Equipment and Adaptations for Patients and Clients during end of life care Reference Number:

Transcription

1 This is an official Northern Trust policy and should not be edited in any way Equipment and Adaptations for Patients and Clients during end of life care Reference Number: NHSCT/11/438 Target audience: This policy is specific to all Trust staff responsible for the provision of care and support of patients and clients during end of life care. Sources of advice in relation to this document: Karen Jenkins, Governance Manager Liz McNabney, Assistant Community General Manager Lesley, Uprichard, Community equipment Services Manager Replaces (if appropriate): Former NHSCT Provision of Equipment and Adaptations for Patients and Clients during end of life care NHSCT Type of Document: Trust Wide Approved by: Policy Committee Date Approved: 7 September 2011 Date Issued by Policy Unit: 14 September 2011 NHSCT Mission Statement To provide for all, the quality of service we expect for our families, and ourselves.

2 Provision of Equipment and Adaptations for Patients and Clients, During End of Life Care 2

3 Index/Contents Page 1.0 Introduction Purpose and Scope of Policy Policy Statement Aims and Objectives of Policy Monitoring and Review of Policy Target Audience Responsibilities Legislative Compliance Equality and Human Rights & DDA 9 10 Alternative Formats 9 11 Sources of Advice 9 3

4 Index/Contents Page References 10 Appendices Appendix I Operational Guidelines: The Provision of Community Equipment for Patients and Clients During End of Life Care Appendix II Flow Charts on Operational Guidelines for the Provision of Community Equipment for Patients and Clients During End of Life Care Appendix III Operational Guidelines: The Provision of Minor Works and Adaptations for Patients and Clients During End of Life Care Appendix IV Operational Guidelines: The provision of Temporary Ramps Clients During End of Life Care Appendix V Guidance for Prioritising Community Occupational Therapy Referrals 42 Appendix VI Referral Criteria for District Nursing Appendix VII Accessing Grants

5 Introduction Patients expect services to be of high quality, timely and to be well coordinated. They wish to be enabled to die in the place of their choice, often their own home. Commissioners of care should ensure that through an integrated approach, needs are identified and equipment and adaptations required to enable patients to be cared for in the community are made available within an agreed timescale, and where appropriate are removed promptly and sensitively when no longer required (National Institute of Clinical Excellence 2004, Department of Health 2000) 1.0 Purpose and Scope of the Policy This policy is written to clarify the position of the Northern Health and Social Care Trust in relation to its responsibility to provide a quality responsive equipment and adaptations service to patients and clients during end of life care not expected to live longer than six months. In addition, the implementation of this policy will support the timely discharge of these clients from hospital enabling them to be cared for in the home setting. Also within this group are patients who are actively dying within hours or days, who wish to die at home. 3.0 Policy Statement 3.1 Terminal Care is defined as the management of patients during the last few days or weeks or even months of life from a point at which it becomes clear the patient is in a progressive state of decline (National Council for Hospice and Specialist Palliative Care Services. Palliative Care 2001: Commissioning through Partnership. London NCHSPC) For the purposes of this policy end of life care is defined as people with active progressive disease for which curative treatment is neither possible nor appropriate and from which death can be expected within 6 months All clients during end of life care will be given priority for equipment, including stair/interfloor lifts, minor works and aids and adaptations where need has been established following professional assessment. 3.2 Assessment All clients during end of life care will have assessments undertaken by professional staff within the Acute and/or Community setting in line with agreed standard service timescales Requirements for equipment and/or adaptations will be identified and prioritised according to assessed need. 5

6 3.3 Requests for Equipment Professional staff carrying out assessments must promptly notify the Community Equipment Service of the need for the provision of equipment. Estates Services or public housing organisations must be promptly contacted in respect of the need for the provision of adaptations Requests for community equipment and or adaptations must comply with Trust Policies and Operational Guidelines. 3.4 Provision of Equipment and Adaptations The Community Equipment Service will provide stock equipment for this client group within the agreed target timescales, at the request of professional staff Where equipment items required are not in stock, alternative rental arrangements will be available until rented equipment can be replaced by stock equipment Professional staff may also issue stock equipment to clients in their own home from their local satellite store In exceptional circumstances it is recognised that there may be a need to access or provide equipment out-of-hours, including weekends and bank holidays. For smaller pieces of equipment professional nursing staff can issue the majority of items required in these circumstances from their local satellite store In exceptional circumstances, where a client has rapidly deteriorated, staff will aim to facilitate his/her choice to die at home by providing equipment on the day of request. However, the provision of equipment on the same day of request cannot always be guaranteed Specialist items of equipment may also be required to provide terminal care. Where such items are not already available within existing Trust stock, professional managers may purchase these from their individual budgets The Trust will maintain a stock of generic specialist chairs specifically for clients in the terminal phase of an illness and for whom specialist seating cannot be provided through normal means within the timeframe available. 6

