. Score 3.5 or 4 (see below)

1/1a &1 b.

Medical/Psychiatric

Management.

If therapy time was

5 hours or less

score 3.5

otherwise score 4

7. Nutrition

If therapy time was 2

hours or less score

3.5 otherwise score 4

All items except 1, 1b, 4, 7 or 21 (see below)

If therapy time was 4 hours or less score 3.5 otherwise score 4

4. Risk (cognitive)

If therapy time was 6

hours or less score

3.5 otherwise score 4

Start at “Medical Management” on the NPTDA tool and work

through each item following these guidelines

Yes

Yes

Yes No

No

Yes

No

Start here

21. Community/home visits

If therapy time was 6 hours

or less score 3.5 otherwise

score 4

Score Level Description

0 None No intervention • Intervention not relevant or • No planned therapy at the current time

1 Low Minimal intervention or Review only (<1 hour per week) e.g. • Single short intervention or • Brief checks only

2 Medium Medium intervention requiring single therapist or assistant only e.g. • Detailed assessment possibly in several sessions or • Medium intervention by a single therapist or • More frequent intervention, but by an assistant only

3 High Intensive intervention requiring additional time or extra pair of skilled hands e.g. • Increased frequency or duration of session from a skilled therapist or • Combined input from therapist and assistant (some sessions)or • Two qualified therapists for 1-2 sessions

3.5 ID Occasional inter-disciplinary (ID) intervention (normally ≤4hours)

• One-off or occasional inter-disciplinary session/intervention

4 Complex Complex intervention requiring regular ID intervention or at very high intensity (total >4 hours/week) e.g. • Two or more disciplines working in close co-ordination i.e usually together in

the same session or in very close collaboration with regularly debriefing/ discussion or

• Combined input from therapist and assistant (all sessions)or • Two qualified therapists from the same discipline for ≥3 sessions or • Very intensive intervention from a single therapist

Section A – Physical version

Physical/handling programme

1. Medical Management

2a. Splinting upper limb

2b. Splinting lower limb

3. Seating/wheelchair

4. Physical therapy:

active/passive handling

Section A – Cognitive version

Medical and Risk management

1a. Medical Management

1b. Psychiatric Management

2. Mental capacity and legal issues

3. Management under Mental

Health Act (MHA)

4. Risk

Relevant to both versions of the tool Lead discipline – Doctors (Docs)

Scores of 3.5 not appropriate (not an interdisciplinary item)

Score based on the previous fortnightly intervention

Hours per week = average fortnightly hours

Score Input Approx

Time

(hours/wk)

Description

0 None 0 Medically stable – no medical intervention other than routine

review or prescribing

1 Low Less than 1 Minimal intervention – e.g. assessment/chasing up results

2 Medium 2-3 Basic intervention – investigations/treatment for active medical

condition

3 High 4-5 Higher intervention – more intense/higher level

investigations/treatment for active or acute medical condition

4 Complex More than 5 Complex/acute medical condition requiring specialist intervention

or very high intensity input

Relevant to physical version of the tool Lead discipline – Occupational Therapist (OT)



Score Input Approx.

Time

(hours/wk)

Description

0 None 0 Not relevant or no planned therapy at the current time

1 Low Less than 1 Minimal intervention or review only: e.g. has satisfactory splints

requiring occasional checks

2 Medium 1-2 Basic intervention for assessment or adjustment of

splints/orthotics

3 High 3-4 Higher intervention – more intense input or additional time/extra

skilled hands for splint making/adjustment

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for upper limb splinting/orthotics

4 Complex More than 4 Complex splinting problem requiring interdisciplinary

intervention or very high intensity input

Relevant to physical version of the tool Lead discipline – Physiotherapist (PT)



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention or review only: e.g. has satisfactory splints

requiring occasional checks

2 Medium 1-2 Basic intervention for assessment or adjustment of

splints/orthotics


skilled hands for splint making/adjustment

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for lower limb splinting/orthotics

4 Complex More than 4 Complex splinting problem requiring interdisciplinary


Relevant to physical version of the tool Lead discipline – Occupational Therapist (OT)



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention or review only: e.g. has satisfactory seating

system requiring occasional checks

2 Medium 1-2 Basic intervention e.g. adjust seating, practice manoeuvring

chair or chase wheelchair order


skilled hands for positioning for demanding seating problem

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for seating/wheelchair

4 Complex More than 4 Complex seating problem requiring interdisciplinary intervention



Excludes time for splints/orthotics or inter-disciplinary seating review



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention or review only: e.g. established programme

undertaken by nursing/care staff or self exercise programme

2 Medium 2-3 Basic maintenance therapy or posture management/stretching

programme

3 High 4-5 Higher intervention – more intensive programme by one

qualified physiotherapist +/- occasional extra pair of hands

3.5 Inter-

disciplinary

5 or less Inter-disciplinary intervention for physical therapy

4 Complex More than 5 Complex physical problems requiring inter-disciplinary


Scenario A - physical.

