#Physio14: Where will the next 100 years take us?

This post has been slightly delayed partly due to me gallivanting in Vietnam for 2 weeks but also due to my change in shift pattern on Trauma and Orthopaedics I have less time in the evenings to sit and write my blog. This post will mainly cover my trip to Physiotherapy UK and will touch on future exciting developments in the pipe line.

Attending Physiotherapy UK was a relatively last minute decision. I had been to the conference for the last 5 or so years as a student and newly qualified, however this year with me going to Vietnam for a couple of weeks I was definitely counting my pennies.

I can tell you the decision not to go did not last long as everyone kept messaging me  asking “Are you going to Physio UK?” and in the end I just didn’t want to miss out! It was a great 2 day event which was credit to the organisers  and council, a truly inspiring event with lots of learning to take away. I have written this blog  in blocks so you can skip to the presentation summary you want,( I have not included all of the presentations as I would be here all night). Each one will be divided by a horizontal line.

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Rob Webster- Meeting the 201 Challenge: Opportunity and Threat. NHS Confederation.

It was great for Rob Webster, Chief Executive of NHS Confederation, to come and deliver a talk at Physio UK. Rob really did set the scene for the challenges faced by the NHS in the near future and where Physiotherapy can play its part.

So the current Challenges:

  • Generational Challenge- A society becoming dependent on the health service.
  • Ageing Population- An increasing demand on the Health service.
  • NHS Reform
  • Funding Cuts
  • A population with multiple issues.

We have a leadership role to be optimistic: 7 Themes the NHS needs to address.

  1. The Need challenge-changing population
  2. The Culture challenge
  3. The Design Challenge
  4. The Finance Challenge
  5. The Leadership Challenge
  6. The Workforce Challenge
  7. The Technology Challenge.

So we need ambition for the future- Where is the NHS going?

The vision and asks: The 2015 Challenge Manifesto a time for action.

  • Start with Prevention
  • Long Term Conditions- supported self care
  • Seven day services- local hospitals
  • Hyper acute trusts to save your life in need.

Things we need to remember as Physiotherapists and other Health Professionals.

  • We are guests in other peoples lives. We need to put ourselves in our patients’ shoes to truly understand what they are going through.
  • Our outcomes should be theirs.
  • We should organise around them and not our professional egos.

The Opportunities.

  • Integration working as one team across community and across organisations
  • Cost effective- using and promoting the work being done by Physio Works.
  • Right Person, Right Care.

Threats

  • Misunderstood Role- we need to learn to shout a bit louder about our profession.
  • The Heft of Status Quo.- “If you always do what you have always done you will always get what you have always got”
  • Visibility- Do commissioners know what we can do?
  • Unintended consequences of safe staffing
  • Plurality.

My take home message: We are facing a challenging environment within NHS whether it be cuts, increasing pressure to meet demands or trying to make Physiotherapy heard. We could easily just sit on our laurels and wait for someone to make a plan for us however we all have a responsibility to push our profession forwards and demonstrate how we can be a major part of the transformation of the NHS.


Centenary Founders Lecture 1912-2014 Karen Middleton.

I think I must have done 3 blog posts including a speech from Karen but each time I take away something different. The lecture was focused on how Physiotherapy has transformed over the last 100 years. How we take for granted our Autonomy and need to look back at how our founders over came the challenges to achieve this. Physiotherapy has a great future if we continue to push the boundaries of our profession.

Karen’s Leadership Lessons.

  1. Take Responsibility for your own development- I have taken this forwards by finding a mentor to guide my development.
  2. Things that Karen reflects on: What are you known for? What do you want to be known for? What challenges you? What have you learnt? What have you recently added to your CV? Why should anyone be lead by you?
  3. We need to be flexible! Learn to live with a bit of mess!
  4. What level of risk can you accept? What can you get away with?
  5. Learn to act quickly but not rashly. Don’t over think.
  6. Leadership takes guts
  7. Speak out when others are silent when integrity is at stake. Would you stand up for Physiotherapy?
  8. Everything in your body will tell you you can’t do it. Imposter syndrome we diminish our own value.
  9. We must be authentic
  10. People need a reason to follow you. People need to feel empowered.

