“When the Book Don’t Work!”
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Transcript of “When the Book Don’t Work!”
Community Living Trust Therapy Team
Jackie Napier & Liz English
Challenging the Boundaries 2012
Innovative Solutions
Who we areB
Community Living Trust Therapy Services
Jackie
Liz
L
TerminologyL
Patients: service users, clients, people we support, subjects, residents
Helpers: Support people, paid workers, volunteers, family members, friends, nurses
Leaders: therapists, educators, team leaders, managers, service co-ordinators
Patient dignityJ
Patients are not just loads. They don’t have handles. They come in different shapes and sizes. They have feelings. They need to be handled safely, with care and dignity.
Patient handling and quality of care are dependent on staff safety and competence.
Quote from Section 2 Why Moving and Handling Programmes are Needed June 2011 Draft.
Decision MakersJ
ClientsFamiliesOrganisationsPolicy –service providersAudits
Risks•Support person
•Client
Who is the client?J
Person referred Person's familyPaid support people – home and vocationalFriends or anyone else who assists transfers
Juggling PrioritiesSafetyIndependenceMaintaining ability to standDuty of careDignity of riskFamily/ethnic cultureDignityLevel of understandingRight to work in a safe environment. A home
becomes a work environment.Who makes the decision?
Behavioural IssuesL
CommunicationTiming
MotivationMedication
Natural rhythmsHitting, biting, head banging
Underlying issues for Behaviour
Ideas
PeterL
Peter is very frail and unable to transfer on his own
Lives in own home with family supportFamily do not want a hoist in the home Also has paid carer coming into his homeHe needs regular position changes
when the book don't work challenging the boundaries 2012
SamJ
• Not walking• Was using standing hoist to remove pants and
go to the toilet• No longer weight bearing effectively for
standing hoist. Relying on extensor tone.• Full hoist now required, however cannot get
pants down even in a hygiene sling• To use the full hoist requires clothing to be
managed on the bed, this now involves many transfers to use the toilet
when the book don't work challenging the boundaries 2012
Mary-JaneJ
Elderly woman with CPVery frail skin ‘tissue paper’Decreasing physical and cognitive abilityToo unsafe for standing hoist, has had falls
and staff want/need to use full hoistMary-Jane very distressed about change
when the book don't work challenging the boundaries 2012
JackL
18 year old man with C.P.Significant I.D. + P.D. – no reliable
communicationLoss of ROM in all jointsLow bone density “density of a 90 yr old”. #’s on
movement. Currently #R patella #L humerusHigh pressure risk – currently ulcer on sacrum
and gluteal creaseFrequent seizuresLives with his mother. Goes to several places for
respite care
when the book don't work challenging the boundaries 2012
BillL
Lives in residential serviceVaried level of ‘skill’ in the team“easy to lift”Refusal from team to use hoist and sling“hoist too hard, not enough space, takes too
long”Staff’s right to choose to do this?
when the book don't work challenging the boundaries 2012
RangiJ
• Mobile but occasionally falls• Once on floor difficult to get up• There is no hoist – and does not meet funding
criteria for one in the home
when the book don't work challenging the boundaries 2012
How do you?BTransfer from seat onto a prone wedge?
Assist a person into a swimming pool where there is no pool hoist?
Position someone in a
contoured seating system without lifting, bending and
twisting?
Is there more to consider about?......
Physical closeness “Therapeutic handling”Essentials of lifeDignity of riskFitness of support personGender considerationsCultural considerations
Solutions needed