7 3.4.8 Estates Services will respond to requests from professional staff for minor works and adaptations within agreed timescales. In exceptional circumstances e.g. inclement weather, adaptations may not be completed within agreed timescales. Public Sector Housing organisations will endeavour to respond in a timely way to requests for minor adaptations Where it is necessary for professional staff to request an urgent feasibility study for an adaptation, the agreed correspondence must be marked urgent and Estates should also be notified by telephone to ensure a timely response 3.5 Where the outcome of the feasibility study indicates significant financial commitment a financial approval must be sought from the designated OT Manager Minor adaptation requests must be ed to Estates Services and followed up with a telephone call for privately owned/ rented property. Professional staff should indicate the necessary response time required. Minor adaptation requests for social sector housing should be documented on an OTACR/16A form and forwarded by post or to the respective housing authority. For requests of an urgent nature a follow up telephone call may be necessary to ensure a timely response. 3.6 Collection of Equipment and Removal of Temporary Adaptations Professional staff will contact Estates Services or the appropriate Public Sector Housing organisation to request the removal of temporary adaptations as appropriate Collection of equipment and removal of adaptations will be undertaken promptly and in a sensitive manner. 3.7 Maintenance of Equipment and Adaptations The Trust will ensure that equipment and adaptations in privately owned property are maintained in line with all relevant policies including Estates Services Minor Works Draft Policy and Infection Control Policy. Public Sector Housing organisations will maintain adaptations in property owned by them All patients and carers will receive the Trust Advisory Leaflet: Community Equipment Service; Information for Users, which provides information on the care and return of equipment as well as contact information for repairs and emergency equipment services. 3.8 Training All Trust staff who are responsible for the provision of care or support to clients during end of life care, will receive awareness training in the implementation of this policy. For new staff this will be included as part of their induction to the Trust. 7

8 4.0 Aims and objectives of the policy All stakeholders within the Northern Health and Social Care Trust will be fully informed regarding the provision of equipment and adaptations for patients and clients during end of life care. 5.0 Monitoring and review of the policy The policy will be reviewed in three years. 6.0 Target Audience This policy is specific to all Trust staff responsible for the provision of care and support of patients and clients during end of life care. 7.0 Responsibilities Directors have overall responsibility for the implementation of this policy. Assistant Directors should ensure implementation and compliance within their respective areas of service. 8.0 Legislative Compliance This policy should be read in conjunction with the following Operational Guidelines and Trust Policies: Operational Guidelines: The Provision of Community Equipment for Patients and Clients During End of Life Care Operational Guidelines: The Provision of Aids and Adaptations for Patients and Clients During End of Life Care Operational Guidelines: The Provision of Temporary Ramps Guidance for Prioritising Community Occupational Therapy Referrals Referral Criteria for District Nursing Accessing Grants Trust Advisory Leaflet: Community Equipment Service Information for Users Policy on the Provision of Minor works and Adaptations in Privately Owned / Rented Property Decontamination Policy (Community Facilities Primary & Social Care Northern Trust Policy for the Provision of Home Lifts for Severely Disabled Persons 8

9 9.0 Equality, Human Rights and DDA This policy has been drawn up and reviewed in the light of Section 75 of the Northern Ireland Act (1998) which requires the Trust to have due regard to the need to promote equality of opportunity. It has been screened to identify any adverse impact on the 9 equality categories and no significant differential impacts were identified, therefore, an Equality Impact Assessment is not required Alternative formats This document can be made available on request on disc, larger font, Braille, audiocassette and in other minority languages to meet the needs of those who are not fluent in English Sources of Advice in relation to this document Policy Author, responsible Assistant Director should be contacted with regard to any queries on the content of this policy. 9

10 References Department of Health (2000) Partnerships in Caring: Standards for Service: A Review of Palliative Care Services National Institute of Clinical Excellence (2004) Guidance on Cancer Services: Improving Supportive and Palliative Care For Adults with Cancer National Council for Hospice and Specialist Palliative Care Services. Palliative Care 2001 Commissioning through Partnership. London NCHSPC

11 Appendix I Operational Guidelines for the Provision of Community Equipment for Patients and Clients During End of Life Care Contents Page 1. Introduction Target Delivery Times Community Equipment Catalogue Stock Protocol for Priority Request from CES Protocol for Issue of Equipment by Professional 14 Staff from Local Satellite Store 4. Specialist Items Provision of specialist items Protocol for provision of specialist seating Review of Operational Guidelines Attachments: Attachment 1: Sample completed CES Requisition Form (MES@LS) 16 Attachment 2: Protocol for the request of Specialist Items from CES Attachment 3: Criteria for the Issue of Specialist Seating For Clients During End of Life Care 19 Attachment 4: List of Equipment Items available from Satellite Stores

12 Operational Guidelines for Trust Staff for the Provision of Community Equipment for Patients and Clients During End of Life Care 1 Introduction The Northern Health and Social Care Trust is committed to providing a quality, responsive equipment service to all patients and clients. However, special provisions apply for the urgent provision of equipment for patients and clients during end of life care. The purpose of this document is to provide Trust Staff with guidance in applying the Trust s Policy and should be read in conjunction with the Policy. 2 Target Delivery Times The Trust s targets for delivery and collection of Catalogue Stock Equipment by the Community Equipment Service (CES) are as follows: - Requisition Target Time Type Priority Issue 24 hours from receipt of request Monday to Friday 3.30 pm deadline for receipt of priority request, excluding Bank Holidays Criteria 1. Equipment required for Terminal Illness; or 2. Equipment Essential for Hospital Discharge Standard Issue Priority Collection Standard Collection 3 Working Days from receipt of request 24 hours from receipt of request Monday to Thursday, excluding Bank Holidays 5 Weeks from receipt of request All other requests 1. Where equipment needs to be removed to provide sufficient space for coffin or wake; or 2. Where the presence of equipment is causing distress or trauma to relatives/carers. All other requests 12

