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Everyone. My name is Rachel. I'm one of the co-lead of this members of the M TT series. Today, we have Ana Abbas who is a general therapist working at and Sussex NHS Trust specifically East Story Hospital. And today he will speak to us more about the role of an occupational therapist. I'll leave it to you, Ana and we, if you have any questions, type in the chat box. Um and he'll do his best to, we'll do our best to answer your questions towards the end of the session if that's all right. Thank you, Adnan. No worries. So, my name as Rachel mentioned, my name is Adnan Abbas. I work as a gen generic therapy instructor at East Surrey um hospital which is Surrey and Sussex Healthcare. Um We cover the Surrey borders and the West Sussex borders. Um So I'm just going to talk a bit more about, I'm gonna focus more on occupational therapy uh within an acute hospital. Um Although I also do work as an acute physiotherapist as well, so I cover both roles, but I think you guys have had a talk already a bit more on physiotherapy. So I'll try and focus more on the occupational therapy side of things. Um So kind of want to start off by um kind of talking about how the a patient's journey when they come into an acute hospital from uh occupational therapy and a physiotherapy point of view. So they kind of get admitted, they have a fall or they're not. Well, they come through to our emergency service and if they, you know, often there are people establish that they have care needs or they're worried about, um, a few things, they uh patients might be starting to get confused. So what the therapists at the front door do they establish that early on? And if they can set them up with help at home very quickly, they do that and try to turn them around and get them home quickly. If not, if there is further medical intervention required, they tend to send them into our acute medical wards, which I cover, I'm currently on my rotation or for, I'm covering a gastro um ward. Um So we're seeing a lot of um sort of patients waiting, gastric, um gastros surgeries and all sorts. Um So when we start to look at a patient, I work really closely with physiotherapists as well as um doctors like Doctor Rachel. Um, we go and review a patient straight away be before we start our session, we want to know more about the patient. So we want to know what their baseline is both physically and cognitively. It's very important that as, as an occupational therapist, you look at the cognitive side of things because often uh within our trust, we're finding that people are missing that side of things. If someone comes into hospital confused, a lot of times people, if nobody tells them, they assume this is kind of ongoing because often people have diagnosis of dementia. But we don't really have an understanding of what their normal baseline cognition is. So we tend to kind of assume that it is confused. Whereas often it could be a new confusion, it could be a delirium on top of their dementia, which is kind of, you know, making them more confused than they usually are. So then uh as in uh sorry about that, as an occupational therapist, what kind of interventions do we have? So we go together to review the patient with the physiotherapy, get a good social history. So we find out about the patient's um cognitive baseline and physical baseline. Now, if they're off their cognitive baseline, there are different kind of testing that we can do. So we do uh one of the most common um test that we use as a mini ace, which kind of looks at their ability to kind of, you know, are they oriented time and space and do they know where they are? We also look at their safety awareness if they're confused because, you know, you don't really want to confuse person living at home alone without any help because there's many things that can go wrong such as their wrist to fire because they could go into the kitchen and cook something so on. So, and then, so we need to kind of assess for that. So we do things like kitchen assessments where we take the patients, we have kitchens within the hospital which are designated for these kind of um assessments. So we take them there, we look at their ability to, to function. We do little things like unplug the socket and see whether the patient identifies that. Um, a lot of times we find if the patients really confused, they will just, um, we ask them to make a hot drink. Er, we find that they will turn the kettle on but they, without checking whether it's plugged in or, um, they will do things really unsafe. Like it could be a little old lady and she would fill up, um, the kettle all the way to the top and won't be able to lift it. So little things like that, whether they're gonna be safe at home or not. Um, then we kind of look at, there's also these patients are quite vulnerable to, um, people who are trying to cause them harm and try and take advantage of them financially. So we need to look at whether they're safe and from scams and things like that. So we question them a little bit about that. We find out what they would do if a stranger rocked up. Um, you know, would they answer the door? How will they get help? Um, one of the most common things we look at is, um, um, making sure that they know what to do when they fall over. A lot of people tend to say I'll just get up. But then on the ward they're needing two people's help, three people's help. So it's for our job is to find out how safe they're gonna be at home. Now, once we