Veronica
Going back to your case, you should definitely not prescribe equipment that you
do not feel will meet your patients needs in a safe way.
I recently recieved a referral from a physio to raise a patients bed to ease
hoisting the patient on/off bed. (the patient lives in a residential home)
On assessment it became clear that the patient who has parkinsons was mostly
transferring on/off bed with time and assistance (not hoist). She at times had
falls and it was in these instances that the home staff were hoisting her off
the floor and into bed. The patient had a divan bed (that was her own) which
they had raised themselves (on inapproriate raisers) to allow the hoist legs to
go under the bed.
So, the bed was 25" high, far too high for the patient to transfer on and off
even with assistance, so not only did it eliminate the patients supported
transfers (which should have been encouraged) but also posed a risk when the
patient was in the bed as she often initiated transfers without requesting help.
On assessment I advised them that the raisers they had put on were
inappropriate and unsafe for that type of bed. They requested I provide the
appropriate raisers, I advised them that I would not reccommend raising the bed
at all for the above reasons. They were very pushy saying that they needed a
bed that they could use a hoist with for the safety of their staff. The patient
was also expressing that she did not want to change her bed.
I sat with the patient and support worker and advised that I recommended the
patient use one of the res home beds which were standard 19" but unlike the
divan bed had a gap underneath to allow space for the hoist if needed.
The patient was not happy with the situation and I left the home and the bed
still inappropriately raised. I then clearly documented the assessment and my
reasoning and completed an advice sheet which I sent to the patient and home.
In any situation where there is conflict it is vital we keep our professional
reasoning and clearly assess risks involved. Sometimes you will have to leave a
potentially unsafe situation because the patient will not listen to our advice,
it feels uncomfortable but as long as it is documented clearly then you can
feel satisfied that you have performed your role effectively while keeping your
professional integrity.
Having said that, there is one more OT tool we can draw upon in this situation
and that is our person skills and therapeutic relationship, if we can develop
trust with the patient then hopefully they will then appreciate our advice is
based on professional knowledge with their interests at heart. In my example
one more visit to the patient and meeting with the staff resulted in the very
simple intervention of them changing the bed, which met the need of the patient
and staff in a safe and appropriate way !!!
Good luck!
Kind Regards
Lucy Simpson
For Quality Stationery and Greetings Cards check out this website:
www.phoenix-trading.co.uk/web/lucysimpson
Save it in your favourites for the next time you need cards.
--- On Thu, 26/3/09, Ron Carson <rdcar...@otnow.com> wrote:
From: Ron Carson <rdcar...@otnow.com>
Subject: Re: [OTlist] Best practice
To: "Veronica" <OTlist@OTnow.com>
Date: Thursday, 26 March, 2009, 11:13 PM
Veronica, IF I were you, I would NOT recommend the equipment and CLEARLY
document why. In my opinion, it's wrong to recommend equipment that in
your professional opinion is inappropriate.
I would NOT cave to pressure from the mom. But, I would also take her
suggestions into consideration. If you have done this and still
"know"
the equipment is inappropriate, do NOT recommend it!
Good luck,
Ron
----- Original Message -----
From: Veronica <groenewal...@yahoo.co.uk>
Sent: Thursday, March 26, 2009
To: OTlist@OTnow.com <OTlist@OTnow.com>
Subj: [OTlist] Best practice
V> Ron, I wish I knew why this mum is asking for inappropriate
V> equipment. At the moment there appears to be a 'competition'
element
V> in my area where one child gets a piece of equipment provided because
V> they DO need it, and then the other mum's hear about it and insist
V> that THEIR child also needs it. Not all of the mum's do it but
this
V> one DOES. We bang our heads against a brick wall trying to get her
V> to 'see' that her daughter is able to manage these tasks
and have had
V> the child 'demonstrate' her ability in executing tasks. I get
the
V> feeling that mum sees her daughter's not quite 'perfect'
movements as
V> being a reason for her to be highlighted as 'special'. This is
a mum
V> who decided to put her daughter (who is in secondary school) in
V> incontinence pants 'just in case' despite the fact that 1. her
V> daughter is ambulatory 2. her daughter is independent in toileting.
V> There are some child protection concerns.
V> Sorry, not trying to shoot down your comments, I appreciate the
V> input, it allows brainstorming... just getting a bit frustrated as it
V> feels like our hands are tied (it doesn't help when the HOD says
V> 'just give in, it's easier' when you know that it's not
in the child's best interests).
V> Thanks again,
V> Veronica
V>
V> Is there anyway that you can safely demonstrate the risks
of the
V> equipment? Can you SHOW the mom that the equipment is dangerous to
the
V> child? Perhaps you can video the child using the equipment as a way
to
V> clearly document your recommendations to not get equipment. Also,
are
V> you SURE that the mom is NOT correct? Why do you think the mom
wants
V> equipment that you feel is inappropriate?
V> Thanks,
V> Ron
V>
V> --
V> Options?
V> www.otnow.com/mailman/options/otlist_otnow.com
V> Archive?
V> www.mail-archive.com/otlist@otnow.com
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