13 3 Community Equipment Catalogue Stock Equipment from Community Equipment Service can be issued to clients in two ways: - a) Priority Request to the Community Equipment Service for delivery b) Issue by professional staff from local Satellite Stores 3.1 Protocol for Priority Request to Community Equipment Service The Community Equipment Service will provide all Stock Equipment within agreed timescales during normal operating hours of: Monday to Friday, 8.30 am to 4.30 pm. Professional Staff Responsibilities Professional Staff should identify and prioritise clients who are in the terminal care phase of an illness, i.e. where life expectancy is less than 6 months. Staff should order equipment via MES@LS before 3.30 pm deadline. Ensure Terminal Ill priority is selected and include any additional information in free text box Community Equipment Service Responsibilities All priority equipment should be issued within 24 hours of receipt of request, as above. At time of delivery, client or carer signs copy of delivery docket as proof of delivery and retains a copy for themselves Community Equipment Service will retain a copy of delivery docket signed by the client. Each client or carer will be contacted prior to delivery to ensure access. Where the client or carer cannot be contacted within the 24 hour period, contact will be made with the requesting officer seeking their assistance to contact the client or their representative in order to gain access to the property for delivery of the equipment. Where equipment requested is not immediately available within the Community Equipment Service, contract purchase and rental agreements will be available and an order will be placed to have the equipment supplied within the 24 hour target time by the relevant external supplier. This is the responsibility of the requistioner 13

14 3.2 Protocol for Issue of Equipment by Professional Staff from a Satellite Store Professional staff who are authorised to requisition equipment may issue a range of equipment to clients directly from their local satellite store. This applies to both staff in acute settings and to community staff who will be visiting the client in his/her own home. Professional Staff Responsibilities Professional Staff should identify and prioritise clients who are in the terminal phase of an illness, i.e. where life expectancy is less than 6 months. Staff should then use own sub-store form when visiting clients with equipment Staff should ensure that Satellite store is replenished by ordering equipment via MES@LS Equipment should be issued to clients with a copy of the Trust s leaflet Community Equipment Service: Information for Users ; The client or carer should sign the sub-store issues form on receipt of the equipment. Community Equipment Service Responsibilities CES staff will process MES@LS satellite store requests. Satellite store stock will be replenished in a timely fashion and on a weekly basis. 4 Specialist Items 4.1 Provision of specialist items Where Specialist items of equipment are needed for clients in the terminal care phase of an illness, Professional staff should, in the first instance, refer to the non stock specialist items available on the Trust intranet to determine if the item is available for issue from recycled Trust stock. A separate protocol is in place for requesting Specialist items of equipment. (Attachment 2) Where the item is not already available from within existing Trust stock, normal procedures for the purchase of equipment through Specials Budgets should be followed or a rental arrangement considered if there is insufficient time to order the required equipment. 14

15 4.2 Protocol for provision of Specialist Seating In the majority of cases, the needs of clients during end of life care for specialist seating can be met by the provision of a standard powered riser/recliner chair. This may be requisitioned in the normal way from the Community Equipment Service. Criteria for the issue of specialist seating for clients during end of life care is outlined in attachment 3. However, where a client requires postural support or integral pressure relief and more specialist seating is needed, Professional staff should, in the first instance, refer to the non stock special seating list available on the Trust intranet to determine if the item is available for issue from recycled Trust stock. If there is no specialist seating in stock consideration should be given to renting or purchasing the seating recognising that procurement processes and delivery can be up to 12 weeks. As an alternative to purchasing a chair a stock of generic specialist seating is available within the Community Equipment Service. 5. Review of Operational Guidelines These guidelines will be reviewed:- in conjunction with any review of the main policy document; following standardisation of services across legacy Trusts; and in response to necessary changes in working practice. 15

16 Attachment 1 16

17 Attachment 2 COMMUNITY EQUIPMENT SERVICE OT Specials List: Protocol for reserving equipment 1. OT Staff in the first instance, refer to the non stock special seating list available on the Trust intranet to determine if the item is available for issue from recycled Trust stock. 2. OT Staff wishing to request an item from the Specials List should contact the OTTI for equipment to confirm availability of the item of equipment 3. If the item is available, the OT TI for equipment will complete a Specials List: Reserve Request form, which will be immediately attached to the piece of equipment. (Copy attached) 4. If the item is already held on reserve, staff may request contact details of the original requisitioner in urgent priority situations, in order to agree client priority. 5. If staff agree to transfer the equipment to a different client, it is the responsibility of the original requisitioner to notify the OTTI. 6. The identified item of equipment will then be requested on MES@Ls 7. All reserved items will be held for 5 working days pending online MES@Ls request for delivery of the equipment. 8. If the equipment is not requested on MES@LS within 5 working days, the OTTI will contact the requisitioner to confirm the item is no longer required so that it can be released for use by other staff. 9. In exceptional circumstances, where the original requisitioner is not available, the OTTI will contact the Senior Practitioner /Clinical Lead OT April