Mr Popple has been on the unit for 2 weeks. Nursing staff alerted the medical team that his consciousness level appears to have declined over the past 24 hours; the medics have completed a full examination and agree that there is a significant unexplained decline and are actively organising repeat bloods, urgent CT/MRI scans and review by the neurologists; they have also liaised with the referring hospital for previous scans to be shared and have spoken with Mr Popple’s family.

During the 2 weeks he has been on the unit the therapy team were providing a full therapy programme –including assessment of Mr Popple’s positioning needs by his treating physiotherapist and development of postural management guidelines with dissemination of information to the nursing team. The bilateral hand splints were deemed suitable by the treating OT. Leg splints were not required.

One physio and 1 OT have been working together across 4 x ½ hour sessions to provide an adequate seating system with appropriate head, arm and lower limb supports, this has been challenging due to poor head and trunk control.

1. Medical Management – score 4 – complex intervention Medics would have completed routine clerking in week one and now this

active acute medical management phase has occurred. This would be complex management for this fortnightly period

2a. Splinting upper limb – score 2 – Medium intervention OT’s completed an assessment to check splints were appropriate

2b. Splinting lower limb – score 0 – No intervention

3. Seating/wheelchair – score 3.5 – Inter-disciplinary intervention requires 4 x ½ hour sessions = 2 hours per therapist during the fortnight ÷ 2

(weeks) = 1 hour for the physio and the same for the OT (this will need to be entered on to score sheet – see next slide) therefore a score of 3.5 is appropriate.

4. Physical therapy – score 3 – High intervention Postural management assessed, Guideline produced, dissemination to

nursing team

1. Medical Management – score 4 For most items on the NPTDA score sheet the average weekly hours would need to be

entered for a score of 4. This rule differs for Medical management (and 17. Emotional load on staff

– this will be covered later) where the algorithm within the software automatically assigns hours

2a Splinting Upper limb - Score 2 – do not enter hours, computer algorithm will assign

2b Splinting Lower limb - Score 0 – No hours 3 Seating – Score 3.5 average fortnightly hours need to be entered

so 4 x ½ sessions = 2 hours per therapist during the fortnight – so the average (2hrs/2 weeks) is 1 hour per therapist. Enter 1 for both the PT and OT. As 2 hours were spent a score of 3.5 is correct (remember a score of 4 has to have more than 4 hours for this item)

4. Physical therapy Score 3 – do not enter hours, computer algorithm will assign

Lead

Discipline

Score P/T O/T SLT Psych S/W Doc Diet Nurse Asst Vol

Doc 4

O/T 2

P/T 0

O/T 3.5 1 1

P/T 3

A. Physical / handling programme

1. Medical management

2a Splinting /orthotics (inc FES) Upper limb

2b Splinting /orthotics (inc FES) Lower limb

3. Seating / wheel-chair

4. Physical therapy: active/passive handling

Relevant to both versions of the tool Lead discipline – Doctors (Doc)

Scores of 3.5 not appropriate (not an inter-disciplinary item)



Score Input Approx

Time

(hours/wk)

Description

0 None 0 Medically stable – no medical intervention other than routine


1 Low Less than 1 Minimal intervention – e.g assessment/chasing up results

2 Medium 2-3 Basic intervention – investigations/treatment for active medical

condition


investigations/treatment for active or acute medical condition

4 Complex More than 5 Complex/acute medical condition requiring specialist intervention


Relevant to cognitive version of the tool Lead discipline – Doctors (Doc)

Scores of 3.5 not appropriate (not an inter-disciplinary item)



Score Input Approx

Time

(hours/wk)

Description

0 None 0 Medically stable – no psychiatric intervention other than routine


1 Low Less than 1 Minimal intervention – e.g. assessment/chasing up results

2 Medium 2-3 Basic intervention – investigations/treatment for active psychiatric

condition


investigations/treatment for active or acute psychiatric condition

4 Complex More than 5 Complex/acute psychiatric condition requiring specialist intervention





Score Input Approx.

