Prescribing Equipment in the Community Elaine Brichard BScHons

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Prescribing Equipment in the Community Elaine Brichard BSc(Hons) OT, PGCE, Post Grad Back Care,

Prescribing Equipment in the Community Elaine Brichard BSc(Hons) OT, PGCE, Post Grad Back Care, Ro. SPA Level 4 Single Handed Care Manager, Equipment Advisory Team Hampshire Equipment Services

Hampshire Equipment Services • • • Integrated, in-house equipment service Drivers x 30 Technicians

Hampshire Equipment Services • • • Integrated, in-house equipment service Drivers x 30 Technicians (Service and maintenance) x 16 + 1 admin Technicians (Minor Adaptations) x 27 (including admin) Admin x 8 Equipment Advisory Team x 10 Decontamination Team x 12 Warehouse x 3 Overseen by Senior Operations Manager and Operations Manager

Hampshire • Population of 1. 37 million (excluding Portsmouth and Southampton) • 5 CCGs

Hampshire • Population of 1. 37 million (excluding Portsmouth and Southampton) • 5 CCGs • 11 District Councils (excludes Portsmouth and Southampton which are unitary authorities)

HES • Currently over 2000 registered prescribers using the equipment service • Professional Users

HES • Currently over 2000 registered prescribers using the equipment service • Professional Users Group • Work closely with commissioners • Adult and Paediatric services

Improving Efficiency Provide better information Provide training on equipment available Resulting in improved prescribing

Improving Efficiency Provide better information Provide training on equipment available Resulting in improved prescribing and reducing number of deliveries to individual clients

Mandatory Training • All prescribers must attend standard equipment training to gain access to

Mandatory Training • All prescribers must attend standard equipment training to gain access to TCES – ordering system • Includes – introduction to Equipment Pathway using Strengths Based Approach and Minor Adaptations

Optional Training • • • Bathing and Bed Accessories Profiling Beds and Mattresses Hoist

Optional Training • • • Bathing and Bed Accessories Profiling Beds and Mattresses Hoist and Sling familiarisation Transfer Aids Also considering adding introduction to Pressure Care and tissue viability

Equipment Advisory Team • Responsible for screening all equipment not in standard equipment list

Equipment Advisory Team • Responsible for screening all equipment not in standard equipment list • Provide information on equipment available • Clinicians on team to give clinical guidance • Training – delivering all courses

Also…. • Held paediatric open day • Run “play days” for TVNs to familiarise

Also…. • Held paediatric open day • Run “play days” for TVNs to familiarise them with new and existing equipment • Give 1: 1 training on specific equipment to prescribers

Information • Guidance/criteria for prescribing equipment • Equipment to manage fallen client • Guide

Information • Guidance/criteria for prescribing equipment • Equipment to manage fallen client • Guide to using TCES • Paediatric manufacturers list

Equipment Pathway • Work in progress updating catalogue • All equipment will have brief

Equipment Pathway • Work in progress updating catalogue • All equipment will have brief description with considerations and contr-indications • Developing competencies – questions around different areas of equipment and case study using MHQs to show clinical reasoning

2. 3 Raised toilet seat and frame - including extra wide model L 1

2. 3 Raised toilet seat and frame - including extra wide model L 1 Description: Plastic coated metal adjustable-height toilet frame with integral toilet seat for use over existing WC. Splayed legs. Can be floor fixed with fitting When to prescribe: The person needs handrail/support to facilitate safe transfers on/off the toilet. The person needs a higher toilet seat to facilitate a safe toilet transfer. The person is unable to pull self to stand but is able to press down Pathway All these other alternatives have been considered: Self purchase Raised toilet seat Toilet frame Techniques to improve transfers Risks/Reasons not to prescribe Persons feet do not reach the floor with frame in situ Other user will be unable to use with frame in situ User exceeds weight limit Considerations Progression of condition Cognition Pipes/boxing around toilet Raised height can impact bowel function Sliding transfers Can be tripping hazard Restricts space Uneven floor surface Other users Consider floor fixing if user has uneven weight distribution and risk of tipping Actions Risks recorded Prescription completed and includes clear instructions and measurements Demo/delivery/fitting Planned review date if necessary

Bathing/showering equipment questions: - level 1 Questions Why would you use a bath board

Bathing/showering equipment questions: - level 1 Questions Why would you use a bath board rather than a shower board when using a bath seat? Answers to include Length of the bath Overhang of bath board Risk assessments What are the advantages and disadvantages of a bath step? Where else would you think of using a bath step? Bed transfers Transfers into a shower cubicle What should you take into consideration when Weight Risks issuing a bath board and bath seat? Risk Assessment Ability / medical condition What environmental considerations do you need to Type of shower tray take into consideration when prescribing a shower Space bench or shower stool? Weight Transfer into the shower Environmental What is the different between a shower stool and Weight shower bench? Size Position in the shower What are the environmental considerations when Size of space issuing a mobile shower chair? Thresholds Type of flooring Case study Justify the chosen piece of equipment rather than another using MHQs

Manual Handling Questions When carrying out an assessment there are 5 basic questions you

Manual Handling Questions When carrying out an assessment there are 5 basic questions you should ask yourself to assist your in your clinical decision making. Q 1 What is normal movement for this task? Q 2 Can I teach the person to do this unaided? NO: - Explain why Go to Q 3 YES: - Detail how Q 3 If person not able to do this completely unaided is there equipment available that would mean the person could this for themselves? NO: - Explain why Go to Q 4 YES: - Which equipment? Detail how Q 4 I f unable to perform the task themselves, what is the minimum of assistance one and then two handlers can give? Without equipment – detail how And With equipment – detail how Q 5 Are there any unsafe ways of doing this I must avoid and if so what are they?

Feedback • Recently a TVN commented that she felt that since the introduction of

Feedback • Recently a TVN commented that she felt that since the introduction of the training that prescriber knowledge had increased • Delegates attending the courses say that they feel more confident in prescribing equipment • Delegates looking at abilities when considering equipment