18 COMMUNITY EQUIPMENT SERVICE Specials List Reserve Request - Specials List Item No: Name of Requisitioner: Contact Tel No: Name of Senior Practitioner /Clinical Lead OT Contact Tel No: Date of Request: Item to be held until: 18

19 Attachment 3 Criteria For The Issue Of Specialist Seating For Clients During End of Life Care Florien chairs - tilt-in-space chairs have been purchased to meet the short-term i.e. less than 12 weeks, specialist seating needs of clients during end of life care. These chairs can be requested by ordering then in the normal way on line on MES@LS. CRITERIA There is medical evidence to suggest that the client is in the terminal care phase of an illness (during end of life care) AND The client has assessed seating needs which cannot be met using a standard high chair or powered riser/recliner chair AND The client requires pressure relief within the chair. AND The clients medical state is such that they can make use of this equipment. NB: It is important that these chairs are recalled and collected as soon as possible, when they are no longer required. They should not be issued to clients who do not meet these criteria. 19

20 Nursing Satellite Stores Access Times Area Satellite Store Location 9am 5pm District Nursing Slemish Community Antrim / Ballymena Nursing sub-store; Inclusive of Week ends and Bank holidays Access to Store 1 st on-call hold key Equipment Available Syringe driver box Static commodes Urinals Incontinence aids Catheterisation packs Multi glide sheet Nebulizer 9am 5pm Inclusive of Week ends and Bank holidays 9am 5pm Inclusive of Week ends and Bank holidays District Nursing Antrim / Ballymena District Nursing East Antrim Rosedale Residential Home Carnmoney Road key held in Rosedale office 1 st on-call hold key Syringe driver box Static commodes Urinals Incontinence aids Catheterisation packs Suction machine Multi glide sheet Nebulizer Syringe driver box Static commodes Urinals Incontinence aids Catheterisation packs Suction machine Multi glide sheet Nebulizer 20

21 Access Times Area Satellite Store Location 9am 5pm District Nursing Castle Practice East Antrim Inclusive of Week ends and Bank holidays 9am 5pm Inclusive of Week ends and Bank holidays 9am 11pm Inclusive of Week ends and Bank holidays District Nursing East Antrim HDNT Antrim Area Lisgarrell Residential Home Oriel House & ALDER HOUSE Antrim Hospital Access to Store Staff hold key Key held in Lisgarrell HDNT 8.45am pm Equipment Available Syringe driver box Static commodes Urinals Incontinence aids Catheterisation packs Multi glide sheet Nebulizer Syringe driver box Static commodes Urinals Incontinence aids Catheterisation packs Suction machine Multi glide sheet Nebulizer Syringe Driver Box Static Commodes Catheterisation Packs 9am 11pm Inclusive of Week ends and Bank holidays HDNT Mid Ulster Area Moneymore Dalriada Urgent Care Office Dalriada Urgent Care Syringe Driver Box (Moneymore Office) Static Commodes Nebulizer 21

22 Access Times Area Satellite Store Location 9am 11pm HDNT Whiteabbey Area Inclusive of Week ends and Bank holidays 24 hours 7 days per week Antrim/ Ballymena Area Whiteabbey Hospital Norah Bain Block C Dalriada Urgent Care Access to Store Equipment Available Syringe Driver Box Static Commodes Catheterisation Packs in the first instance, refer to the non stock special seating list available on the Trust intranet to determine if the item is available for issue from recycled Trust stock. Nebulizer Dalriada Urgent Suction Machine Care 24 hours 7 days per week Mid Ulster Area Moneymore Dalriada Office Dalriada Urgent Care Suction Machine 24 hours 7 days per week Whiteabbey Area Whiteabbey Hospital Dalriada Office Dalriada Urgent Care Suction Machine 22

23 Nursing Satellite Stores Causeway Legacy Trust Access Times Area Satellite Store Location 9am 5pm Coleraine Portrush Portstewart Inclusive of Week ends and Bank holidays 9am 5pm Inclusive of Week ends and Bank holidays 9am 5pm Inclusive of Week ends and Bank holidays Ballymoney Cloghmills Garvagh Kilrea Glens of Antrim Ballycastle Bushmills Staff on duty at weekends and bank holidays carry equipment with them Staff on duty at weekends and bank holidays carry equipment with them However staff within Trust premises do have access. Equipment can be obtained within these sites. Staff on duty at weekends and bank holidays carry equipment with them. Access to Store Contact staff oncall The Brook: Contact Dalriada Urgent Care To obtain number of District Nursing staff on call Contact Dalriada Urgent Care at To obtain number of District Nursing Equipment Available Syringe driver box Urinals Incontinence aids Catheterisation packs Multi glide sheet (Suction machine available in The Brook) Wound dressings Syringe driver box Urinals Incontinence aids Catheterisation packs Multi glide sheet Suction machine (Suction machine also available in Robinson Hospital) Wound dressings Syringe driver box Urinals Incontinence aids Catheterisation packs Multi glide sheet 23

