This information aims to help you when faced with a non-emergency situation.
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1 WHEN TO STOP There are many reasons to stop a treatment session. This information aims to help you when faced with a non-emergency situation. It is important however to acknowledge that some of these situations can develop into an emergency situation. To SUMMARISE - if in doubt, stop and inform Registered Practitioner. PRECAUTIONS FOR REHABILITATION STAFF WHEN WORKING WITH SERVICE USERS (COMMUNITY AND HEALTH CARE PREMISES) Aim To ensure knowledge of when to proceed with or stop an intervention To recognise danger/warning signs Before any rehabilitation it is important to check; Observation charts, where they are present The Service User feels able to participate and is not experiencing a significant change in function/social/emotional circumstances or an increase in pain The treatment notes should have been read Ask the Service User how they feel Ask if they have any new symptoms or any increase in pain Ask if they feel able to carry out the activity planned. If not feeling able it is important to distinguish between not feeling physically able or not wishing to participate. The Service Users safety and well being should over-ride planned rehabilitation. Your decision not to carry out rehabilitation will not be questioned. Observation charts The observation charts are kept in the front of the Service User s cardex OR at the bottom of the bed. By reading the charts it gives an indication as to the Service User s medical stability.
2 It is important to know the normal limits for each measurement so that anomalies can be noted. 1. Blood pressure systolic Pulse / heart rate Temperature 36.5 C 4. Respiratory rate Oxygen stats above 95% 6. Early warning score less than 3 If any measurements are outside these parameters, consult with the Registered Practitioner prior to carrying out any treatment. If you have any doubts regarding the patient s medical status at any time, stop and report immediately to a Registered Practitioner. Declining/refusing treatment After you have explained what you wish to do with the Service User, they may say no. Be polite do not take offence. Acknowledge their view. Try and explain your intentions once more. Try and establish why they do not want treatment. If the Service User still does not wish to proceed, accept this - do not cause embarrassment/upset to either party. Document clearly in Service User s notes. Avoid personal subjective comments. To write Service User declined treatment due to knee pain would be an adequate example. Inform Registered Practitioner Feeling unwell non-specific If a Service User reports before or during the session that they feel unwell, do not proceed. Find out quickly what symptoms the Service User has e.g. are you light headed, dizzy, and feeling sick, in pain? Have you felt like this before? Ask if the Service User needs to sit or lie down. If the feeling worsens seek advice, if the Service User s level of consciousness deteriorates ring 999 or if an in-service User situation or hospital base call for help immediately from registered staff.
3 If the feeling passes quickly, ask if they feel able for the treatment session to proceed. Proceed with caution and monitor the Service User closely, regularly asking how they feel. If it occurs again, stop. Report to the Registered Practitioner as soon as possible with as much detail as possible. Inform the spouse/carer of the Service User s condition. Document clearly and state, which Registered Practitioner was informed. Shortness of breath If there is shortness of breath at rest before starting, do not proceed with exercises/activity. Checks if the Service User requires regular medication (e.g. inhaler), get this for Service User if appropriate. Ask why the Service User is breathless (they may for example have recently been walking or have a chest infection). Wait until the Service User is no longer breathless- if they remain breathless do not proceed and contact Registered Practitioner During exercising it is normal to become slightly breathless. If a Service User s shortness of breath becomes excessive, stop the activity and allow them to rest until their breathing rate settles. If they remain breathless contact Registered Practitioner. If outside, it may not be possible to sit down to rest. An alternative would be to get them to lean against a wall. If the Service User uses an inhaler, encourage them to use it. Inform a Registered Practitioner as soon as possible. Document clearly and state which Registered Practitioner was informed. Chest pain Do not commence exercise/activity if the Service User reports chest pain or has had it within the previous 3 hours. Inform a Registered Practitioner and document. If the Service User experiences chest pain during treatment, stop activity immediately If the Service User has prescribed medication for angina (spray or tablet) ask them to take it. If the Service User continues to experience chest pain telephone 999 Do not continue with activity, even if the chest pain subsides. Inform a Registered Practitioner as soon as possible and document. Document event clearly and state which Registered Practitioner was informed.
4 Outdoor Mobility If the Service User has regular inhalers or GTN spray ensure these are taken with you. Weather If you have been asked to take a Service User outside as part of a treatment session. Assess if weather suitable not wet, windy, slippery etc give the Service User the choice if they wish to proceed or not. At all times make sure Service Users are dressed appropriately for the temperature outside. If a session has been cancelled due to weather conditions document this clearly. Clarify if the session was offered but declined by the Service User. Inform the appropriate Registered Practitioner Service User not following instructions safely Sometimes Service Users have difficulty following instructions. Sometimes we need to be clearer with the instructions given. If you feel that a Service User is not following instructions and therefore treatment is inadequate, try to clarify the instructions, for example by demonstrating the activity. If this does not work, stop and seek guidance from a Registered Practitioner. If the Service User is putting himself or herself and/or you at risk because they are not following instructions, stop the activity immediately. Inform a Registered Practitioner with appropriate details. Document clearly and state which Registered Practitioner was informed.
5 SUPERVISED TASKS/EXERCISES CARRIED OUT BY REHABILITATION ASSISTANT COMPETENCIES NAME: TAUGHT MODELLED COMPETENT E02 WHEN TO STOP: PRECAUTIONS FOR REHAB STAFF WHEN WORKING WITH SERVICE USERS DATE DATE DATE 1 Check plan 2 Demonstrate awareness of Service User s current state of health - Any increase of pain? - Any increased symptoms? 3 Identify if current function is as expected from treatment plan 4 Demonstrate awareness of reasons to stop treatment - Service User declines/does not consent - Service User unwell/upset eg dizziness - Shortness of breath - Pain/swelling unexplained - Chest pain - Increased symptoms of current problem
6 E02 WHEN TO STOP: PRECAUTIONS FOR REHAB STAFF WHEN WORKING WITH SERVICE USERS DATE DATE DATE - Service User not following instructions 5 Explain how to summon help if condition deteriorates 6 If outdoor work awareness of safety issues - Weather conditions 7 Remember Service User s medication if prescribed 8 Documentation 9 Feedback to delegating Registered Practitioner Sign and date when achieved Signature of Learner Signature of Assessor (Hand Hygiene Champion) Date of Review
7 SUPERVISED TASKS/EXERCISES CARRIED OUT BY REHABILITATION ASSISTANT COMPETENCIES NAME: TAUGHT MODELLED COMPETENT E02 WHEN TO STOP: OBSERVATION CHARTS DATE DATE DATE 1 Check plan 2 Demonstrate awareness of Service User s current state of health - Any increase of pain? - Any increased symptoms? 3 Assess if current medical status is as expected from past treatment interventions 4 Demonstrate awareness of reasons to stop treatment - Service User declines/does not consent - Blood pressure - Pulse / heart rate - Temperature - Respiratory rate - Oxygen stats
8 E02 WHEN TO STOP: OBSERVATION CHARTS DATE DATE DATE - modified early warning score 5 Explain how to summon help if condition deteriorates 6 Documentation 7 Feedback to delegating Registered Practitioner Sign and date when achieved Signature of Learner Signature of Assessor (Hand Hygiene Champion) Date of Review
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