Time

(hours/wk)

Description

0 None 0 Not relevant – has full capacity – no legal issues

1 Low Less than 1 Minimal intervention or review only (e.g. lacks capacity or on-

going legal issues, not currently requiring active intervention)

2 Medium 1-2 Basic intervention – capacity or legal issues requiring

engagement of one discipline only

3 High 3-4 Higher intervention – more intense input or additional time

required: more complex capacity or legal issues requiring more

time or senior level intervention (e.g. for external legal advice)

3.5 Inter-

disciplinary

4 or less Inter-disciplinary team engagement in capacity or legal issues

(e.g. for assessment of capacity or facilitation of choice)

4 Complex More than 4 Complex capacity or legal issues requiring inter-disciplinary




Hours per week = average fortnightly hours Score Input Approx.

Time

(hours/wk)

Description

0 None 0 Not relevant or no planned therapy intervention at current time

1 Low Less than 1 Minimal intervention or review only (e.g. managed under MHA

section but not currently requiring assessment or review)

2 Medium 1-2 Basic intervention e.g. managed under MHA section and

requiring review/occasional enforcement

3 High 3-4 Higher intervention – more intense input or additional time:

requires evaluation for assessment/treatment under section

requiring external assessor/co-signatory

3.5 Inter-

disciplinary

4 or less Inter-disciplinary team engagement in review/enforcement of

MHA section

4 Complex More than 4 Complex MHA section issues requiring interdisciplinary

intervention, or very high intensity

Relevant to cognitive version of the tool Lead discipline – Nursing



Score Input Approx.

Time

(hours/wk)

Description

0 None 0 Not relevant or no significant risk issues

1 Low Less than 2 Minimal intervention or review only: e.g. Medium observations

only – able to go out unescorted

2 Medium 2-4 Basic intervention e.g. Medium observations but requires

escorting when outside the unit

3 High 5-6 Higher intervention – more intense input or additional time:

above Medium observations as well as escorting outside unit

3.5 Inter-

disciplinary

6 or less Inter-disciplinary intervention to manage risk issues e.g.

management of patients refusal to accept escort outside unit

4 Complex More than 6 Complex or very high risk requiring constant 1:1 supervision or

very intensive inter-disciplinary team intervention to contain risk

Scenario A - Cognitive.

Since Mr Gray has been on the cognitive/behavioural unit he has continued to show greater insight into his impairments and limitations. His family request that he signs the financial power of attorney form permitting them to manage his affairs whilst he is unable to do so.

The treating team are pleased with his progress but are unsure if he has sufficient understanding to sign the power of attorney form – the psychologist and medic completed a full capacity assessment over 2 planned 1 hour sessions. The final comprehensive findings were documented and circulated to the relevant parties.

During the fortnight the nursing team noticed that Mr Gray was becoming more anxious, agitated and disorientated and were concerned for his safety when off the unit (management on the unit was unchanged) – therefore they had increased their supervision to ensure he did not leave the unit unaccompanied; the medical team chased up blood results to establish the possible reason for this change in behaviour

1a. Medical Management – Score 1 – Low intervention – do not enter hours Minimal intervention at this stage – chasing blood results only

1b. Psychiatric management - Score 0 – No hours

2. Mental capacity and legal issues - Score 3.5 (Inter-disciplinary intervention) average fortnightly hours need to be entered so 2 x 1 hr sessions = 2 hours per therapist during the fortnight – so the average (2hrs/2 weeks) is 1 hour

per therapist. Enter 1 for both the Psychologist and Medic. As 2 hours were spent a score of 3.5 is correct (remember a score of 4 has to have more than 4 hours for this item)

the documentation of the capacity assessment will captured in Section F item 24

3. Management under MHA section- Score 0 – No hours

4. Risk – Score 2 – Medium intervention - do not enter hours Supervised off unit but routine observations on unit (this level of intervention would not be captured on

nursing dependency as does not require 1:1 all the time so can be captured on the therapy assessment)

Lead

Discipline

A. Medical and risk management Score P/T O/T SLT Psych S/W Doc Diet Nurse Asst Vol

1a Medical management Doc 1

1b Psychiatric management Doc 0

2. Mental capacity and legal issues Doc 3.5 1 1

3. Management under MHA section Doc 0

4. Risk Nurse 2

Section B – Physical version

Basic Function

5. Respiratory/Tracheostomy

Management

6. Swallowing

7. Nutrition

8. Supported Communication

9. Speech and Language

Section B – Cognitive version

Basic Function

5. Physical Management

6. Swallowing

7. Nutrition

8. Supported Communication

9. Speech and Language




Score Input Approx.