24 Access Times Area Satellite Store Location However staff within Trust premises do have access. Equipment can be obtained within these sites. 9am 5pm Inclusive of Week ends and Bank holidays 8.30am 7.30pm Inclusive of Week ends and Bank holidays 7.30pm 10.30pm Access to Store staff on call Equipment Available Suction machine (Suction machine also available in Dalriada Hospital) Wound dressings Rathlin Island Rathlin Syringe driver box Static Commode Urinals Incontinence aids Catheterisation packs Multi glide sheet Suction Machine Wound dressings Rapid Response Team Twi-light Nursing Service Twilight Room (Robinson Hospital) Twilight Room (Robinson Hospital) Key available at nurses station in Robinson Hospital Key available at nurses station in Robinson Hospital Drip stands Drip counter IV access Syringe driver box Incontinence pads Urinals Wound dressings Drip stands Drip counter IV access Syringe driver box Incontinence pads Urinals Wound dressings 24

25 Access Times Area Satellite Store Location 24 hours 7 days per week 24 hours 7 days per week 24 hours 7 days per week 24 hours 7 days per week Ballycastle Ballymoney Bushmills Cloghmills Coleraine Garvagh Glens of Antrim Kilrea Portrush Portstewart Ballycastle Bushmills Glens of Antrim Ballymoney Cloughmills Garvagh Kilrea Coleraine Portrush Portstewart Causeway Hospital Outpatient department Dalriada Hospital Ballycastle Robinson Hospital Access to Store Causeway reception Equipment Available Static Commodes Suction Machine Robinson Hospital Suction machine The Brook Suction machine 25

26 OT Satellite Stores Access Times Area Satellite Store Location Access to Store Equipment Available 9.00 am 5.00 pm Mon Frid Antrim Community O.T. Team Oriel House 2-8 Castle Street Antrim Oriel House Tel: A range of non-stock equipment and small items of stock equipment. am 4.30 pm Mon Frid Antrim Acute O.T. Team O.T. Department Level B Antrim Area Hospital Bush Road Antrim Antrim Area Hospital Tel: A range of non-stock equipment and small items of stock equipment am 5.00 pm Mon Frid 9.00 am 5.00 pm Mon - Frid Community Rehab Team Antrim Magherafelt Community O.T. Team Community Rehab Oriel House 2-8 Castle Street Antrim Magherafelt Community O.T. Store Community Services Centre 60 Hospital Road Magherafelt Oriel House Tel: Community Services Centre Tel: A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment. 26

27 Access Times Area Satellite Store Location Access to Store Equipment Available 8.30 am 4.15 pm Mon- Frid 9.00 am 5.00 pm Mon Frid 9.00 am 5.00 pm Mon Frid 8.30 am 4.30 pm Mon Frid 9.00 am 5.00 pm Mon Frid Magherafelt Acute O.T. Team Magherafelt Rehab Team Cookstown Community O.T. Ballymena Acute O.T. Team Ballymena Community O.T. Team Mid Ulster Hospital 59 Hospital Road Magherafelt Community Rehab Garden Street mews Garden Street Magherafelt Cookstown O.T. Store Westlands 2 Westland Road Cookstown O.T. Department Braid Valley Hospital Cushendall Road Ballymena. Spruce House Braid Valley Hospital Site Cushendall Road Ballymena Mid Ulster Hospital Tel: Garden Street Mews Tel: Westlands Tel: O.T. Department Braid Valley Hospital Tel: Spruce House Tel: A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment am 5.00 pm Mon Frid Ballymena Rehab Team Houston s Mill 10 Buckna Road Broughshane Houston s Mill Tel: A range of non-stock equipment and small items of stock equipment. 27

28 Access Times Area Satellite Store Location Access to Store Equipment Available 9.00 am 5.00 pm Mon Frid 8.30 am 4.30 pm Mon Frid 9.00 am 5.00 pm Mon Frid 9.00 am 5.00 pm Mon Frid 8.30 am 4.30 pm Mon Frid Larne Community O.T. Team Larne Acute O.T. Team East Antrim Rehab Team Newtownabbey Community O.T. Team Whiteabbey Acute O.T. Team Gloucester Park Day Centre Site Larne O.T. Department Inver House Moyle Hospital Gloucester Avenue Larne Edward House 8 Edward Avenue Whitehead Hillcroft Community Services Office Abbots Road Newtownabbey O.T. Department New Ward Block Whiteabbey Hospital Doagh Road Newtownabbey & O.T. Department Ward 9 Whiteabbey Hospital Doagh Road Newtownabbey Gloucester Park Day Centre Tel: O.T. Department Tel: Edward House Tel: Hillcroft Community Services Office Tel: New Ward Block Tel: & Ward 9 Tel: A range of non-stock equipment and small items of stock equipment A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment. 28

29 Access Times Area Satellite Store Location Access to Store Equipment Available 9.00 am 5.00 pm Mon Friday 9.00 am 5 pm Mon Frid 8.30 am 5.00 pm Mon Frid Newtownabbey Community O.T. Team Coleraine / Ballymoney Community O.T. Teams & Ballycastle Community O.T. Team Causeway Acute/Community/ Rehab Teams Glengormley Community Services Centre 40 Carnmoney Road Newtownabbey & Hillcroft Community Services Office Abbots Road Newtownabbey PDSI/O.T. Building Mount Fern Complex 8a Rugby Avenue Coleraine Dalriada Hospital Site 1a Coleraine Road Ballycastle Unit 7 Ballybrakes Business Park Ballymoney Glengormley Community Services Centre Tel: Hillcroft Community Services Office Tel: PDSI/OT Building Mount Fern Complex Tel: Dalriada Hospital Site Tel: Unit 7 Ballybrakes Business Park Tel: A range of non-stock equipment and small items of stock equipment A range of non-stock equipment and small items of stock equipment. A range of non-stock equipment and small items of stock equipment. 29

