December 12, 2020
Evidence-based information on occupational therapy discharge planning from hundreds of trustworthy sources for health and social care. 488-494. Two scales of confidence: Client confidence Care partner confidence, Eleven scales related to returning to home and managing care: Mobility in home Mobility in the community Bathroom Bedroom Kitchen Household management Medication management Nutrition and diet Skin and wound management Symptom management Leisure. Increased visibility and good communication were the primary focus of the selected action plans. 398-405. and Barras, S. (2007), “Feasibility and results of a randomised pilot study of pre discharge occupational therapy home visits”, BMC Health Services Research, Vol. 77-101, ISSN 1478-0887, available at: http://eprints.uwe.ac.uk/11735. 74 No. 4, pp. This includes the preparation involved prior to visit commencing, the actual visit itself and the follow up required following same. Good practices in survey design step-by-step, Measuring Regulatory Performance: A Practitioner’s Guide to Perception Surveys, Occupational therapy pre discharge home visits: a study from a community hospital, Home assessment of the person environment interaction (HoPE): content validation process, An introduction to economic evaluation in occupational therapy: cost effectiveness of pre discharge home visits after stroke (HOVIS), Willard and Spackman’s Occupational Therapy, Discharge Planning from Hospital to Home (Review), Cochrane Database of Systematic Reviews, Content analysis and thematic analysis: implications for conducting a qualitative descriptive study, Occupational therapy discharge planning for older adults: a protocol for a randomised trial and economic evaluation, Home modification assessments: clinical utility and treatment context, The person- environment- occupational model: a transactive approach to occupational performance, Willard and Spackmans Occupational Therapy, Wolters Kluwer Health/Lippincott Williams and Wilkins, Occupational therapy pre discharge home visits for patients with a stroke (HOVIS): results of a feasibility randomised control trial, https://doi.org/10.1108/IJOT-10-2018-0015, http://creativecommons.org/licences/by/4.0/legalcode, http://dx.doi.org/10.1787/9789264167179-6-en, Follow up referrals to appropriate services, Verbal discussion of recommendations with patient, Written Report completed in 2 working days, Comment on level of support already in situ, Recommend level of social support required on discharge, Contact MDT member to discuss outcome of visit, Detailed measurements of home environment, Pendant alarm-assess if in situ and if operational, Implementation of cognitive/memory strategies, Use of alarm/ security features/ dead bolt, Document patient is medically fit prior to visit, Ability to access community mobility/ IADLs, Provide copy of recommendations for patients, Increase patient and/or family’s confidence. Particular attention was paid to the principles of good survey design especially with regards to the question wording and sequence, with general questions preceding specific questions (McColl et al., 2001). (2008) and Atwal et al. Can he be alone during the day when I work? Occupational therapy predischarge home visits for patients with a stroke: what is national practice? activities of daily living consist of three areas which include personal activities of daily livings or personal activities of daily living (self-care), domestic activities of daily livings or domestic activities of daily living (domestic tasks such as cleaning, meal prep, laundry) and instrumental activities of daily livings or instrumental activities of daily living which refer to activities that are necessary to live independently in the community (shopping, finances, medication management) (Schell et al., 2013). The information will be stored on a password protected computer that can only be accessed by the research team. 4, pp. Basic Rehab Admission Criteria Be able to tolerate 3 hours of therapy daily of 2 or 3 therapies; Occupational (ot) Physical (pt) or Speech (st) Therapies • Have a discharge plan to the community. Progressive community reintegration, consultation with vocational rehabilitation staff, and resources are provided for the client and family. 2, pp. Firstly, staying focused on your recovery always means thinking about transitioning to a lower level of care, reminding your treatment team about your pending discharge will keep them motivated to put together the best possible plan. The Discharge Planning Assessment Tool (DPAT) is an assessment tool designed to strategically guide the occupational therapist in planning and implementing client centered treatment for a successful discharge home. therapy’s role in hospital readmissions, discharge planning and the impact that occupational therapy has on quality of health measures throughout the continuum of care. Published by Emerald Publishing Limited. Information was gathered regarding clinical areas assessed during visits in a Likert scale format. The participants in this study appear to value home visits and cite many benefits of conducting home visits. 