Time

(hours/wk)

Description

0 None 0 Not relevant or no intervention

1 Low Less than 1 Minimal intervention or review only e.g. stable tracheostomy or

brief one-off intervention

2 Medium 1-2 Basic or regular intervention e.g. supervision of weaning

programme

3 High 3-4 Higher intervention – more intense input or additional time for

demanding tracheostomy problems

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for tracheostomy management

4 Complex More than 4 Complex tracheostomy issues requiring interdisciplinary


Relevant to both versions of the tool Lead discipline – Speech and Language Therapist (SLT)



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention e.g. review of stable dysphagia or

monitoring at meal-times by assistant only

2 Medium 1-2 Basic intervention e.g. planned regular sessions by SLT for

changing consistency of diet

3 High 3-4 Higher intervention – more intense SLT input or additional time

e.g. for swallowing/feeding interventions, blue dye or

videofluoroscopy

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for swallowing

4 Complex More than 4 Complex swallowing issues requiring interdisciplinary


Relevant to both versions of the tool Lead discipline – Dietitian (Diet)



Score Input Approx.

Time

(hours/wk)

Description


1 Low 0.5 Minimal intervention e.g. review of stable diet, weekly weight

check

2 Medium Less than 1 Basic intervention e.g. regular sessions and/or liaison with

kitchen/other team members

3 High 1-2 Higher intervention – more intense dietetic input or additional

time e.g. for monitoring enteral feeding/special diet

3.5 Inter-

disciplinary

2 or less Inter-disciplinary intervention for nutrition

4 Complex More than 2 Complex nutrition issues involving daily liaison with multi-

disciplinary team, kitchen/community liaison or very high

intensity input




Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention e.g. review of established communication

aid/supported communication

2 Medium 1-2 Basic intervention e.g. Assessment/adjustment of

communication aid/programme or by assistant only


to establish communication aid/programme

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for supported communication

4 Complex More than 4 Complex communication needs requiring inter-disciplinary





Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention e.g. review of self-monitored programme

2 Medium 1-2 Basic intervention for speech/language problems with short

preparation time, or by assistant only


e.g increased preparation time

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for speech and language

4 Complex More than 4 Complex speech and language issues requiring

inter-disciplinary intervention or very high intensity input

There is a difference between the physical and

cognitive versions of the tool for Item 5.

Cognitive version – item 5 is Physical

management – (see next slide)

All remaining items in Section B are identical for

both physical and cognitive versions of the NPTDA

tool (see previous slides)

Relevant to both versions of the tool (item 4 on physical version)

Lead discipline – Physiotherapist (PT)

Includes physiotherapy, seating, wheelchairs & splinting)



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention or review only: eg established programme

undertaken by nursing/care staff or self exercise programme

2 Medium 2-3 Basic maintenance therapy or posture management/stretching

programme

3 High 4-5 Higher intervention – more intensive programme by one

qualified physiotherapist +/- occasional extra pair of hands

3.5 Inter-

disciplinary

5 or less Inter-disciplinary intervention for physical therapy

4 Complex More than 5 Complex physical problems requiring inter-disciplinary


Scenario B.

Mrs Kaur has been on the unit for 6 weeks – her tracheostomy continues to

get frequent mucus blocks; normally these are managed by the nursing team

with daily sessions from the physiotherapist, but during the last fortnight the

physiotherapist has also provided unplanned intervention.

She continues to receive all her nutrition via the PEG and received close

monitoring of her dietary requirements from the dietitian during the last

fortnight – Mrs Kaur is currently underweight.

The speech therapist had 2 x 1 hour sessions to try various communication

aids to facilitate Mrs Kaur being able to express her basic needs.

5. Respiratory/Tracheostomy management – Score 3 –High intervention - do not enter hours Daily sessions + unplanned management

6. Swallowing - Score 0 – No hours

7. Nutrition - Score 3 – High intervention - do not enter hours Close monitoring suggests more than medium intervention

8. Supported communication – Score 2 – Medium intervention – do not enter hours

9. Speech and language interventions - Score 0 – No hours

P/T O/T SLT Psych S/W Doc Diet Nurse Asst Vol

5. Respiratory/Tracheostomy management P/T 3

6. Swallowing SLT 0

7. Nutrition Diet 3

8. Supported communication SLT 2

9. Speech and language interventions SLT 0

B. Basic Functions

Section C – Physical & Cognitive

Activities of daily living

10. Personal/self-care

11. Domestic/community based

activities

12. Vocational/leisure/use of

computers for work or leisure

Relevant to both versions of the tool

Lead discipline – Occupational Therapist (OT)