30 Appendix II FLOW CHARTS ON Operational Guidelines for the Provision of Community Equipment for Patients and Clients During End of Life Care 30

31 PRIORITY REQUESTS FOR COMMUNITY STOCK EQUIPMENT FOR CLIENTS During End of Life Care Assess and identify equipment needed for client with a life expectancy of < 6 months Order equipment on line using the Trust MES@LS system. Identify on MES@LS that client is terminally ill by selecting the correct category. CES will prioritise this request and make contact with client /carer to arrange delivery of equipment within 24 hours CES will deliver equipment and update MES@LS Professional member of staff will follow up to ensure client need has been met 31

32 SUB-STORE ISSUE OF COMMUNITY STOCK EQUIPMENT FOR CLIENTS IN THE TERMINAL STAGE OF AN ILLNESS Assess and identify equipment needed for client with a life expectancy of < 6 months Identify equipment required from sub store Issue equipment sourced from sub store, to client Gain signature from client /carer indicating receipt of equipment Provide client/ carer with a copy of Community Equipment Service: Information for Users Update MES@LS system indicating that equipment was issued from sub store. Hold receipt of equipment form in client file CES will replenish sub store with equipment similar to that issued 32

33 REQUEST FOR NON STOCK EQUIPMENT FOR CLIENTS IN THE TERMINAL CARE PHASE OF AN ILLNESS Assess and identify equipment needed for client with a life expectancy of < 6 months OT staff will reference the specials non stock list of equipment on Trust intranet or contact OTTI to identify non stock equipment required OT staff will agree non stock item to be held for issue and OTTI will complete specials list request form and attach to item of equipment OT will request the delivery of the identified item of equipment on line on MES@LS indicating that client is terminally ill. If item of equipment required is not available from the specials non stock list the OT should complete a non stock requisition and clinical reasoning form-otacr15 and forward this to OT Head of Service for immediate purchase or consider a rental arrangement When item of purchased non stock equipment is delivered to the CES the OT will be contacted to request delivery using MES@LS on line system 33

34 Appendix III Guidelines for Trust Staff for the Provision of Minor Works and Adaptations for Patients and Clients During End of Life Care 1.Introduction The Northern Health and Social Care Trust is committed to providing a quality, responsive equipment and adaptation service to all its patients and clients. However, special provisions apply for the urgent provision of equipment and/or adaptations for patients and clients during end of life care. The purpose of this document is to provider stakeholders with guidance in applying the Trust s Policy on The Provision of Equipment and Adaptations for Patients and Clients during end of life care should be read in conjunction with this policy. 2. Provision of Aids and Adaptations The Northern Health and Social Care Trust Estate Services Department will provide a direct minor works and adaptations service for patients and clients in the terminal care phase of an illness who live in privately owned or privately rented property in The Northern Health and Social Care Trust locality. Provision is based on the recommendation of an Occupational Therapist to the Estate Services Department who arrange the works using Directly Employed Labour or Local Contractors as required. Social sector housing organisations fulfil this responsibility for their own properties. The normal operational hours are 8am to 4.30pm Monday to Friday but special emergency arrangements can be made, as required for urgent out of hours provision. Estate Services provides two levels of support: Minor Works requested through the helpdesk. (Homefirst Legacy Trust and electronically in Causeway Legacy Trust) Aids and Adaptations by application on the appropriate pro-forma (Attachment I) Public sector housing adaptations are requested using the appropriate pro forma (Attachment II) 2.1 Minor Works and Adaptations Requests For the purposes of this policy, the NHSCT Minor Works and Adaptations are defined as those alterations or modifications to a clients property which the Trust has identified a clinical need for and for which funding is available to provide. Major Adaptations are processed in private housing sector via the Disabled Facilities Grants process administered by the Northern Ireland Housing Executive. 34

35 These minor works may include such items as: Internal grab rails - Bath, shower, w.c., fold down rails and newel rails Stair gates External Grab Rails Stair hand rails Handrails internal/external (excluding stair hand rails) Removal of door saddles / changing the swing of a door Repositioning of electric sockets Provision of adequate lighting internal/external In certain circumstances in line with clear guidelines and criteria, the Trust also provides for higher costs works / adaptations. These works are more specialist or technical in nature and when approved by the Occupational Therapy Service are forwarded by NHSCT Estate Services to the contractor for completion. These works may include such items as Home lifts and overhead tracking hoists Ramps Extended/Graduated Steps Cooker isolation switches Level surface access Door widening Special taps/wash hand basins (Home Dialysis) Miscellaneous where technical input is needed i.e. fencing, safety glass, working in support of environmental control systems etc Application process for provision of Minor Works and Adaptations Following the identification of need Occupational Therapy staff will make a request via to Estate Services or the Social Sector, depending on home ownership, using the attached proforma OTACR/16b for privately owned properties and OTACR/16a for Social Housing. The request will include the following information as a minimum requirement; Their section s/team s identity. Their name, office, contact telephone and fax number. The client s name, address, postcode and telephone number etc. Details of special access arrangements where necessary. Directions to clients address where necessary. An accurate and detailed description of the request dimensions and fitting reference points. Response time required. 35

