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Chapter 6 E-materials



Author profiles



Karen Rix GradDipPhys MCSP


Karen Rix is a Clinical Specialist Physiotherapist working in Croydon Community Health Services as Clinical Team Leader.


Karen has worked in the Community since 1982, 8 years of which have been in Intermediate Care gaining extensive experience of working in different community teams.


She is currently Chair of the Association of Chartered Physiotherapists in the Community and editor of Out & About, their quarterly Newsletter.



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Maureen Carter


Maureen has a wealth of experience gained from working in the NHS and overseas in a variety of clinical specialities.


Since 1986 Maureen has worked in the Community setting, first in a domiciliary team and in the latter part of her career as part of an Intermediate Care team.


In addition to her clinical experience Maureen has worked extensively as a clinical educator providing support for students during placements in the primary care environment.


Maureen has held regional and national posts with AGILE and the ACPC.


Maureen retired officially in 2009, but as with contributing to this book she admits to being ‘tempted back from time to time!’



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Yvonne Wren GradDipPhys


Yvonne Wren retired from the NHS in 2008 after working as a physiotherapist for 35 years in south-east London. Initially specialising in stroke rehabilitation, the last 20 years she has worked in elder rehabilitation and in the community. Her last post was as the clinical therapy lead for intermediate care in Southwark, working within integrated services.


As an experienced clinical educator, Yvonne was approached by the link tutor at the University of East London and asked to become a specialist lecturer there for the community module of the physiotherapy degree course. In this role, she gave lectures and facilitated seminars at the university for the five years before she retired.


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Appendix 6.1 Community resource file



Policies and procedures


The method of accessing these should be clearly identified on induction to the department.


The Community Therapy team should have easy access to local policies and procedures, either in electronic format via the intranet or as hard copy in folders (these must be regularly updated).


Up-to-date national guidelines and policies should also be available to staff and if access via a ‘search engine’ is not allowed then these should be available as hard copies in the department.




Sources of online guidelines and policies




www.csp.org.uk


www.dh.gov.uk


www.nice.org.uk/guidance



Local groups and services


This information is invaluable to the community physiotherapist and will have been collected by the team as a general resource. If not then maybe this can be a project for the next therapist on rotation or for a student’s presentation.


Contact details for other community colleagues such as occupational therapists, podiatry, community dietetics, general community and specialist nursing teams, continence services, and community pharmacy services should be readily available.


The voluntary sector, charities and self-help groups are all essential for patients with long-term conditions to be managed effectively.




Online resources voluntary sector and self-help groups




www.nhs.uk/conditions


www.patient.co.uk


www.netdoctor.co.uk


www.ageuk.org.uk


www.carers.org


www.self-help.org.uk


www.charitiesdirectory.com



Assessment forms, outcome measures and exercise sheets


General and specialist assessment forms, a selection of appropriate outcome measures and a selection of printed exercise sheets are essential to standardise interventions between therapists. Leaving written information with the patient maximises the benefit of the intervention.


Specific treatment protocols requested by a referring consultant should be available for routine referrals or obtained individually if necessary.


It is essential that a physiotherapist is aware of these before visiting a patient.



Equipment


A community physiotherapist should have a panic alarm and mobile phone with preprogrammed essential contact numbers with them at all times.


It is also essential to be aware of any phone network black spots in their area.


Equipment such as walking frames should be delivered by the local equipment service, but small items such as crutches and walking sticks can safely be carried in the boot of a car.


Also helpful to be kept in the car is a small supply of different size ferrules, a tape measure, hacksaw and a spanner.


A torch and satellite navigation system, or at least a street map are also essential.


Other essential equipment such as a stethoscope, goniometer, tape measure and resuscitation mask need to be carried in an appropriate lockable bag that can be easily carried. The bag will also be needed for safe transportation of the patient notes, work diary and spare paperwork.


A copy of the BNF (British National Formulary) can be useful to identify medication during patient assessment.



Infection control equipment


Gloves, aprons, hand wash and paper towels, hand gel and protective goggles should be carried in the car.



Case Study 6.1



80-year-old lady (Mrs A) – fall in nursing home


Assessment begins on receipt of the referral from GP stating Mrs A fell 4 weeks ago, sustaining soft tissue injury around the right knee, but no fracture.



Past medical history




• Left hemiarthroplasty 2 years ago.


• Osteoarthritis in knee joints managed with analgesics.


• Congestive cardiac failure controlled by diuretics.


• Type II diabetes controlled by tablets.


• Difficulty mobilising independently and safely.



Social history




• Resident in a nursing home for past 6 months after having increasing difficulty coping at home.


• History of self-neglect.


• Recurrent urinary tract infections.


• Confusion.


• Frequent falls.


• Mobile with a frame and assistance/verbal prompting.



Subjective assessment




• Patient remembered tripping over her slippers when trying to reach her clothes.


• No apparent injury at the time.


• Right knee feels stiffer and more painful to walk on the next day.



Objective assessment (patient supine)




• Arthritic valgus deformity bilaterally in both knees.


• Right knee more swollen and tender.


• Pitting oedema bilaterally at ankles.


• Movement and muscle strength reduced in lower limb joints, particularly around right knee.


• Patient had difficulty rolling onto her side and sitting up in bed (staff always helped).


• Sitting balance good, dizzy initially.


• Needed assistance sit to stand, again felt dizzy, and needed frame for support in standing.


• Mobilised using the frame, with verbal prompting, to turn and sit safely.


• Became breathless after mobilising for 20 steps.



Outcome measure


Elderly Mobility Scale (Smith R 1994 Validation and reliability of the Elderly Mobility Scale. Physiotherapy 80:744–747).



Treatment plan


Assessment findings discussed and agreed with Mrs A.


The agreed goals were to:



1. Be able to walk without fear of falling


2. ‘Get the knee moving again’


3. Be more independent.


It was discussed how this might be achieved, using SMART goals and involving the nursing home staff.



Plan



Problem 1 Reduced range of movement in right knee




• Teach patient and staff active knee flexion/extension exercises.


• Give staff written/diagrammatic instructions.


• Instruct staff how and when these exercises should be performed.



Problem 2 Reduced muscle strength in right knee




• Provide strengthening exercises for right knee.


• Give staff written/diagrammatic instructions.


• Instruct staff how and when these exercises should be performed.


• Teach correct technique for standing from sitting.


• Teach staff how to supervise safe standing technique.



Problem 3 Dizziness related to postural changes




• Staff to check lying/standing blood pressures until GP review.


• Staff to monitor blood glucose levels as agreed by diabetic nurse.


• Medication review by GP.


• Patient and staff advised on potential risk and not to carry out activities alone or too quickly.



Problem 4 Difficulty moving in bed




• Advise on methods of increasing bed mobility.


• Arrange for provision of bed lever.


• Decrease patient’s level of dependence on nursing home staff.



Problem 5 Fear of falling




• Advise patient of causes and risks of falling and how to avoid them.


• Ensure appropriate footwear available.


• Discuss with patient how to be independent and safe.



Advise staff to




• Ensure patient’s property, drinks and call bell are always within reach.


• Arrange an eye test if appropriate.


• Ensure regular podiatry visits take place.


• Ensure medication review takes place (Smith R 1994 Validation and reliability of the Elderly Mobility Scale. Physiotherapy 80:744–747).


• Make dietetic referral if necessary.


• Monitor condition and suitability of walking aid.

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Nov 5, 2016 | Posted by in MANUAL THERAPIST | Comments Off on E-materials

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