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention e.g. review of self-monitored personal care

programme or undertaken by carers

2 Medium 2-3 Basic intervention for practice in personal care (ADL), or by

assistant only

3 High 4-5 Higher intervention – more intense input or additional time e.g.

extra hands from Occupational Therapy Assistant (OTA) or time

for cognitive issues

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for personal/self-care

4 Complex More than 4 Complex intervention for personal care/ADL requiring

interdisciplinary intervention or very high intensity input

Relevant to both versions of the tool Lead discipline – Occupational Therapist (OT)



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention e.g. review of self-monitored programme of

EADL

2 Medium 1-2 Basic intervention for supervised practice, or by occupational

therapy assistant (OTA) only

3 High 3-4 Higher intervention – more intense OT input or additional time

e.g. extra hands from OTA or time for cognitive issues

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for domestic/community based

activities

4 Complex More than 4 Complex intervention for EADL requiring interdisciplinary


Relevant to both versions of the tool Lead discipline – Occupational Therapist (OT)



Score Input Approx.

Time

(hours/wk)

Description

0 None 0 Not problems identified or no intervention

1 Low Less than 1 Minimal intervention towards vocational issues or review only

e.g. self-monitored programme

2 Medium 1-2 Basic intervention on work preparation/liaison with relevant

agencies/computer skills etc.

3 High 3-4 Higher intervention – more intense input or additional time in

computer work preparation/liaison with employers and relevant

agencies etc.

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for vocational/leisure

4 Complex More than 4 Complex vocational issues requiring inter-disciplinary

intervention or very high intensity input/work place visits

Scenario C.

Mrs Grundy has been receiving rehabilitation for 2 months and plans for her

discharge are being explored. She is keen to return home and care for herself,

her husband and her 2 children.

In the hospital she is independent using the “walk-in” shower but at home she

will need to use the bath. The physiotherapist has been practising bath

transfers with her during the past fortnight and the Occupational Therapy

Assistant has had 3 short sessions each week for dressing practise which Mrs

Grundy is getting much better at.

Last week she had 1 x 1hour session in the kitchen with the OT to assess her

ability to make a cup of tea and slice of toast (using a toaster). Mrs Grundy

hopes to progress to making a full meal prior to discharge.

10. Personal/self care – Score 2 - Medium intervention - do not enter hours The bath transfer by physiotherapist would be scored under item

4(physical tool) or 5(cognitive tool) – Physical therapy Dressing practise with OTA

11. Domestic/ community based activities - Score 1 – Low intervention - do not enter hours 1 session only during the fortnightly reporting period

12. Vocational/leisure/computers/driving - Score 0 - no hours


O/T 2

O/T 1

O/T 0

C. Activities of daily living

10. Personal / self-care

11. Domestic / community based activities

12. Vocational / leisure / computers / driving

Section D – Physical & Cognitive

Cognitive/psychosocial and family support

13. Cognitive Interventions

14. Behaviour Management

15. Emotional/Mood

16. Formal family support

17. Emotional load on staff

Relevant to both versions of the tool Lead discipline – Psychologist



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal cognitive intervention or review only e.g. self-monitored

programme

2 Medium 1-2 Basic psychology review or assessment by assistant only

3 High 3-4 Higher intervention – more intensive intervention or assessment

requiring additional time for cognitive training.

3.5 Inter-

disciplinary

4 or less Inter-disciplinary cognitive intervention

4 Complex More than 4 Complex cognitive issues requiring inter-disciplinary intervention





Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal behavioural intervention or review of established

programme

2 Medium 1-2 Basic intervention e.g. review and monitoring of on-going

programme or intervention by assistant only


requiring additional time for behavioural management.

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for behaviour management

4 Complex More than 4 Complex behavioural problems requiring inter-disciplinary





Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention e.g. psychology review or assessment by

assistant only

2 Medium 1-2 Basic intervention for assessment or regular intervention for

support/counselling etc.


requiring additional time for support/counselling

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for emotional/mood issues

4 Complex More than 4 Complex emotional problems requiring inter-disciplinary



Includes counselling etc. to specifically support family members’ needs



Score Input Approx.

Time

(hours/wk)

Description


1 Low Less than 1 Minimal intervention e.g. one-off support session, review

meeting or support by assistant only

2 Medium 1-2 Basic intervention for assessment of support needs or regular

intervention for support/counselling etc.


requiring additional time for support/counselling

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for formal family support

4 Complex More than 4 Complex family support needs requiring inter-disciplinary



Score based on the previous fortnightly intervention Score based on staff coping levels – score the highest load e.g.

keyworker or nurses may be struggling with load No score of 3.5 allocated to this item

Score Input Approx.