establish they're gonna be safe at home, we need to make sure we have three different pathways within our trust where a patient can leave the hospital. So pathway number one is, they can either go, they can go home with without, without support. If they, if we think they're gonna be safe, they, they're gonna manage or they have a family member who can help them. Um er, same within pathway one, we have, they can go home with carers. Now we have a full package of cares. Um, so we can have a carer coming once a day, twice a day, three times a day and four times a day. Um within our trust, we don't offer a service where we provide overnight care. So that's something we need to look at as well. So we ask our nursing staff to do behavior diaries on the patients for 24 hours. So then we can kind of monitor and have a look whether they're going to be safe um overnight, whether the patient is confused and they're trying to get up. Um We often find patients wandering around the ward in the middle of the night. So we would like them to know about these things. So then we can um you know, um have a chat with the family to say, look, um your mum or your dad or your relative is quite disturbed during the night. And we are concerned that because often what can happen, we often see these cases, we find a lot of elderly people, they're confused during the night and people often find them on the street, um, they find them on the floor, they wake up in the night and then they have a fall. So we have to look at the whole picture, a really holistic approach, um, working with, um, within the occupational therapy team. We know we want to make sure they're safe all round now. Um, so sorry, I'll keep going off topic. So pathway number one is aiming for home now, that could be with or without carers. We want to, if we are sending them home with carers, the carers will roughly, er, the rough care package would look like somebody would come in in the morning to help them with breakfast, washing and dressing, set them up for the day, leave them in the chair and then they'll come again at 12 to give them lunch medication. Then another visit would be around five o'clock for their evening tea, evening meal. Um, and another final call would be around 89 o'clock to put them to bed safely. Um, now it's very important that we establish that the patient can manage between the care calls now because they'll be left alone at 88 to 12. Now, what happens between the four, between those four hours, we want to make sure that they're going to be safe. Um They're going to manage and not end up on the floor. And so we make sure while they're on the ward, we do assessments where we see if they can get out of bed themselves that they can toilet themselves, they do their own personal care. So we want to make sure they're going to be safe at home. Now, that's pathway number one, pathway number two is going to an inpatient rehab community hospital, which is um the sole purpose of this hospital is to rehabilitate the patient. Now, often we go to review a patient and the patient is completely off their baseline. They, they could have had um hip injuries, they could have had a stroke, they could have had um just off their feet from um things like UTI A K I. And we find that they're quite deconditioned at elderly age. Um It's quite easy to get deconditioned really quickly because there are a lot of medical complications to getting your patients up too early. So we have to kind of let them rest in bed and get them out when it's the appropriate time. There's things like BP, um their bloods are not correct and their hemoglobin could be low. There could be many things stopping us from seeing a patient so that can often decondition the patient. And when it, it gets to a point where the patient is medically fit for discharge, we need to find a way to get them to inpatient rehab quickly. Um because they're at risk of infections within an acute hospital. Um things like COVID, um DMV neuro virus, anything could spread and they could catch it and that could extend the hospital stay. So once we establish a patient has rehab potential, we try to do a referral to, to a rehab center local to them and we try and get them there as soon as possible. And while they're on the ward, we keep working with them to make sure that they get back to their physical baseline and cognitive baseline. Now, the final option is um quite a restrictive one. It's when we have a patient who is, are either not managing at home will not be safe for home, is wandering during the night or is really confused, doesn't have mental capacity to make decisions. Then we're kind of looking at someone who can't care for themselves and they need 24 hour round the clock care and those patients we tend to send to nursing homes or residential homes. Er, quite a common thing. Um, we find is doctors often document care home. So try to, my advice would be, try not to document that because within the UK, it's either you have nursing needs or you have, you can manage it by yourself and you can go to a residential home. Those are the two places you can go to either a nursing home or residential home. Often people book care home, which can often confuse people and delay discharge, documenting care home. Could, could mean either nursing or residential. It makes it easier if you can streamline. It get a bit more history from the relative to find out it actually a nursing home or residential home. It would help us a lot. It will help the whole MDT nurses, therapist, um doctors