How do occupational therapists contribute to patient safety?

Summary

1- 7 November 2021 is Occupational Therapy Week. In this blog, Susanna Keenan, occupational therapist and Joanna Gilmore, student occupational therapist at Northumbria Healthcare NHS Foundation Trust, explain what their role involves and the important part occupational therapists play in patient safety.

Content

As occupational therapists our aim is to maximise independence and support people to carry out daily life activities - their ‘occupations’. These activities include self-care, leisure and productivity - ranging from brushing your teeth to going to the supermarket. Our role requires a deep understanding of the significant impact that these seemingly ordinary routines have on peoples’ health and wellbeing.

Occupational therapists are found in a variety of services across both physical and mental health. The role of an OT in any setting involves striking a balance between optimising patient safety, and positive-risk taking. Both of us are currently hospital-based and our primary role is to assess how each patient will manage at home. Our goals are to ensure patients are discharged safely and effectively and to prevent readmission. 

When working with a patient to increase their independence, we look at three areas: the person, the environment and the activity. We might make adjustments in any or all of these areas.

The person

For every patient, we consider the physical, cognitive, spiritual and psychological aspects that might affect their recovery and independence. By establishing what restricts, motivates and matters to a patient, we can tailor our support to best support them.

Fear of falling is a major barrier to independence for many patients we see in hospital, and helping them overcome the associated anxiety and lack of confidence can make a huge difference to their quality of life and ability to function. Fear of falling can result in patients displaying physical symptoms such as shaking or stiffness and avoidance behaviour. Patients can enter a deconditioning spiral of loss of confidence and anxiety, causing a reduction in activity which leads to decreased muscle strength and mobility. This in turn further decreases independence and increases the patient’s falls risk. 

As occupational therapists, we can make patients safer by helping them overcome this fear and regain mobility. There is evidence that encouraging someone to keep active through positive risk taking can increase confidence and help them form a realistic view of their falls risk. We educate patients on the actual risks and provide opportunities to learn-through-doing, helping them translate this knowledge into experience and change their behaviours. This might be as simple as suggesting a patient gets up at each advert break when watching TV, walks five steps then sits back down.

The environment

Occupational therapists consider all aspects of a patient’s environment and use clinical reasoning to decide on interventions to promote their safety and independence.

When a patient has fear of falling, we can put in place changes to the environment to help mitigate that fear as well as the actual risk of falling. 

When we look at a patient’s environment, it’s important we have a clear picture of the setting a patient will be living in. I (Susanna) hate only having a downstairs toilet because it is so far away during the night! If one of our patients was in this situation and needed easy access to a toilet, we would consider all aspects of their living space before deciding on interventions, for example:

• Do they have a partner living with them who could help if needed?
• Do they have blood pressure issues and associated risks?
• Do they have urinary urgency?
• Are they at risk of falls?

In this case, a simple urinal bottle or commode placed next to the bed can save a patient from having to travel large distances to access a toilet during the night. We could also introduce adaptations such as grab rails to assist independent toilet transfers (sitting down and standing up). As a last option at home, carers could be provided to assist with personal care in the morning.

The activity (occupation)

There is huge pressure on bed-capacity in the NHS, and occupational therapists can play a key role in patient safety in this area. We help free up beds for other patients that need them and make sure our patients are safe to be discharged. An inpatient who is medically fit for discharge is also at risk of picking up hospital-acquired infections, so we need to reduce this risk with prompt discharge. 

We carry out functional assessments of a patient’s ability to fulfil the basic activities required for independence at home: mobility, transfers from bed/chair/toilet, washing and dressing, and meal preparations. If we can find out the dimensions of a patient’s home furniture, we can sometimes replicate this on the ward to help us assess them more accurately.

Working closely with physiotherapists, we provide walking aids and assistive equipment that will make patients safer at home. We also liaise with social workers to put packages of care in place to support independence once a patient has left hospital. 

Under a new ‘discharge to assess’ government policy, this assessment process is changing to become more community-based and occupational therapists will be carrying out more of these assessments in patients’ homes. Although this is hard to picture now, it means we will get a much more accurate understanding of a patient’s occupations within their own home, where they know where things are and ‘have a knack’ of doing things their own way.

Are you an occupational therapist with an interest in patient safety, or a patient who has benefitted from working with an occupational therapist? Tell us about your interests and experiences in the comments.

Further reading

Roots of recovery: Occupational therapy at the heart of health equity (1 November 2021)