Time

(hours/wk)

Description

0 None 0 No load at all, staff look forward to sessions

1 Low 0 Mild emotional load – but staff coping well

2 Medium 0 Moderate emotional load – requires preventative strategies to

support or relieve staff

3 High 0 Severe emotional load – requiring active intervention to support

or relieve staff

4 Complex 0 Extreme emotional load – staff at breaking point

Scenario D

Mr Oke is emerging from a low awareness state but continues to have 1 x ½ hour session a fortnight for formal evaluation of his cognitive state using the Wessex Head Injury Matrix (WHIM) assessment. This was completed by a PT/OTA/SLT in week 2.

During this emerging phase he is becoming physically aggressive towards staff and family. The psychology team are monitoring trigger factors for these behaviours (this fortnight) by reviewing behaviour charts completed by the nursing team with a view to producing guidelines on management next week.

This change in behaviour is upsetting the family and they are struggling to cope with this phase of his rehabilitation as it is completely opposite to his pre-morbid behaviour. They have started attending the family and friends support group and have had one session with the psychology assistant.

The nursing staff have expressed difficulties in coping with his behaviour and the constant daily questions/unrealistic demands from the family.

13. Cognitive interventions – Score 3.5 – Inter-disciplinary intervention - enter fortnightly average hours Psychology were not involved in intervention Average hours = 0.25 as during both weeks the total time spent by each discipline was ½

hour Assistant hours can be entered for scores of 3.5 and 4

14. Behavioural management - Score 2 – Medium intervention - do not enter hours Still completing assessments/review of triggers

15. Emotional/mood - Score 0 - no hours 16. Formal family support – Score 1- Minimal intervention

one-off session with assistant Family/friends group will be scored under “groups”

17. Emotional load on staff – Score 2 – Medium intervention Nurses are experiencing some difficulties needing support


Psych 3.5 0.25 0.25 0.25

Psych 2

Psych 0

Psych 1

Psych 2

D. Cognitive/Psychosocial/family support

13. Cognitive interventions

14, Behavioural management

15. Emotional / Mood

16. Formal family support

17. Emotional load on staff

Section E – Physical & Cognitive

Preparing for Discharge

18. Discharge Planning

19. Benefits/finances

20. Equipment/adaptation provision

21. Community/home visits

22. Key Working

Relevant to both versions of the tool Lead discipline – Social Worker (SW)

Includes housing, placement and care issues Score based on the previous fortnightly intervention Hours per week = average fortnightly hours

Score Input Approx.

Time

(hours/wk)

Description

0 None 0 No problems identified with discharge planning, no intervention

1 Low Less than 1 Minimal intervention or assessment towards discharge planning

2 Medium 1-2 Basic intervention towards discharge planning/liaison/funding

negotiations


requiring additional time for discharge planning/liaison

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for discharge planning

4 Complex More than 4 Complex discharge planning issues requiring inter-disciplinary


Relevant to both versions of the tool Lead discipline – Social Worker (SW)



Score Input Approx.

Time

(hours/wk)

Description

0 None 0 No problems identified, no intervention

1 Low Less than 1 Minimal intervention for benefits/financial issues

2 Medium 1-2 Basic intervention for completion of benefit applications etc. or

by assistant only

3 High 3-4 Higher intervention – more intensive intervention or additional

time for chasing up benefits/financial management

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for benefits/finance

4 Complex More than 4 Complex benefits or financial issues requiring inter-disciplinary


Relevant to both versions of the tool Lead discipline – Occupational Therapy (OT)



Score Input Approx.

Time

(hours/wk)

Description

0 None 0 No equipment /adaptations required, no intervention

1 Low Less than 1 Minimal intervention for equipment or adaptation

needs/provision

2 Medium 1-2 Basic intervention for equipment assessment/ordering/liaison

with equipment agencies or assistant only

3 High 3-4 Higher intervention – more intensive intervention or additional

time for chasing up equipment

3.5 Inter-

disciplinary

4 or less Inter-disciplinary intervention for equipment home/adaptation

4 Complex More than 4 Complex equipment/adaptation needs requiring

inter-disciplinary intervention or very high intensity input

Relevant to both versions of the tool Lead discipline – Occupational Therapy (OT)

Includes journey time Score based on the previous fortnightly intervention Hours = Total hours during fortnight (not average)

Score Input Approx.