pharmacists even because um it helps them when they're doing um kind of screening their TTS um to kind of help them with the right type of medication for the patient. So those are the three pathways that we tend to um tend to make sure we send our patients. And our job is to assess and establish really quickly which pathway the patient's gonna go to. Now we, I work with, I worked with Dr Rachel quite recently with what I would say, one of the best wards within our hospitals in terms of working as an MDT. So I think with, with you're gonna find there's a lot of therapists on your ward. It would help you a lot if you want to discharge patients quickly to befriend them, as you would find, if you befriend the therapist, they can quickly get the patient discharged effectively. Um, try to learn, just have a chat with your therapist on the ward. Um What is your plan with the patient? They will explain that to you and that would make it easier for you to document your, um your plans as well. Um As once you start, you know, working within the UK, you'll find when you're documenting your plans. Um People would write things like awaiting package of care, awaiting nursing home. So it just always helps if you know what the plan is for your patient. And the final thing I kind of want to go over is that one thing that we do quite a lot is mental capacity assessments. We, I find myself doing at least 3 to 5 a day. Um because I often do work within elderly care. So one thing about mental capacity is within the UK. Its mental capacity is looking at someone's ability to make a decision around a specific topic. Now, that topic could be their, their nutrition, that could be their medication, that could be their, um, DDNR that could be their further treatment that could be discharge planning, which is what I focus on mainly. So um for example, a case study. Um I have a patient coming in. She was at home, living by herself, but her family a little bit concerned that she's starting to get a little bit more confused, not managing her home, having quite a few falls. Um So the family reach out to us, ask us to do a capacity assessment. We would look at her safety awareness, whether she's gonna be safe at home. Um We go have a discussion with the patient and the patient feels she'll be able to manage by herself, doesn't need care where within the ward, the nurses are doing everything for that patient. So we would deem that patient to not have capacity as she doesn't have insight into her care needs. So we would then go and say the patient doesn't have capacity to make decision regarding discharge planning. We'll document that and then we will have a discussion with the next of kin because um it would have to be an MDT decision. So with, with the doctors, nurses, um therapist, social workers and family involved, everyone would be involved to make a decision for the patient in their best interests. So it's very important that we, you figure out what you're doing a capacity assessment for because as doctors, you would find you'd have to do quite a few as well. Um surrounding medication DNA R and other stuff. And that's kind of a really brief explanation as to what I do in the hospital. Is there any questions? How do I open the chat box? Because there is a message. But I don't know if that's from when I signed up. I can't hear you things off. That's from me. Sorry, that I have a question. So, you know, it, obviously we worked recently and I really value the input that you guys put into it and I know that sometimes it's quite difficult, especially with bad pressures on the, you know, OTs and PTS. What, what would you say is one of the, like the daily struggles of being in this role? Um The struggle of the, of this role is I find within the UK the system we have, we can't turn patients away. So often people, when they come into hospital, there's a lot of social matters. So we often finding people are waiting for for long periods of time within our wards. Um For example, I just had a patient within my ward who was on the ward for almost two months and all he needed was he's a deep clean of his property which um falls within a task that social services need to sort out to make his property safe. So I'm finding that there are a lot of people coming with social matters which are, which are causing, which are sort of bed blocking for. You know, now I'm sure as a doctor you want to, you want somebody who you want to treat within your ward, not somebody who's medically fit waiting for, just because that patient is, as you from your experience is catching all sorts of infections. And so that can often change our plan as well. So someone could be medically fit and there's a delay with their package of care or their care home. And next thing you know, they catch COVID, they catch um DMV C diff all sorts and, you know, they're not the same patient as. So now the plan has to change. We need to look at another plan and reviewing them again. So that, that's really the, the pressure I think is just, um, at the minute, a lot of people coming in for social reasons mainly. Yeah, I definitely feel that definitely, it was very evident, especially during the four months we worked together. What do you think is something that we could help as, you know, doctors or even just part of the MDT in general that we could do to make things a bit run more smoothly with the, with like occupational therapist to help their job a bit easier. I know it's, it's easier said than done. But while something that you were