Harris et al. (2008), “Occupational therapy home assessments: more than just a visit? 2, pp. -Occupational therapist working in rehabilitation, I was able to stop a discharge today. -Occupational therapist in acute care setting, Oh, I guess I need to grocery shop for Dad now. Only four participants provide over 15 recommendations and 12.00 per cent provide less than 5 recommendations post visit. As DPHVs are a valued element of the discharge planning process, it is important to examine their efficacy and regulation within OT practice. The researcher intended to include participants who regularly completed DPHV as part of their clinical practice i.e. The caregiver really responded to being part of the planning. 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. The 12.50 per cent (15 participants) who reported always using a tool, said they use either the SAFER Tool or HOMEFAST and in some cases have a departmental checklist. In all, 67 participants reported taking between 30 min and 1 h to complete reports. There is a clear need to streamline and justify clinical practice on DPHV within an Irish context. An interesting finding from this study was that 57 per cent of participants reported that they “almost never (1in 10 visits)” used a formal assessment tool, of note many authors strongly recommend the use of a formal tool to guide the assessment process (Barras, 2005; Harris et al., 2008; Chibnall, 2011). 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. These requirements apply to both electronic and written forms of documentation. The information will be stored on a password protected computer that can only be accessed by the research team. The researcher aimed to achieve saliency with the questions so they would be relevant, important and of interest to the participants (OECD, 2012). 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. This can be difficult to simulate in hospital”. 18 No. However, several participants also advised that a decision that home discharge is not suitable is also considered to be a successful DPHV, “achieve end goal - discharge home or rule out discharge” and “it is evident if a patient is safe/unsafe for discharge home and clear recommendations can be put in place following”. There is limited research into the role of occupational therapy in discharge planning in palliative care. -Daughter responsible for father discharging from rehabilitation, Page last updated 10:47 AM, July 10, 2020, DentonMCL Building 810P.O. The urgent need for consistency in clinical practice has also been identified by many authors (Atwal et al., 2008; Barras et al., 2010; Sampson et al., 2014) and one would hope that professional bodies may develop procedures to guide and advise practice. 1, doi: 10.1002/14651858. Participants concern for the safety of the patient was also evident with many citing falls risk or medical emergency as potential risks during DPHV, “if the patient becomes unwell and they are a significant distance from medical staff”. Evidence-based information on occupational therapy discharge planning from hundreds of trustworthy sources for health and social care. Assess Transitional Options and Formulate Therapy Services Plan A narrative review of current literature was completed and from this, a survey questionnaire was formulated. Research suggests that DPHVs are costly and high-risk interventions (Rousseau et al., 2013). A viewpoint”, Australian Occupational Therapy Journal, Vol. It is unfortunate that a majority of participants in this study identified potential risk factors of such significance, e.g. 77-101, ISSN 1478-0887, available at: http://eprints.uwe.ac.uk/11735. Occupational Therapists (OT’s), Physiotherapists (PT’s) and rehabilitation assistants who assess the patients ongoing care and therapy needs at home. 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. 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. These results will be discussed in more detail below. As part of discharge planning occupational therapists set goals, which are used to guide the therapy. Occupational Therapy. 193-203. Certainly, this is an area that requires further investigation, to address this issue and safeguard both patient and therapist. SPHINXonline 4.8 (2016), “SPHINX data analysis package”, available at: www.sphinxonline.com/v4/login.aspx or www.lesphinx-developpement.fr/en/. (2012) that investigated home visit practice for stroke patients found similar results in relation to time spent on visits (63 min), time spent writing reports (61 minutes) and time spent organising the visit (50 min). Drummond et al. Occupational therapy (OT) intervention often includes carrying out discharge planning home visits (DPHV) (Harris et al., 2008). 74 No. A viewpoint. Can he be alone during the day when I work? 13-23. occupational therapists, with therapy-led discharge planning for people with complex health care needs. Data collection was carried out by using a survey questionnaire (postal and electronic options). 40-47. 2, pp. The criteria for DPHV that was identified by participants’ echoes a study by Boronowski et al. This review was limited by the heterogeneity between the five randomized control trials reviewed with regard to methods, sample size and diversity of settings. 