INTENSIVE care patients at Basildon University Hospital are the first in Essex to benefit from a dedicated occupational therapist to help with their rehabilitation.
Rakesh Guru is the unique position of becoming the first occupational therapist in a district general hospital to be based solely within the critical care units (CCU). He covers 25 CCU beds in Basildon University Hospital and The Essex Cardiothoracic Centre.
Rakesh’s appointment will help with the Trust’s response to a Care Quality Commission’s (CQC) report in August which overall rated the hospital as ‘good’ but identified critical care as an area where improvements needed to be made.
Patients are in CCU for medical and surgical reasons and require the most intensive care and treatment. Research has shown the psychological and physical trauma of being in CCU is lessened the sooner occupational therapy begins. This also leads to less time spent in the unit and overall less time in hospital.
Following NICE guidance and advice from the Royal College of Occupational Therapists, Rakesh was seconded to the new post on 1 June and his presence has made an impact.
He said: “I used to be a discharge coordinator, so I was dealing with patients who were well enough to go home. Now I am dealing with the initial rehabilitation of the hospital’s most poorly patients. CCU is a very intense environment. I have had to be very diverse in my approach. I’m not used to being so involved with patients and their families, right from day one, but I am enjoying it.”
Initial therapy includes early mobility, strength-building, balance work to help the patient sit on the edge of the bed, functional activities such as feeding themselves, washing themselves, plus cognitive work, memory work and so on.
In order for Rakesh’s role to work, he relies on the help of ward staff, plus the expertise of the physiotherapy team, dieticians and speech and language colleagues.
Cheryl Terrington, respiratory team lead physiotherapist, works with Rakesh. She said:
“I’ve lost count of the amount of times I’ve said to Rakesh, ‘this patient may need your help from a rehabilitation point of view’. He is always on the ward with a patient. The nursing staff are seeing that, seeing the improvements in the patient and the multi-disciplinary approach we are taking and it is having a positive impact on the care of our patients and morale of the staff.”
As well as patient care, Rakesh is developing patient assessment tools and other documentation so eventually he can train other occupational therapists and ward staff to provide rehabilitation care packages for patients. To do this he is visiting the country’s top teaching schools where occupational therapists are already in place on CCU, to see how they do it.
The aim is to create a seamless rehab plan for patients throughout their hospital stay. Eventually, as well as having an established team in place with all necessary assessment tools and documents, they hope to introduce a more extensive rehabilitation plan including more advanced rehab exercises, so even those patients on breathing apparatus can move about and get out of bed.
He said: “I see this role as improving care for patients and their families, but also educating and supporting my colleagues to make sure the hospital meets national guidance. I’ve already had good comments from relatives. I believe the perception of therapies is slowly going to change. We need to increase the awareness of rehabilitation. It’s not just about the medical care and treatment a patient receives, but how we get them back on their feet and equip them to stay well and healthy once they are back at home.”
Michelle Perham, integrated therapy lead and driving force behind the project, added: “If the patient’s rehab needs are identified early on and discharge planning begins, we can be sure they get the right care, the right equipment and the right support throughout their time in hospital and when they return home.”
The team are working hard to become compliant with NICE guidance in relation to the rehabilitation of critically ill patients. The Royal College of Occupational Therapists have also identified as this is an area where work needs to be focused.
Amanda Fife, nurse consultant for critical care, said: “30 years ago patients in CCU were heavily sedated but now we know better and the focus is on getting them back to doing normal things as quickly as possible.
Staying in intensive care takes a physical toll on the body, with muscle waste and nerve damage, but not many people recognise the psychological toll it takes too, with conditions like post-traumatic stress disorder affecting some patients.
“Early intervention, providing rehab as soon as possible and following that through onto the wards and discharge, means seamless care for the patient.
“Rakesh’s role is unique as we are the only Trust in Essex with such a post, we are ahead of the game. We want to ensure a thorough and structured approach to the rehabilitation of critical care patients to provide the best care possible, now and in the future.”