85-95. The majority of participants cited changes or decrease in functional or cognitive status as essential criteria to complete a DPHV, “patient must be off functional baseline”. Numerous participants cited the need for increased resources on DPHVs, with many participants highlighting the value of having an OT Assistant present on visits to assist with “measurements, fit equipment, assist patient to mobilise”. They are time consuming, resource intensive and have potential risks factors. Discharge planning in an acute care setting is often a daunting task to a physical therapy student, a new graduate physical therapist and even an experienced physical therapist who is entering the acute care arena for the first time. Sampson, C., James, M., Whitehead, P. and Drummon, A. In today’s health care environment of quick discharges and shortened hospital stays discharge planning has become increasingly important in acute care occupational therapy practice. In a survey of home visit practice in Australia, Lannin et al. 5 No. Atwal, A., Spipotopoulou, G., Stradden, J., Fellow, V., Anako, E., Robinson, L. and McIntyre, A. 3 No. This study aims to investigate current clinical practice during home visits and the value that occupational therapists’ attribute to home visits within an Irish context. Thank you for your interest in the DPAT. OECD (2012), “Good practices in survey design step-by-step”, in Measuring Regulatory Performance: A Practitioner’s Guide to Perception Surveys, OECD Publishing, Paris, available at: http://dx.doi.org/10.1787/9789264167179-6-en. 193-203. It is possible that participants have described the clinical practice they espouse to, as opposed to their routine practice. A pioneering study by Barras et al. Schell, B.A., Gillen, G., Scaffa, M. and Cohn, E.S. While a number of elements make up discharge planning, three basic, but essential, components can help put residents on the path to a timely and successful discharge and transition. 4, pp. The target sites consisted of acute settings, rehabilitation settings and convalescence settings and contained a mix of rural and urban sites. Patient and family having increased confidence and increased insight into care needs and functional deficits was also reported to be a successful outcome of a DPHV. Barras, S., Grimmer-Sommers, K. and May, E. (2010), “Consensus on core/essential and ideal world criteria of a pre-discharge occupational therapy home assessment”, Journal of Evaluation in Clinical Practice, Vol. Squat balance initially was poor and at discharge had improved to good. The majority of participants cited lone working as a significant risk during DPHV practice. (2004) and Lockwood et al. The caregiver really responded to being part of the planning. This section aims to gather information regarding participants’ practice prior to completing a visit, it aims to investigate the level of preparation required prior to a visit. A study by Hoy et al. A narrative review of current literature was completed and from this, a survey questionnaire was formulated. aggression of family members, anger regarding service provision faults etc.” Entering an unknown environment with potential hazards was also cited as a risk by participants, “unruly pets like dogs, cats, snakes”, “poor hygiene within the home”, and “some houses in poor repair, vermin, holes in floorboards-risk to OT”. 7 No. (2009), Willard and Spackmans Occupational Therapy, Wolters Kluwer Health/Lippincott Williams and Wilkins, Philadelphia, PA. Drummond, A.E.R., Whitehead, P., Fellows, K., Sprigg, N., Sampson, C.J., Edwards, C. and Lincoln, N.B. Occupational therapists play an integral role in the discharge planning process and determining whether a patient can safely return to their home environment (Lockwood et al., 2015). Bio; OT Foundation. I never thought he would need l so much help. Lannin, A.N., Clemsonn, L. and Mc Cluskey, A. In all, 77.00 per cent of participants reported taking between 15 and 45 min to prepare for a home visit. Discharge Planning in Traumatic Brain Injury Rehabilitation. Data were analysed using the SPHINX data analysis package (SPHINXonline 4.8, 2016). 172-177. To provide occupational therapists with the necessary tools to ensure quality service provision and promote a seamless discharge plan for patients, there is a clear need for the development of standards of practice in this area. An audit of occupational therapy practice in oncology and palliative care”, British Journal of Occupational Therapy, Vol. and Mc Clure, P. (2019), "An exploratory study of discharge planning home visits within an Irish context – investigating nationwide practice and nationwide perspectives", Irish Journal of Occupational Therapy, Vol. Discharge planning in outpatient OT. Safety issues pertaining to falls risks and cognitive concerns were also identified as criteria, “cognitive impairment risk resulting in possible death or injury in home” (Table V). Therapy Course: The patient attended scheduled therapy daily for either one hour or for two 30-minute sessions and came in extra time to work on his activity program. (2010) no single assessment tool was appropriate for all patient types and home environments, and advised that “it is the responsibility of the therapist to match their patient to an appropriate home assessment tool” (p. 408). The codes were analysed and divided into sub themes which were them categorised under super ordinate themes for each qualitative question. 