67 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. All 52 target sites were contacted over a 5 day period, with the researcher contacting the gatekeeper to discuss the study. In total, 122 occupational therapists that completed the survey questionnaire were recruited for the study. (2015) found low to moderate quality evidence that DPHVs can increase participation in activities of daily livings (ADLs) and reduce falls risk. During treatments, the OT may provide education on energy conservation techniques, address self-care, functional mobility, or therapeutic exercise. Copyright © 2019, Aisling Jane Davis and Patricia Mc Clure. If no response was received from agreeable target sites following a two-week period, a follow up phone call was made to ascertain the status of the responses. Discharge Planning in Traumatic Brain Injury Rehabilitation. This did not include travel times and refers to the direct intervention in the home. A study by Drummond et al. 63 No. Discharge planning is an activity where ethical con- flicts may occur. 1, pp. It also identified the necessity for best practice guidelines to be established, to ensure that patient’s safety and independence on discharge are not compromised. 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. 172-177. Discharge home was reported by the vast majority of participants as an indication of a successful DPHV, with many participants citing the importance of a “sustainable” and “safe” discharge. 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]. 9-23. The OT will look at a wide range of factors that impact a patient's daily life and their ability to care for themselves on returning home. (2008) found that home visit preparation time ranged from 31-80 min. 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. Discharge planning in an outpatient setting is often much simpler than in inpatient settings. (2014), “Factors influencing occupational therapy home visit practice: a qualitative study”, Scandinavian Journal of Occupational Therapy, Vol. 396-340. 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). Discharge planning is occurring throughout this entire process. 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. 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. This includes the preparation involved prior to visit commencing, the actual visit itself and the follow up required following same. and Pickens, N.D. (2010), “Home modification assessments: clinical utility and treatment context”, Informa Healthcare, Vol. Discharge planning is the process by which the hospital team considers what support might be required by the patient in the community, refers the patient to these services, and then liaises with these services to manage the patient’s discharge. Following a thorough literature review for this study, it was found that there has not been a study to date that has investigated or commented on the risk factors to occupational therapists during DPHV. Qualitative data identified benefits, risks, recommendations to improve home visit practice and clinical criteria for home visits. This included Health Service Executive facilities and private and semi-private hospitals facilities in the Republic of Ireland that have an OT department. Only 1.70 per cent (two participants) completed 10-14 visits and 0.80 per cent (1 participant) completed a significant 15+ visits a month. Several studies explore Occupational Therapists’ perceptions of pre discharge home visit practice, Nygard et al. (2015), “Pre-discharge home assessment visits in assisting patient’s return to community living: a systematic review and meta analysis”, Journal of Rehabilitation Medicine, Vol. The questionnaire was divided into two sections, quantitative and qualitative. The ability to identify potential difficulties, reduce falls risk and improve safety was also mentioned by a number of participants, “opportunity to identify any hazards or barriers to independence, opportunity to maximise patients’ safety, a picture of the home environment thus practical recommendations”. 2, pp. McColl, E., Jacoby, A., Thomas, L., Soutter, J., Bamford, C., Steen, N., Thomas, R., Harvey, E., Garrett, A. and Band, J. Consent was obtained via the completion of the questionnaire. 248-256. Search results Jump to search results. Only 3.00 per cent of participants take less than 30 min to write reports; 41.00 per cent of participants reported they take between 1 h and 1 h 30 min+ to complete reports. and Barras, S. (2007), “Feasibility and results of a randomised pilot study of pre discharge occupational therapy home visits”, BMC Health Services Research, Vol. Only nine participants reported bringing a personal alarm and 56.00 per cent a cardio pulmonary resuscitation mask. Discharge planning is a complex and challenging process for health-care professionals, patients, and carers. (2011), “Survey of current pre- discharge home visiting practices of occupational therapists”, Australian Occupational Therapy Journal, Vol. There appears to be a consensus on some areas of clinical practice during visits; however, this requires further investigation and standardisation. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode. 59-63. Sheppard, S., Lannin, N.A., Mc Cluskey, A., Cameron, I.D. They are resource-intensive (Sampson et al., 2014) and often require two therapists to attend a visit. Renforth et al. In addition, occupational therapy is effective for improving functional ability in ADL performance (D’Amico et al., 2018; Smallfield & Heckenlaible, 2017; Wolf et al., 2015). When I did the DPAT, I realized he had major problems in medication management, nutrition, and symptom management. Atwal, A., & Caldwell, K. (2003). The target sites consisted of acute settings, rehabilitation settings and convalescence settings and contained a mix of rural and urban sites. Nygard, L., Grahn, U., Rudenhammer, A. and Hydling, S. (2004), “Reflecting on practice: are home visit prior to discharge worthwhile in geriatric patient care?”, Scandinavian Journal of Caring Sciences, Vol. occupational therapists who are able to give informed consent. Target sites were contacted via a gatekeeper (OT manager or senior OT if a manager was not in post). Please note: once the Lock button has been selected, the form will no longer be editable. The questionnaire was piloted with a sub sample of Occupational Therapists from a mix of target sites to ensure its usability. (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). (2004), they explored 23 Occupational Therapists’ perceptions of home visit following both a DPHV and a follow up visit 2-3 weeks later. 