If you want to see the video to Karen’s inspirational lecture please click the link below.

http://www.csp.org.uk/news/2014/10/10/karen-middleton-calls-action-stop-physiotherapy-sleepwalking-obscurity


Supporting People with Long Term Conditions- Prof Ann Ashburn

Patients need:

  • Support, Information, choice- patient preference, self-management, Information about their condition, prevention+ health promotion, psycho-social, point of contact when things go wrong, feedback from patients for service improvement and Training for all.

The Strengths of Physiotherapy

  • Active participants
  • Targets set and agreed
  • Collaboration
  • People views of Physiotherapists.

Challenges

  • Limited Research
  • Psycho-social aspect
  • Leisure activities- health promotion
  • Utilising Technology

Disempowerment and Psycho-social factors in long term conditions

  • Attention
  • Diminished concentration affects learning
  • Not being given enough time to think
  • Too many instructions
  • Background noise
  • Fatigue
  • Day to day variability, medication cycle & sleeping patterns. Affected by dehydration (as a result of slowness to swallow,concern about bladder control) so could have headaches, fatigue, constipation all of which will affect performance.
  •  Answering phone – better face to face

Empowerment

  • Allow patients to achieve
  • Recognition of previous life and the patient as a person
  • Choice
  • Support

The final part of Ann’s presentation looked at some of the health promotion activities that Physiotherapists could be involved in such as a scheme called Life after Parkinson’s. For example they set up a dance group for patients with PD . This was just one example of how we need to be creative to improve patient experience and that there is life after a diagnosis of a long term condition.


Assessment and Treatment Planning for MS- Dr Jenny Freeman

Symptoms of MS

  • Fatigue
  • Weakness
  • Poor Coordination
  • Spasticity
  • Sensory Disturbance
  • Visual Disturbance
  • Poor Swallow
  • Bladder and Bowel etc

Some questions and top tips for people with MS.

What are you currently doing to manage your health? What exercise?

Is there anything putting you off?

Do you ever Fall? Impaired  balance during Transfers, STS, Turning./Delayed motor response/Alteration of 2 sensory inputs/use of walking aids.

Exercise is proven to be beneficial and is not associated with relapse. Transient symptoms should settle down.

Should be aiming to complete Resistance training 2-3/week at mod intensity 60-80% 1rep max 1-3sets for min 8 weeks. Aerobic training 2-3 times a week 30 mins 4x a week.

Some of the balance interventions: Increase sway in quiet stance, delayed anticipatory + autonomic postural adjustments. Evidence suggests the benefits for balance interventions.

Current Outcome Measures Used.

10m Timed Walk, Single leg stance, lateral reach, confidence scale ABC, MS Walking scale, Activities specific MS, Grip strength, 9 hole peg test.

Useful Resources: Rehabilitation Measures Database- Neurology/ MS edge outcome measures database.


Measuring Respiratory Symptoms in Advanced MS? What’s the point? What’s the evidence? What are the options? by Rachel Moses.

This was a regular problem when I was working on an acute respiratory ward, MS patients being picked up too late for respiratory Ax. If these patients are caught early there are many interventions which can be taught to prevent admission to hospital but the new NICE guideline for MS have removed speech/swallow and respiratory management from the guidelines even though anecdotal evidence suggests there is a need.

MS pulmonary dysfunction and function 

  • Marked expiratory dysfunction – poor cough
  • Severe diaphragm weakness ? Indication or higher cervical cord lesion.
  • Limited ability to maximally exhale
  • reduced vital capacity for patients who desaturate over night.
  • MS- abnormalities in breathing control, resp muscle weakness, bulbar dysfunction.

What’s the Point?

So when we are assessing a patient we want to be looking at their peak cough flow. If the patients peak cough flow falls below 270ml then it is likely they will need some support to have an effective cough.

  • Lung Volume recruitment bags would be the first port of call this aids breath stacking to increase lung volume for a more effective cough.
  • If LVR isn’t enough some patients may need a Manual assisted cough as well.
  • The final port of call would be manual Insufflation: Exsufflation. This is a machine which delivers a volume and then switches the pressure release the volume and augment a cough. MI:E has been shown to be a cost effective admission avoidance strategy for patients with advanced NMD.

From this presentation it reiterated the importance of early respiratory assessment to prevent acute admissions. It also highlighted a need to educate commissioners on the benefit of respiratory management for patients with MS.