13-23. This study is timely, as there is limited evidence to support DPHV within the current literature. This did not include travel times and refers to the direct intervention in the home. 75 No. The graphic non-verbal language was also taken into consideration with particular attention to spatial arrangement, colour and brightness of the text (Burns et al., 2008). There is a clear need to streamline and justify clinical practice on DPHV within an Irish context. The findings from the study are based on reported practice, not observed practice. With evidence reporting that the financial cost of DPHVs is increasing, this highlights the growing need to justify these interventions. Several studies have highlighted the importance of adequate and thorough preparation for home visits (Boronowski et al., 2012 and Sampson et al., 2014). Findings conclude that DPHVs are routinely carried out by occupational therapists and that there is consistency in clinical practice within an Irish setting. Lannin, N.A., Clemson, L., Mc Cluskey, A., Lin, C.W.C., Cameron, I.D. As DPHVs are a valued element of the discharge planning process, it is important to examine their efficacy and regulation within OT practice. This included Health Service Executive facilities and private and semi-private hospitals facilities in the Republic of Ireland that have an OT department. 2, pp. Evidence supports assessing occupational performance within the context of a familiar environment and highlights the potential for this to provide a holistic overview of an occupational being (Harris et al., 2008; Atwal et al., 2011 and Wales et al., 2012). Consent was obtained via the completion of the questionnaire. Hibberd, J. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. 1, pp. Assess Transitional Options and Formulate Therapy Services Plan It helps me in talking with clients (patients post-stroke). Barras, S. (2005), “A systematic and critical review of the literature: the effectiveness of occupational therapy home assessment on a range of outcome measures”, Australian Occupational Therapy Journal, Vol. Dad was so independent before. The outcomes are designed to guide care providers, the client, and care partners in planning for discharge. International OT organisations including AOTI (Association of Occupational Therapists of Ireland), WFOT (World Federation of Occupational Therapists) and the Royal College of Occupational Therapists have yet to provide clinical guidelines, policies or procedures, to guide practice in relation to DPHVs. 245-252. Over half the participants in this study worked in large acute hospitals with 201+ beds. (2015) found low to moderate quality evidence that DPHVs can increase participation in activities of daily livings (ADLs) and reduce falls risk. © 2019, Aisling Jane Davis and Patricia Mc Clure. There is also a dearth of formal guidelines or policies to inform clinical practice and clinical judgement during these potentially high-risk assessments. 289-299. There are a limited number of small trials investigating OT clinical practice in relation to carrying out DPHVs (Wales et al., 2012). This is the first study of its’ kind to date and the results are of interest. We will protect your information by allowing only limited access by the research team. 27 No. -Occupational therapist in acute care setting, Oh, I guess I need to grocery shop for Dad now. There are a number of reasons why being relentless around your discharge planning is important. The aim of the questionnaire was to investigate clinical practice during DPHV and clinical reasoning guiding Occupational Therapists. OT discharge planning service can include pre and post discharge assessments for a range of needs. The researcher intended to include participants who regularly completed DPHV as part of their clinical practice i.e. The researcher aimed to have a user friendly and accessible format that would encourage completion of same. (2015) had highlighted the importance of completing recommendations after a visit. Discharge planning in an outpatient setting is often much simpler than in inpatient settings. 8, pp. This can be difficult to simulate in hospital”. Atwal, A., Luke, A. and Plastow, N. (2011), “Evaluation of occupational therapy pre-discharge home visit information leaflets for older adults”, British Journal of Occupational Therapy, Vol. Harris et al. In all, 70.00 per cent of participants provide between 5 and 10 recommendations post visit. Discharge planning home visits (DPHVs) are a routine part of occupational therapy clinical practice. Numerous participants cited the need for increased standardisation of the home visit process with many advising the need for standardised checklists, policies and procedures. Discharge planning has been proposed as a way to prevent negative outcomes following discharge. and Miller, W.C. (2011), “Measurement properties of the occupational therapy discharge needs screen”, Canadian Journal of Occupational Therapy, Vol. Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P. and Letts, L. (1996), “The person- environment- occupational model: a transactive approach to occupational performance”, Canadian Journal of Occupational Therapy, Vol. Many Occupational Therapists reported that standardised guidelines or protocols would afford consistency in practice during visits, “standardise guidelines/criteria to enhance clinical reasoning and minimise unnecessary “just in-case home visits”. This study identified seven areas to consider when assessing the need for a DPHV – mobility, ADLs, social supports, readiness for discharge, environmental barriers, patient knowledge and medical conditions. Diagnoses; Evaluation . There is limited research into the role of occupational therapy in discharge planning in palliative care. A study by Hibberd (2008) found that the average cost of a DPHV was £135, while a more recent study by Sampson et al. (2004), Atwal et al. As part of discharge planning occupational therapists set goals, which are used to guide the therapy. Planning for a successful discharge from therapy services begins at admission. 10 The occupational therapy process JEAN W. SOLOMON and JANE CLIFFORD O’BRIEN Chapter outline Roles of Occupational Therapist and Occupational Therapy Assistant in the Occupational Therapy Process Models of Practice Referral, Screening, and Evaluation REFERRAL SCREENING EVALUATION Intervention Planning, Goal Setting, and Treatment Implementation INTERVENTION PLANNING … 179 No. They are resource-intensive (Sampson et al., 2014) and often require two therapists to attend a visit. (2011) in which a screening tool was developed to identify patients who would require a home visit prior to discharge. and Forster, D.P. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. 47 No. A DPHV affords the occupational therapist the opportunity to assess a patient’s occupational performance within their home environment (Lannin et al., 2007) which has the potential to provide unique functional information that can assist health-care teams to make appropriate discharge plans. It is clear that participants consider a change in functionality as a strong indication that a DPHV should take place prior to discharge. In total, 122 participants completed questionnaires and the vast majority of these were from the greater Dublin area with over 95 participants. The administration of the assessment requires communication and collaborations between the client, care partners, and healthcare providers. There are a number of standardised home assessment tools available, including the SAFER Tool (the Safety Assessment of Function and Environment for Rehabilitation), HEAP (Home Environment Assessment Protocol) and HAP (Home Assessment Profile). It is of interest that 56.70 per cent (68 participants) almost never use a formal home visit assessment tool. This means patients no longer wait in hospital for these assessments, which reduces delayed discharges and improves patient flow. In all, 67 participants reported taking between 30 min and 1 h to complete reports. Occupational therapists value home visits as clinical assessments and have identified risks during practice, benefits of visits and ways to improve practice. This section aimed to gather ordinal data regarding DPHV practice in relation to type of workplace (urban or rural), size of hospital/institution (number of beds in same)number of visits completed per month, time spent per visit and staffing levels. Several extract examples were selected as these provided nuanced representation of the data (Vasimoradi et al., 2013). 79 No. and Barras, S.L. You can join in the discussion by joining the community or logging in here.You can also find out more about Emerald Engage. Descriptive statistics were gathered in the form of summary statistics to summarise and synopsise the answers to the survey, central tendency statistics such as mean, median and standard deviation were captured to summarise a large quantity of data. This study also found a higher rate of pre discharge home visits being completed in urban facilities versus rural facilities. Content analysis was use to analyse qualitative data. 95-113. https://doi.org/10.1108/IJOT-10-2018-0015. The study by Drummond et al. To download the DPAT, we are asking you to complete a form containing information regarding you, your institution and potential use of the DPAT. Our results fill this knowledge gap by suggesting the relevance to apply an occupational therapist-led discharge planning intervention (HOME) to this growing patient population who are at higher risk of poor outcomes [62, 63]. (2011) reported an average home visit time of 1 h 20 min. Only nine participants reported bringing a personal alarm and 56.00 per cent a cardio pulmonary resuscitation mask. It is clear that participants consider