Producing the evidence-base for complex assessment - PowerPoint Presentation

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Producing the evidence-base for complex assessment

Sheenagh OrchardRegistered member of National Back ExchangeRGN, RNT, CertEd, DN(London)

06/06/2014

SRO/HSP

Meeting complex need

Patients and Clients are presenting with a need for increasingly complex care managementTherapists and Risk Assessors decisions are being challenged particularly on the cost of complex managements Imperative that meeting the individuals need is not compromisedHow do we ensure the individuals need is central to the decision and demonstrate to clinicians and budget holders that our assessment is valid?

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Competent Assessor

Required by Law Management of Health & Safety at Work Regulations 1999 (UK)Every employer shall:“

appoint one or more competent persons…”

A person shall be regarded as competent where:

“

they have sufficient training and experience or knowledge and other qualities to enable them properly to undertake the measures …”

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Complex case assessment

Requires a wider knowledge and understanding of how to apply that knowledge effectivelyNeed to understand the law and its interpretation so as not to be swayed by ‘myth’ or ‘opinion’Need to ensure managements are evidence-based demonstrating sound knowledge of:

Best practice

Biomechanics and normal movement

Ergonomics and

E

quipment

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Analysis and Evidence

Must be confident of our competencyMust be able to source and use evidence to support our decisionsMust be able to produce our own evidence to support our decisions e.g. use ergonomic assessment tools such as Borg, REBA.Must be able to undertake analysis e.g. of equipment

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Positive Risk Taking

This is nothing new – discussed in Health Care in Later life 1996Need to empower staff to think this way Hayes (1992) suggests ‘ the notion of risk as a wager – assessing both losses and gains – would seem a more appropriate conception of risk’Risk taking is a normal part of daily living at all stages of life

In order to experience maximum fulfilment

in life and reach one’s potential it is necessary to take risks

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Benefits

For the individual include:Increased emotional and physical independenceGreater ability to make choicesIncreased confidence Regain and retain control over their lives within the limits imposed by their physical and mental capacity

For Social Care the benefit is mostly on cost

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Negative

Outcomes

Possibility

of injury must not be ignored

Each case must be considered individually and agreement reached on the levels of risk, possible outcomes and possible injury

Best Practice

How do you develop and evidence your own ‘Best Practice’?The guides to the Handling of People are just that – Guides – Adaptation of standard practices is required if we are to meet some specific client needHow do you develop ‘variance practice’ and evidence it?

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An Example

Use of REBA – postural analysis

Borg – perceived exertion of carer

Comfort

Likert

scale

Activity

Likert

scale

Benner – skill level of

carer

E.g. to comply with MHOR 4(3) ..” the physical suitability of the employee to carry out the operations – their knowledge and skills …”

Use of FIM to identify individuals ability

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Assessment must take account of

Security & stability of individualBody Mass Index ratio

Avoiding 2 tasks at once

The handling management can use 2

carers

OR

Ergonomically ‘design out’

the issue to allow a single

carer

to safely undertake the management

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Equipment

Require sufficient depth and breadth of knowledge to be able to consider the ‘pros’ and ‘cons’ of every piece of equipment to be able to make sound choices for specific managements and individualsAbility to analyse

for ourselves not just accepting manufacturers claimsMake sound business case to demonstrate that cost of equipment can be off-set (e.g. reduced re-assessment, cost-effective use of

carers

Does

the equipment -

Utilise

function and promote some independence

Reduce effort for the

carer

Enable a single

carer

to complete a task

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Cost benefits of correct equipment

Time

Cost

Cost profile when using 2 carers to assist Service User

Cost profile when using 1 carer to assist Service User

Initial investment in equipment

Potential Benefit

The breakeven point will move dependant on whether new or second user equipment is used

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Managements using a single carer

This is one of the most topical complex case management situationsThe framework just described can be used to ‘evidence’ the decision to use a single carer.

Benefits to the individual -

Improved dignity

Less stressful and invasive, physically and socially.

Improved flexibility in care routine.

Empowering

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What ‘evidence’ supports the decision

BIOMECHANICAL – REBABorg Considering Body Mass Index match

ERGONOMICTraining/Skill level/competence

Risk Assessment

Design

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The Framework

Aiming to improve functional ability and confidenceThe outcomes for the individual are key and a balanced-decision making process must be usedKeep a ‘broad vision’ on equipment provision – providing even relatively high cost equipment has a cost benefit over provision of careInvolve all ‘interested parties’ but the individuals needs and opinions are central

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The Process

Identify Broad Goals and the Desired OutcomeUndertake an Activity Analysis – may use ergonomic assessment tools such as FIM and identify what the ‘normal movement patterns’ areUndertake a Task AnalysisIdentify the current difficulties for the individual in achieving the task

Set staged goals for the individual to progress towards the Desired Outcome

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Task Analysis

Task analysis is the systematic analysis and recording of human work activity:Identify risk elements/factors/exposureInvestigate usability and effectiveness of proceduresDevelop instructions/job aidsEnsure the system will work and can be maintained

Determine whether assistance required to meet care/enablement needs

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Competent Assessors

Does your knowledge/skill/experience match the level of Risk Assessment you are undertaking?Could you benefit from learning how to develop and apply evidence to support decisions?Can you apply specific legislation to support your decisions?

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An Ergonomic systems approach to complex risk assessment in Health and Social Care

1 day Introduction workshop - Ethos5 day Advanced practitioner courseFacilitatorsJacqui Smith – Editor

Sheenagh Orchard – Contributing author

of

The Guide to the Handling of People 5

th

& 6

th

editions

www.angelbeck.co.uk

or

www.work-fit.co.uk

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References

Michael V Hayes (1992) On the epistemology of risk: Language, logic and social scienceFrances Heywood & Lynn Taylor (2007).  Better Outcomes,

Lower costs.  Implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence.  Office for Disability Issues

.

Jennifer

Hurstfield

,

Urvashi

Parashar

and Kerry Schofield (2007).  The Costs and Benefits of Independent Living. Office for Disability Issues

HSE (1999)

Management of Health & Safety at Work Regulations 1999

, (2nd edition) Norwich: HMSO.

HSE (2004)

Manual Handling Operations Regulations 1992 (as amended)

(3

rd

edition) Norwich: HMSO

Smith, J (

ed

) (2005)

The Guide to the Handling of People

5

th

ed

2005,

BackCare

Smith, J (

ed

) (2011)

The Guide to the Handling of People

6

th

ed

2011,

BackCare

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