The Dementia Challenge- Iain Lang

What is Dementia?

  • A set of symptoms, progressive condition.
  • Not easy to differentiate between different types of dementia
  • variable condition day to day.

Why is dementia important?

  • Common
  • It’s frightening- most feared health condition, reliance on others
  • £26 billion cost to UK Economy
  • people with dementia stay an average five days longer in hospital.

How can we respond to the challenge?

  • Diagnosis more than 1/2 of people with dementia are not diagnosed.
  • Treatment- drugs are used to reduce symptoms and deal with psychosis, anxiety or depression. No current drug developments.
  • Understand how to communicate with patients with dementia- now mandatory training.
  1. Prevention- managing other commorbidities  HTN, Diabetes.
  2. Don’t smoke this increases the risk of dementia
  3. Eat a Mediterranean diet
  4. stay engaged prevent social isolation, learn new things
  5. Exercise best evidence to prevent dementia

Implicit memory- how you do things?

  • Evidence suggests the way forwards
  • error less learning
  • positive experience
  • repetition guiding what you want.

Implicit vs Explicit

  • Priming
  • errorless learning
  • repeated constant practice
  •  avoid multitasking

Dual Tasking

  • Capactiy overaload
  • Structural interface- sensory overload- for example during standing use fingers instead of hands to support patient.
  • be patient
  • don’t overload senses
  • one thing at a time
  • may choose to do this as part of rehab.

Communication

  • Dementia questionnaire inpatient- what do they enjoy?
  • Smile
  • Understand where people come from.

Pain

  • Very overlooked
  • most unable to verbalise
  • unable to process pain
  • unable to identify pain
  • unable to understand why they are in pain
  • What were they taking before?
  • Pain scale- Abbey pain scale.

People with dementia should be given the opportunity to maximise their potential.

  • Approach from the front good eye contact
  • think about what they are called
  • short commands and being courteous
  • keep hand movements open
  • use positive tone
  • goal based- lets go and look out the window
  • stand up tall
  • use gesture or tap where
  • avoid jargon
  • use of equipment be aware may not understand how to use.

I have been able to take this learning into practice in the acute setting by adapting my communication and limiting sensory bombardment, in turn I have found my patients with dementia have made good progress. Sometimes you need to be patient and try and build rapport  before asking them to do something but if you can get them on your side you will make your job a lot easier. I have also found that by reducing my handling has encouraged patients to be more active during the treatment session which has limited the manual handling load for me.


So that was just a review of some of the presentations I attended whilst at Physio UK. During the event I was able to catch up and network with many different people who I aim to stay in contact with. Physio UK always offers a great opportunity to speak to new people who share a similar interest to you whether that be Management, Education, MSK, Respiratory, Neurology and more. Whilst at the drinks reception I got talking to Paula Manning, outgoing Vice Chair East Midlands Regional network and Catherine Pope, Vice Chair of council. They asked me whether I would be prepared to stand as Vice Chair for the East Midlands Network. I was ecstatic to have been asked but I suggested that I would need to confirm this with my manager. My manager has now agreed to support me and I have been selected to run as Vice Chair of EMRN. The role will be a challenge but it will give me valuable experience which can be transferable to my professional developent. I have lots of people to support me so I am looking forward to taking the role forwards into 2015.

One final thing in the pipe line, I have been asked by the CSP student reps to speak at the annual rep development weekend.  I am really looking forward to sharing my experience as a new graduate with reps and hopefully inspiring them to do great things and take the future of our profession forwards.

Apologies for the length of this blog, but Thank you for taking an interest. Wishing everyone a Merry Christmas and a Happy 2015! Any comments or questions please leave a message below or tweet me @LCphysio.

Better Together!

Hi everyone this post is really just to give you a bit of a background of the work being done by the Industrial Relations Committee. The last meeting was on the 1st October at CSP head quarters. It was a really productive meeting and the key messages were produced by Claire Sullivan ERUS Director (See below).

Key messages arising from the IR Committee.

1. Members agreed to take it in turns to contribute a ‘guest blog’ on an area of interest to them, for the IRC news bulletin each month. Jill Barker and Kim Gainsborough will be covering October and November.