36 2.3 Response Times for Estate Services There are 2 response times, in line with Departmental Guidance which relate to the time scales within which it is anticipated the request will be completed. Urgent Works 10 working days Routine Works 20 working days Where a patient or client qualifies under the provision of this Policy Document or these Guidelines then the Urgent response will be applied though Estate Services are committed to ensuring such work is completed within 2-3 working days. It is important to note however that external work such as ramps can be weather dependent and complex requests such as a curved track lift can take up to three months to complete due to procurement processes. Social sector housing organisations endeavour to respond to urgent minor adaptation requests in a timely way. In these circumstances direct contact, via telephone may also be necessary between the therapist and the Housing provider to highlight the urgency of the case. 3.0 Feasibility Requests for Adaptations Feasibility survey responses are normally provided to Professional Staff for home lifts and overhead tracking hoists, ramps etc. Fast track requests can proceed on the authority of the designated OT manager with the survey response following in due course. Where there is a practical or technical reason why a request cannot proceed, Professional Staff will be contacted for further instructions. Professional Staff will provide the following information when completing a feasibility request. Their section s / team s identity. Their name, office, contact telephone and fax number. The client s name, address, postcode and telephone number etc. Details of special access arrangements. Directions to clients home. An accurate and detailed description of the request dimensions and fitting reference points. Response time. Feasibility request forms should be ed to Estate Services (OTACR/16b) with a clear indication of the need to fast track the process. These requests will be addressed in a timely way by for the attention of the Aids and Adaptations Officer. 36

37 4.0 Quality Standards for Estate Services The Estate Services department will endeavour to abide by the following standards in relation to: 4.1 The Client Access arrangements will be made by telephone or letter. Estate Services staff or contractors calling on their instructions will carry and show photographic identification to the client/carer. Estate Services staff or contractors will be courteous, considerate and patient with the clients and carers. Contractors will minimise delay in completing the works and disruption to the normal routine of the client and carer. Contractors will leave the working area in a clean and tidy condition on completion of the works. All aspects of the work and client details will be treated in strictest confidence. 4.2 The Professional Staff Ensure that minor works and adaptations are installed only in accordance with the professional staff s instructions. Where practical or technical constraints prevent installation the professional staff will be contacted for further instruction. Participate in joint visits or arrange for contractors to participate in a joint visit if the professional staff considers it necessary. Provide feedback on completed works for service monitoring and budgetary purposes. Provide brochures, technical literature and advice as may be requested by the professional staff. 4.3 The Works/Installation The contractor will follow only the recommendations provided by the Occupational Therapist. Only minor works and adaptations approved by the Trust, Professional Staff and Estates Department will be installed. Minor works and adaptations will always be installed in a manner consistent with good working practice and in accordance with the manufacturers constructional arrangements. Work subject to Statutory Standards, British Standards or a Local Authority Regulations will always be carried out in a manner consistent with those standards or regulations. These guidelines are covered in more detail in the Policy for the Provision of minor Works and Adaptations in Privately Owned / Rented Property, included in the 37

38 policy are copies of the various pro-forma to be used when submitting a request to Estate Services. Attachment I OTACR/16b OCCUPATIONAL THERAPY ESTATE SERVICES REQUEST Urgent (10 working days) Routine (20 working days) MINOR WORKS & ADAPTATION FEASIBILITY REQUESTS IN PRIVATELY OWNED / RENTED PROPERTY To: ot.works@northerntrust.hscni.net From: Prescribing OT: Lead OT: Service User Details Name: Address: Postcode: Tel: No. Minor Work(s) Required Adaptation(s) Required Access Arrangements /Directions 38

39 Signed: Band: Date: Occupational Therapist OTACR/16a OCCUPATIONAL THERAPY MINOR ADAPTATIONS - SOCIAL SECTOR To: NIHE District Office / Housing Association Maintenance Dept. Minor Adaptations -Social Sector Housing Name: Address: Tel.No / Contact details ADAPTATION: Further to assessment I would confirm that the above named would qualify for registration under the Chronically Sick and Disabled Persons (NI) Act 1978, Section 1. The following adaptations are considered necessary and appropriate: Recommendation(s): If you have any queries regarding the recommendation(s), please do not hesitate to contact me. 39