4, pp. Poor discharge planning can lead to poor patient 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. 34. 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”. Initially the patient rated pain at 10/10 and at discharge 1/10 to occasionally 8/10. This is the first study of its’ kind to date and the results are of interest. It helps me in talking with clients (patients post-stroke). 47 No. 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. Boyt Schell, B.A., Scaffa, M., Gillen, G. and Cohn, E.S. 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). 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. 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. Wales, K., Clemson, L., Lannin, N.A., Cameron, I.D., Salked, G., Gitlin, L., Rubenstein, L., Barras, S., McKenze, L. and Davies, C. (2012), “Occupational therapy discharge planning for older adults: a protocol for a randomised trial and economic evaluation”, BMC Geriatrics, Vol. Of note, 44.00 per cent (53 participants) completed 2-5 visits per month, while 8.00 per cent (10 participants) completed 5-9 visits. 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). 79 No. An audit of occupational therapy practice in oncology and palliative care”, British Journal of Occupational Therapy, Vol. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Published in Irish Journal of Occupational Therapy. This is similar to the findings from a study by Atwal et al. 3 No. Visit emeraldpublishing.com/platformupdate to discover the latest news and updates, Answers to the most commonly asked questions here. 75 No. Discharge Planning • There are no EASY rehab patients • It takes a TEAM to discharge a patient • No Patient gets from rehab to home ALONE. The study by Drummond et al. Of interest, many participants believed having additional time to complete visits would afford a more thorough assessment and allow the patient to adjust to being in their home. 387-397. 77 No. (2008) acknowledged that DPHVs are historically accepted in OT practice, however this study highlights the need for further research by occupational therapists to develop an evidence base to support their practice and justify both the high costs and use of clinical time. Search Strategy The following search strategies were undertaken to identify relevant literature for the review. (2008), “The home visiting process for older people in the in patient immediate care services”, Quality in Ageing and Older Adults, Vol. (2004), “Occupational therapy pre discharge home visits: a study from a community hospital”, British Journal of Occupational Therapy, Vol. Vasimordai, M., Turunen, H. and Bondas, T. (2013), “Content analysis and thematic analysis: implications for conducting a qualitative descriptive study”, Nursing and Health Sciences, Vol. 1, pp. Occupational therapists play a significant role in the discharge process and are often exposed to ethically challenging decision-making. (2008), “A guide for the design and conduct of self-administered surveys of clinicians”, Canadian Medical Association Journal, Vol. In total, 122 participants completed questionnaires and the vast majority of these were from the greater Dublin area with over 95 participants. They also found that the Occupational Therapist would recommend or advice regarding care services need/care visit frequency in 68 per cent of patients’ cases post visit. ; occupational therapists working within the Health Service Executive, semi state or private hospitals; occupational therapists who regularly complete DPHVs, a minimum of one per month; and. Hibberd, J. Squat balance initially was poor and at discharge had improved to good. (2008), “Occupational therapists’ perceptions of pre discharge home assessments with older adults in acute care”, British Journal of Occupational Therapy, Vol. (2010) aimed to establish a “core/essential” and “ideal world” criteria for assessment during DPHV. In all, 77.00 per cent of participants reported taking between 15 and 45 min to prepare for a home visit. If the gatekeeper was agreeable to the researcher accessing participants, an electronic link to the questionnaire was disseminated to staff members by the gatekeeper via the SPHINX data analysis package (SPHINXonline 4.8, 2016) or paper copies sent to each target site. A study by Hoy et al. Thank you for your interest in the DPAT. CL489N (082019) Occupational Therapy Discharge Report Page 1 of 8 Occupational Therapy Discharge Report If applicable, please select the Lock button before submitting the form. 9 No. 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. 4, pp. Over 93.00 per cent of participants reported bringing a mobile phone, measuring tape and gloves on home visits as standard. Reflecting on practice: are home visit prior to discharge worthwhile in geriatric patient care? 383-386. (2001), “Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients”, Health Technology Assessment, Vol. Sampson, C., James, M., Whitehead, P. and Drummon, A. 95-113. https://doi.org/10.1108/IJOT-10-2018-0015. 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