2. Lesley Mercer joined the committee for lunch and a presentation of thanks on her first full day of retirement from the CSP as ERUS Director!

3. The new Director, Claire Sullivan, talked briefly to the committee about some of her ideas and plans and some of the likely key challenges ahead.

4. Elaine Sparkes (currently SNO for the East Midlands) has been appointed as interim Assistant Director. The post will be recruited to permanently next April

5. Heledd Tomos has joined the committee as the nominated representative for Wales, replacing John Walpole. The committee is also seeking a new directly elected member for Northern Ireland and all ideas and expressions of interest are welcome

6. A number of issues have been thrown up by the recent exercise to update the CSP membership lists for a possible industrial action ballot. These will be discussed in more detail over the coming months. Please can I just encourage people to access their online CSP account and update your details. The stewards have been doing a great job to update membership lists but it has been a big struggle for them on a national front.

7. The committee considered the current position regarding NHS pay across the UK. It was agreed to continue to update the membership lists for NHS members in England and to convene a meeting of the pay reference group in late October to review whether or not the CSP wishes to proceed to ballot members for industrial action short of strike. Feedback and views from members on this issue continues to be mixed. It is worth noting some of the successes from previous action the link below provides a small summary.
http://www.csp.org.uk/frontline/article/making-commitment-jill-barker-industrial-relations-committee

  1. In relation to Wales the committee agreed to consult members over any offer of a longer-term deal and then to refer the outcome of that to the pay reference group for further consideration9. In Northern Ireland, the committee agreed that we should continue to apply concerted pressure for a Ministerial decision as there has still been no announcement as to whether or not NI will implement the PRB recommendation

    10. The committee agreed that we should gather information on vacancy procedures and long recruitment delays through both stewards and managers. Also, that members would be encouraged to feed in information about recruitment difficulties to the CSP

    11. It was agreed to request a slot to hold an IRC fringe meeting at ARC on future sustainability of the NHS

    12. It was also agreed that an ‘easy guide’ for members should be drawn up on future sustainability of the NHS

    13. The committee agreed to promote the TUC’s video encouraging young workers to join unions to the SEC and wider student community and also to seek a delegate to attend the TUC Youth Conference in 2015 (delegates need to be under 26) and interested volunteers are welcomed

    14. The committee agreed a number of action points arising out of the TUC Congress this year, which had been attended by 5 first time CSP member delegates. These included:
    • to publicise to members the new online petition to repeal part of the health and social care bill and the value of lobbying MPs locally ahead of a debate on this private member’s bill on 21st of November.
    • to be aware of, and support, the Stand up for Justice campaign. The justice system is currently undergoing extensive privatisation and fragmentation and this is resulting in deleterious effects to quality services and accountability
    • to publicise a new film called ‘Pride’ to CSP members. The film, which has attracted excellent reviews, is about the role of LGBT members in the 1984/5 miners’ strike.

15. Don’t forget the TUC march this weekend Oct 18th: Britain Needs a Pay Rise- see video below and reasons to go.

http://www.csp.org.uk/news-events/events/march-rally-18-october

The main message to take away from this blog is that we are better together. The society needs members to engage and update their memberships details so that we can we truly represent what members want. Likewise if you have suggestions  you would like to take forward to CSP council please attend your regional network meetings so that regional council members can take your ideas forwards.

Thanks for taking an interest in my blog any questions or comments please leave a message below or tweet me @LCphysio.

My next post will give a round up of Physiotherapy UK 2014.

Physiotherapy Works!

Last Friday I was fortunate to be able to attend the Physiotherapy Works Locally event as part of the East Midlands Regional Network. I have been asked by the network to be a core part of the committee. This will hopefully allow me to build some momentum with social media and help get students and newly qualified members involved. This will aid the discussion regarding key decisions about the region and society which can be fed back to council. The Physio Works locally event was a joint event between East Midlands and Yorkshire/ Humber  Regions. The event was a fantastic success with a lot of social buzz and pledges being made.

Photos from Anne Jackson CSP

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The event kicked off with Karen Middleton CEO of the Chartered Society of Physiotherapy giving a talk on: “The Case for Change”

Whenever I listen to a speech by Karen I feel so empowered, I want to run outside and tell everyone how fantastic we are as Physiotherapists and that we can really make a difference to peoples lives. Her talk was powerful and to the point. She said that we as Physiotherapists need to start talking about the benefits of Physio before we miss out on our golden opportunity. The health climate in 2014 is creating an environment where people are living longer. This creates a society with patients with more long term conditions and people needing to be fit for work for longer.