the psychological aspects of DPHVs with many citing benefits such as increased confidence, decreased anxiety, ease of transition from hospital to home as valuable aspects of DPHVs (Table III). Discharge planning is occurring throughout this entire process. MoHO, because the outcome will be affected by the pt’s volition to participate in the treatment plan, the habituation of the safety techniques, and mind body performance. Only four participants provide over 15 recommendations and 12.00 per cent provide less than 5 recommendations post visit. As it is not possible to determine the number of Occupational Therapists within the study population, it is difficult to ascertain whether the 122 participants of the study are representative of the population targeted. Therefore, one of the most important roles occupational therapy practitioners in this setting perform is their role in discharge planning. Over 93.00 per cent of participants reported bringing a mobile phone, measuring tape and gloves on home visits as standard. The study population comprised occupational therapists across 52 sites including acute, rehabilitation and convalescence settings within the Republic of Ireland. Boca Raton, FL: CRC Press. Discharge planning is an activity where ethical con- flicts may occur. FOR: Cognitive Behavioral, because the pt’s thoughts, physiology, emotions, and behaviors will be addressed in the handout and will affect follow-through with the treatment plan. Along with getting the patient up and moving, OTs also play an important role alongside physical therapy in discharge planning, assessing the patient each treatment of where they should go. In addition, we are asking that you agree to be contacted periodically with a survey about the use of the DPAT. Occupational Therapists (OT’s), Physiotherapists (PT’s) and rehabilitation assistants who assess the patients ongoing care and therapy needs at home. The goal of an OT assessment is to support the patient on homecoming at discharge. A census sampling method was used as the researcher wished to invite all Occupational Therapists within the Republic of Ireland to participate in this study that met the inclusion criteria. 387-397. Safety concerns and environmental issues were acknowledged by participants in this study as criteria indicating the need for a visit. Rationale: Occupational therapists play a crucial role in achieving successful transitions between services. Search Strategy The following search strategies were undertaken to identify relevant literature for the review. 289-307. Renforth, P., Yapa, R.S. 58 No. OT Discharge Planning is popular when a patient has sudden change in mobility, a need for more support or has a long period of recovery. Data collection was carried out by using a survey questionnaire (postal and electronic options). (2014), “An introduction to economic evaluation in occupational therapy: cost effectiveness of pre discharge home visits after stroke (HOVIS)”, British Journal of Occupational Therapy, Vol. (2012) found that the average time spent on DPHV was 223 min, this included report writing and preparation time for the visit. 31 No. Drummond, A.E.R., Whitehead, P., Fellows, E.C. Rousseau, J., Potvin, L., Dutil, E. and Falta, P. (2013), “Home assessment of the person environment interaction (HoPE): content validation process”, Occupational Therapy in Healthcare, Vol. The researcher aimed to achieve saliency with the questions so they would be relevant, important and of interest to the participants (OECD, 2012). Occupational Therapy. 1, p. 42. Published in Irish Journal of Occupational Therapy. (2013), Discharge Planning from Hospital to Home (Review), Cochrane Database of Systematic Reviews, Vol. Using action research, acute care occupational therapists explored current discharge planning practices and through consensus implemented and evaluated several strategies to improve their discharge planning skills. 58 No. They identified the benefits of home visits as being able to assess the suitability of the home environment and addressing family’s concerns regarding discharge home. 34. The need for standardised checklists, assessments and policies governing DPHV practice was cited by a large number of participants, many reporting that this would improve practice, as it would establish clear guidelines regarding patient type suitable for a visit, “streamlining the criteria-having set criteria for who we do/do not do visits with”. The revised questionnaire was re-piloted within the researcher’s workplace to ensure usability prior to commencement of the study. Working as a designated car/van or timely taxi services were also suggested as ways increase! That there is a dearth of formal guidelines or policies to inform clinical practice and meaning... And the follow up required following same treatment context ”, British Journal of therapists. Planning has been selected, the hospital may refer to occupational therapy, Vol table. Agree to be a consensus on some areas of clinical practice they espouse to, as there is limited to... 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