40 Signed: Occupational Therapist Date: Appendix IV OPERATIONAL GUIDELINES FOR THE PROVISION OF TEMPORARY RAMPS FOR CLIENTS DURING END OF LIFE CARE Patients and clients during end of life care, will receive temporary ramped access in a timely and sensitive way. A ramp will be provided where a patient/client is almost or totally wheelchair dependent for all mobility. In all instances a portable temporary ramp should be the first option considered. Where this is feasible the Occupational Therapist should check with the Equipment Service that a portable ramp is immediately available. The Occupational Therapist should then complete the stock equipment requisition form, indicating No. 1 on the high priority box on top right-hand corner of the form. This form should then be faxed to the Community Equipment Service. The Occupational Therapist will carry out a follow up visit to confirm the suitability of the temporary ramp. 1. Privately Owned Property Where a built temporary ramp or modular ramp is required, the Occupational Therapist will request an urgent feasibility for ramped access by completing the appropriate Proforma, 0TACR/16b.(see attached). A follow up telephone call to Estates will also ensure timely intervention. Estate Services will carry out the feasibility and the outcome of this feasibility to the Occupational Therapist within 2 working days. If the feasibility indicates a temporary built ramp can be fitted, the Occupational Therapist will obtain permission from the Senior Practitioner/Clinical Lead Occupational Therapist to proceed immediately. This information will be conveyed to Estate Services by and confirmed by telephone call. A temporary built or modular ramp will then be fitted at the client s home within 5-7 working days. Where a portable temporary ramp or a built temporary or modular ramp is not feasible, a step lift will be considered. This should be carried out in conjunction with Estate Services and the supplier/installer to determine feasibility and costing. Funding approval is necessary through the OT Services Manager. It is important to note that due to the manufacturing and procurement process for this equipment installation could take up to 12 weeks. 40

41 Social Sector Housing The Occupational Therapist will assess and identify the need for ramped access. A request, using the appropriate Proforma form (OTACR/16a) will then be forwarded to the appropriate Housing Association or the Northern Ireland Housing Executive (NIHE), indicating that the request is urgent. The Housing Association or NIHE will complete this work as a priority. The Occupational Therapist will liaise on a regular basis with the Housing Association or NIHE to ensure the most responsive timescale is achieved. It is noted that timescales for ramps in private and public sector housing are dependent on suitable weather to complete this work. 41

42 Appendix V GUIDANCE FOR PRIORITIZING COMMUNITY OCCUPATIONAL THERAPY REFERRALS All referrals are categorised as: - Priority or Routine A priority referral will receive an initial assessment within 10 working days. A routine referral will receive an initial assessment within 3 months. All referrals are prioritized on the basis of the content of the referral, other information received, previous file information (if available) as well as the professional judgement of the Senior I Occupational Therapist. All referrals are recorded in chronological order. Priority Referrals In all cases clients in the terminal care phase of their illness will be treated as priority Other priorities include: Living alone and at risk or living with an elderly/disabled person and at risk. Hospital discharge - where intervention is required to facilitate hospital discharge or to meet urgent need (linked to risk) Mobility - where client s mobility has deteriorated and client is now at risk - where equipment is broken/needs replaced - where client is required to attend treatment (e.g. Chemotherapy/dialysis) CMA - Toileting - where the care situation has broken down (not respite care) or permanent care placement is imminent where the client is now unable to manage this task Some clients will be fast tracked due to high-risk clinical need. All other referrals will be prioritised as routine February

43 Appendix VI REFERRAL CRITERIA FOR DISTRICT NURSING SERVICES September

44 Vision Appropriate referral The aim of the district nursing service is to provide a responsive, holistic service, which meets the needs of the individual patient and their carers, within their own environment. We are committed to a multidisciplinary approach to health and social care, based on partnership, collaboration and teamwork and with a focus on health promotion. House bound patients with an identified nursing need Risk assessment to be completed where is an identified nursing need Inappropriate referral Patient is able to mobilise & attend the health centre Requires equipment not related to a nursing need. Suggested alternative referral Refer to treatment room Refer to Social Services, O.T., Physiotherapy. The District Nursing Service supports patients and carers, to enable them to cope with ill health and disability thus allowing them to reach their optimum quality of life, whilst maintaining dignity and respect. Patients requiring continence management Personal care/hygiene needs only. Refer to Social Services for personal care or bathing services. September 2004 Patients with complex need requiring a nursing assessment as part of a multi disciplinary assessment. Referrals from other disciplines due to service shortages/delays & no obvious nursing needs. Referral returned for forwarding to appropriate professional service. 44

45 Referral Criteria Appropriate Referral Inappropriate referral Patients requiring advice & Monitoring visit support to achieve where there is no optimum levels of selfcare. defined nursing need. This referral criteria is designed as a guide to improve the referral process. Where referrals are made to the service, district nursing staff will continue to exercise their professional judgement in terms of acceptability onto the service. 1. The judgement to accept a patient onto the District Nursing Service is based on a holistic nursing assessment. The patient must have a specific nursing need. 2. Patient and /or carers should be advised of the need for a district nursing assessment and must have consented to the referral. 3. Referral forms must be fully completed before the District Nursing Service can accept a patient for assessment. Incomplete forms will not be accepted Inappropriate referrals will be returned for further discussion with the referrer. In an emergency, telephone referrals will be accepted and must be followed by the written referral form. 4. All patients referred to the District Nursing Service will be assessed as new admissions regardless of previous care provision. It should not be assumed that previous service provision would be given. A new assessment and care plan will be offered to all patients as required. 5. Patients should either be housebound, that is only able to leave home by ambulance, or have a nursing need which makes a home visit more appropriate Patient who have a terminal illness or who require clinical interventions in their own homes. Dispensing and/or collection of medication. Retrieval of samples. Administration of medication that can be administered by a non-nursing professional. Patients who have fallen & are unable to rise without assistance. Suggested alternative referral Refer to the appropriate service or return to referrer. Request can be made to carers, family or pharmacy. Training of a nonprofessional can be arranged with the appropriate support, supervision & follow up. Refer to GP or Ambulance Service. 45