Time

(hours)

Description

0 None 0 None planned

1 Quick visit Less than 2 Short visit by one therapist

2 Routine

plus

3-4 Longer visit(s) by one therapist, or requiring assistant

3 Long Visit 5-6 Distant visit by one therapist, or requiring assistant

3.5 Inter-

disciplinary

6 or less Inter-disciplinary community/home visit(s)

4 Complex More than 6 Inter-disciplinary visit involving 2 or more qualified professionals

Relevant to both versions of the tool Lead discipline – Key- worker (discipline to be added to form)



Score Input Approx.

Time

(hours/wk)

Description

0 None 0 No key-worker allocated

1 Low Less than 1 Light key-working duties

2 Medium 1-2 Basic key-working duties

3 High 3-4 Higher intervention – more intensive key-working duties

involving frequent input or additional time

3.5 Inter-

disciplinary

4 or less Inter-disciplinary key-working duties

4 Complex More than 4 Complex or highly intensive key-working duties e.g. challenging

/ very distressed family or complex liaison issues

Scenario E.

Mr Buttercup will be discharged during the middle of next week. The team are busy putting plans in place to ensure a seamless service from the hospital to the community.

The physiotherapist completed a morning home visit with Mr Buttercup to practise transfers in his home environment; OT was also present and assessed the need for additional chair/bed raises and handrails. The OT also made a phone call/sent a fax to the local area OT to arrange installation of equipment.

The OT also arranged for the local private care services to provide 2 calls a day for basic care needs to commence on day of discharge.

Referral for appropriate benefits had been made earlier in his stay but the social work assistant made follow up calls this week to ensure all were being processed. The key-worker (SLT) liaised with the team, family and Mr Buttercup to ensure all discharge paperwork was completed and to review goals and objectives and assess satisfaction with in-patient stay.

18. Planning discharge – Score 2 Medium intervention - do not enter hours

O/T arranged care package – change lead discipline

19. Benefits & finances - Score 1 – Minimal intervention - do not enter hours

short phone call to check on benefit processing

20. Equipment/adaptation - Score 2 – Medium intervention - do not enter hours

phone call/fax for installation of equipment

21. Community/home visit - Score 4 – Complex intervention Morning visit by both PT & OT – record total time spent

22. Key-working - Score 2 – Medium intervention - do not enter hours

Routine intervention


SW O/T 2

SW 1

O/T 2

O/T 4 4 4

SLT 2

21. Community / home visits * (score 4 if >6 hours)

22. Key-working (Indicate discipline)

E. Preparing for discharge

18. Planning discharge / housing / care package

19. Benefits and finances

20. Equipment / adaptation for home

Section F – Physical version

Additional Activities

23. Multi-disciplinary meetings

24. Reports

25. Groups

26. Clinic attendance

Section F – Cognitive version

Medical and Risk management

23. Multi-disciplinary meetings

24. Reports

24a. Serious untoward incident

management

24b. Serious untoward incident report

25. Groups

26. Clinic attendance

Relevant to both versions of the tool No Lead discipline

Include patient specific meetings – e.g. additional meetings to normal routine unit meetings – family meetings, discharge meetings etc.

Do not include ward rounds or goal setting


All disciplines present at meeting to enter hours (prior to calculating score)

Hours = Total hours during the fortnight (not average)

Score Input Approx.

Time

(hours)

Description

0 None 0 No meetings

1 Low 2 hours or

less

Short meeting (may be more than 1 during the fortnight) but

total time does not exceed 2 hours

2 Medium More than 2

hours

Long meeting or more than 1 meeting - total time exceeds 2

hours


Include patient specific reports – additional reports e.g discharge reports, medico-legal reports, SMART reports etc.

Do not include note writing


All disciplines involved in report writing to enter hours (prior to calculating score)


Score Input Approx.

Time

(hours)

Description

0 None 0 No reports

1 Low 2 hours or

less

Short report e.g. transfer letter, or involvement from 1-2

discipline


hours

Long report e.g. discharge report or requires input from 2 or

more disciplines

Relevant to cognitive version of the tool No Lead discipline


All disciplines present during the management of the serious untoward incident to enter hours (prior to calculating score)


Score Input Approx.

Time

(hours)

Description

0 None 0 No serious untoward incident

1 Low 2 hours or

less

Serious untoward incident managed by 1 or more disciplines

and resolved in short time frame


hours

Serious untoward incident managed by 1 or more disciplines

and resolved in a longer time frame

Relevant to cognitive version of the tool No Lead discipline


All disciplines involved in write-up of the serious untoward incident to enter hours (prior to calculating score)


Score Input Approx.