like, you wish it was done a little bit better and then it would help your job a little bit more, I think it would, it would help greatly if the doctors understood the pathways, the different pathways, it doesn't matter what trust you go to, if you can quickly establish and learn what pathways are, where your patients can go, you would find your job would be so much easier because you don't want to be because you'll find, you pick up the phone to update a family member. And next thing you know, you're talking to them about nursing homes, the carers and the stuff you don't really know. So if you can really quickly learn the different pathways and keep up to date and make sure that your ward, um, is up, find out about you, even just your bay or the patient that you allocated, what their discharge plans are, you would find that it makes it so much easier for you. Er, rather than being on the phone for 30 minutes, you'll be on the phone for 10 minutes with the relative because you know exactly what their care needs are, what they need, where, what the therapist are doing with them. And I think it's something for, for myself as well. I'm trying to do a bit more. I'm trying to figure out what, um, patients medical plans are so I can update the next of kin because I often find, and I think it takes a big load off the doctors because I know they're really busy and everybody wants to talk to doctors and, um, you've got relatives coming in with their own Google research that they're doing. Now telling you how to do your job basically, which can be very difficult. You start talking to a relative and next thing, you know, 30 minutes of your day is gone. Um So I think it's just learning the different pathways really quickly, I think would, would help us as well as help you guys as well. Thank you. And I just have one more question. I know, I have a lot of follow up questions. What is, I know you're a general therapist and um, so you do, you can do both jobs. What is the, what is the, the educational pathway like for, you know, your job versus the person who's, who would want to be an occupational therapist for instance. So, uh an occupational therapist and a physiotherapist would have to just go do um, a course at university, whereas um a generic therapist would have to do more inhouse training. So you start off, um As, so I started off as a physiotherapy assistant. And then I've kind of gained experience with both working with both uh physio and occupational therapist to then kind of, you know, made myself competent to a point where I can do both of those jobs. Um So you kind of have to work within your trust. Know, so you have to kind of start, um you have to have some experience working with the physiotherapist as well as an occupational therapist. You have to be able to work within your trust and know your trust pathways really well, um, know all the different assessments that you do. So it's mainly to get to a generic therapy level. You have to do it through experience within, working within your trust. And since, did you do the training in then? Yeah. Ok. And does that mean you can still do the same thing you're doing now in a different trust without it being an issue? Or is it not transferable? I think it is fairly now that I've got the experience I have, I think I can go to other trust and work, but I think it would be a lot difficult for me to adjust. It will take a while. It's a bit like going to a new trust. You know, they, they have different systems. Um, you know, to, for example, our trust is completely paperless, whereas other trusts might still be working the old fashioned way and it's just learning about different pathways. East Trust trust is different. East Trust has a different allocated budget and um you know, things like East Trust doesn't have social workers or discharge coordinator. So you have to do a lot of referrals, learn all those things. And so it's just learning the different pathways again. That's what it would be. But in terms of assessments, things like kitchen assessments, stair assessments, washing and dressing assessment, these are all things that happen across the nation. So it's not much different. Sounds good. Does anybody in the audience have any question. You can either type in the chat box and I, no, I don't think you can turn on the mic, but I think you can type in the chat box. Let's see if anybody has any questions. But while we're waiting for questions, thank you so much, Adam for this information. I think it's very helpful for doctors who are even like doctors who are not from a foreign place, um, who are looking to work in the UK because oftentimes it's not really in our curriculum as to what exactly entails the job of an occupational therapist or a generic therapist. Yes. And II, I do agree. I think it helped a lot when you know, we've talked about the different pathways that a patient can go through and how to realize which one is the most appropriate for them. It helps us and it helps you guys as well to save time so that we can use that extra time to pro perhaps work on a more complex case to facilitate more discharge. So I think that was very helpful. I found it very helpful. All right. OK. We don't have any questions. If you have any questions afterwards, feel free to pop a message to my bleep and then I can direct the question to a who probably is very happy to answer any questions. So we'll let him go and thank you very much for everybody who joined today. Thank you. Thank you. Thank you. Rachel. Thank you. Bye.