A day in the life of an Occupational Therapist
"Monday mornings are always unpredictable as I pick up the handovers left by my colleagues from the weekend. The Situation, Background, Assessment, Recommendations (SBAR) handover system has certainly improved the quality and efficiency of passing on clinical information since its introduction 3 years ago.
Today is also the day when the elderly care ward that I am covering have their full Multi-Disciplinary Team (MDT) meeting, so until that takes place it’s difficult to start prioritising the caseload of 30 acute beds. However, I have had 4 cases handed back to me from the weekend that need active Occupational Therapy intervention, so before I receive a new list of referrals that’s where I’ll start.
One of these patients has been struggling to manage their personal care so it is important for me to use my activity analysis skills to determine why. This individual has been diagnosed as having delirium due to urinary infection, which has exacerbated their chronic dementia related cognitive impairment. The delirium appears to be resolving and I am keen to understand the impact of the ward environment on the person’s occupational performance. There has been some feedback from the ward that their behaviour can be challenging at times but as an Occupational Therapist, I am very aware that this is likely down to a change in routine, familiarity, understanding of need, anxiety and/or frustration.
When I re-introduce myself to the patient they cannot recall our contact in the previous week but can retain information about the nature of the assessment and provide an appropriate response. There are also no behavioural indications that the patient does not want to engage in the activity, therefore I feel consent is gained. Unless I can evidence that one of the ‘capacity domains’ is unfulfilled, I have to assume the patient has capacity per the Mental Capacity Act.
After assessing the patient washing and dressing there are some very interesting presentations such as the patient likes all materials in very specific places, either perseverates or is obsessive and appears quite emotionally detached. The patient also made some interesting statements about their home environment, which has made me interested to see whether it could provide more insight into daily routines. Therefore, I arrange an environmental/site visit for that afternoon with the patient’s daughter.
The MDT are ready for the meeting now so I head in, it’s around 10.30. The meeting finishes at midday with 12 new referrals, 2 of which have an estimated discharge date of 24 hours, a further 6 of 48 hours and the remaining 4 aiming to be medically ready for discharge by the end of the week.
On reflection, I find it interesting how terminology relating to discharge has changed over the last few years. Patients became ‘medically fit’ when I first started practicing whilst now they are ‘medically optimised’, creating the perception that patients are being discharged more unwell than they used to be, with the expectation that community based services and primary care manage on-going complex needs in the patient’s home.
I have a very quick lunch whilst inputting the mornings contacts into our database then straight out to the site visit.
It becomes apparent on entering the property that there is more to the patient’s history than we were aware of, with high levels of hoarding. I can barely see a clear floor or surface in any of the home’s rooms. Putting this together with the patient’s presentation this morning I wonder about unexplored Mental Health needs with presentations of Asperger’s, obsessive traits and depression. I return to the office and complete visit report, which I will use as evidence for the consultant to refer into Mental Health services.
It’s 15.00 so there is just about time to see the second person who could potentially go home tomorrow, I complete a joint assessment with a Physiotherapy colleague to maximise efficiency. We both quickly agree that this person’s potential recovery and long-term independence would be hindered by going home at this time and instead recommended a period of in-patient rehabilitation.
There appears to be an increasing momentum for in-patient rehabilitation to be limited and instead moving totally towards re-ablement at home or ‘discharge to assess’ models. However, my strong view is that although re-ablement at home should be a stage of rehabilitation for some patients, there should still be opportunity for in-patient rehabilitation.
After I have spoken to the patient’s next of kin and written up my notes in the patient’s pathway, it is 16.30 and I need to input the afternoon’s statistics onto the database.
Finally, I delegate some assessments and tasks for tomorrow morning to the OT technical instructors, as well as tentatively booking one of them to support me with a home visit if required.
It’s 17.15 and after a busy but very interesting day, it’s time for home. Being an Occupational Therapist and having such a positive impact on someone’s life at a time where they are often frightened, in pain and feeling like they are losing control gives me huge satisfaction and pleasure."