Time

(hours)

Description

0 None 0 No serious untoward incident

1 Low 2 or less Serious untoward incident report completed in short time frame


hours

Serious untoward incident report completed in longer time frame


Score based on the number of groups attended

Hours to be set up in advance for regular groups = Average number of patients in group, weekly group time, number of therapists by discipline

Score Input Approx.

Time

(hours)

Description

0 None 0 No group attendance

1 Low No minimum

or maximum

Attended 1 group

2 Medium No minimum

or maximum

Attended 2 or more different groups


Score based on the number of hours at clinic

Hours to be set up in advance for regular clinics= Average

fortnightly time patient in clinic, number of therapists by discipline

Score Input Approx.

Time

(hours)

Description

0 None 0 No clinic attendance

1 Low 1 hour or

less

Short clinic/departmental visit/s, probably on-site – required

therapy/nurse intervention during clinic assessment


hour

Longer clinic/department visit/s, possibly off-site – required

therapy/nurse intervention during assessment

Scenario F.

Mrs Bambi managed to abscond off the cognitive/behavioural unit. 1 nurse

and a doctor searched the grounds for about 1 hour whilst another member of

the nursing team contacted security and her family. She was found safe and

well and returned to the unit with the assistance of the security guard with

minimal encouragement. Once back on the unit she was settled and observed

on a 1 to 1 basis by the nursing team.

A further hour was spent by all 4 nurses on duty, the doctor and the security

team to complete the reporting process. A formal meeting was held with the

family to explain the situation.

During the latter part of the fortnight Mrs Bambi was able to resume her

weekly attendance at the ½ hour art group with another 3 patients and

attended a 2 hour audiology appointment with the nurse

23. MDT Meeting – Score 0 24. Reports - Score 0

report was for specific SUI

24a. SUI management Score 2 - enter total fortnightly hours 1 hour nurse/doctor looking for patient. ½ of nurse calling family/security The family meeting will be scored on item16 Formal family meeting

24b. SUI reporting - Score 2 - enter total fortnightly hours 4 hours nursing time and 1 hour medical time (security not included as not part of units

funded establishment)

25. Groups – Score 1 Attended Art therapy (see next slide for time allocation)

26. Clinic attendance – Score 1 2 hour appointment but average per week = 1 hour therefore less than 2 hours so scores 1


0

0

24a. SUI - management of incident (Score 2 if >2hrs total) 2 1 1.5

24b. SUI - investigation/reporting incident (Score 2 if >2 hours) 2 1 4

1

1 1

25. Groups / extra therapies (Score 2, if >1 group)

26. Clinic attendance (Score 2, if >2 hrs total)

F. Additional activities

23. Multi-disciplinary meetings* (Score 2, if >2 hrs total)

24. Reports* (Score 2 if > 2 hrs total)

25. Additional therapy activities / groups attended0-2

If 1group attended, score 1 Group Name

No. of pts in

group

Hrs per

week

Tick if in

group (State number of clinicians present at group)

If >1, score 2 Art Therapy 4 0.5 P/T 1 O/T SLT Psych S/W Doc Diet Nurse Assistant 1 Vol

P/T O/T SLT Psych S/W Doc Diet Nurse Assistant Vol





Groups/Clinics All regular groups/clinics should be pre-populated in to the

UK ROC software and the score sheet

Once populated the number of patients/therapists should not

be altered on a fortnightly basis

Review the group/clinic set-up on a quarterly/six-monthly basis

and make any fundamental changes then only

Add-hoc clinic attendance to X-Ray, audiology etc. should be

added during the fortnight that it occurs

26. Clinic attendance 0-2 Clinic Name

Weekly

Time in

Clinic

Tick if in

clinic (State number for each discipline attending)

No clinic Score 0 Audiology 1 P/T O/T SLT Psych S/W Doc Diet 1 Nurse Assistant

If ≤2hr score 1 P/T O/T SLT Psych S/W Doc Diet Nurse Assistant

If >2hr score 2 P/T O/T SLT Psych S/W Doc Diet Nurse Assistant

P/T O/T SLT Psych S/W Doc Diet Nurse Assistant

27. Special Facilities

28.Medical Investigations

29. Medical Procedures

30. Special equipment hire

31. Basic Special equipment

32. Highly Specialist Equipment

These 6 items are tick box responses Indicate all that apply

Add additional items as appropriate

You have now completed Part 2 of the NPTDA

training slides.

If you need any further advice on scoring the tool or

obtaining the software please contact the UK ROC

team

[email protected]

mailto:[email protected]



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