 

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Physiotherapy can influence all of these groups!!

So what are you going to do about it?

The quality of a service is essential to achieve positive outcomes. We need to be effective, collect outcomes, safe and develop positive patient experiences.  However, how are we going to do this? We have less money available and a dependent medicalised society. So what innovative ideas can we take forward? The profession of physiotherapists is far too modest regarding what we can bring to the table in terms of healthcare. Overcoming this apprehension will enable us to take our ideas forward and make them reality before it is too late.

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So here are few of the things Karen suggested we should be doing:

  • See opportunities and take them.
  • Realise our potential as leaders.
  • Come of age as autonomous practitioners.
  • Use CSP support, materials and tools.
  • Make a lasting difference to patients.
  • Nobody will do this for us.

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So some tips:

  • Be flexible.
  • Connect, build, link and network!!!!
  • Think ahead and talk solutions.
  • Know how local decision makers think.
  • Use the evidence.
  • Show our impact through data collection.
  • Talk about money as well as outcomes.

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Action Point:

Think about becoming a pioneer for Physiotherapy Works –  for more information:

Web: www.csp.org.uk/physioworks

Twitter: #physioworks

Email: physioworks@csp.org.uk 

  • So what?  Now what? What difference does it make? Be Brave, Physiotherapy Works.

 

Change is the Only Constant- Alison Hughes NHS ENGLAND

Alison Hughes was another fantastic speaker of the day. She is currently Director of West and South Yorkshire and Bassetlaw Commissioning Support Unit.  She was initially a physiotherapist and an advocate for clinicians leading the NHS. As physiotherapists we are ideally placed to lead. We are able to diagnose, listen, work as an individual and as a team.

However the change you want to see starts with you!

And you need to be clear on what success looks like.

To me success looks like : Everyone in the general public knows what a Physiotherapist is and what they can do.

What are your barriers to change?

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I thought this image summed up a lot of clinicians anxiety to change. Mostly due to hidden barriers created by a Top down  organisational structure created by management. To overcome this we need  to be brave and inform management of the challenges faced by front-line staff and the solutions to overcome these difficulties (this may be where physiotherapy comes in)

Alison referred everyone to a book by Robert Kegan- Immunity to change. Which links to the image above. http://www.amazon.co.uk/Immunity-Change-Potential-Organization-Leadership/dp/1422117367 n

When planning a strategy for change, below is a great diagram to help you organise your contacts so that you target certain individuals to help promote specific campaigns.

Importance of Stakeholders

Influence of Stakeholder

Unknown

Little/ No importance

Moderate

Significant

Unknown
Little/ No importance
Moderate
Significant

So in summary:

  • In creating change we need to clarify what success looks like.
  • Set realistic goals
  • Grow and use the support you have.
  • Understand stakeholders
  • Understand hidden competing commitments for yourself and others.

 

Physiotherapy Works- Make Every Contact Count. Knowing Your Service.

The principles of this focused on:

  • The context of change
  • Knowing your Service
  • Knowing your Population
  • Knowing your Evidence.

Know where you fit in our healthcare system.

Knowing your service

Quality is based on:

  • Effectiveness
  • Patient Experience
  • Patient Safety

+COST

Quality +COST= Value.

The CSP is developing tools to give bite size pieces of evidence to show the value of Physiotherapy. This will be based on for every £ spent on Physiotherapy will save the NHS…. compared to without. The cost of Falls Tool will be launched alongside Older Peoples Day on the 1st October 2014 (and more to follow).

Knowing your Population

A population is made up of – current users of the service and future users of your service.

Accessing Health Profiles can give you  information regarding the demographics and problems in your region.

http://www.apho.org.uk/default.aspx?QN=P_HEALTH_PROFILES

Knowing the Evidence

  • Published research
  • National guidance
  • Local data- audit, patient experience, satisfaction, outcome, KPI’s
  • Other
  • This can be used to challenge the status quo!

There was a great emphasis on developing your service and having your elevator pitch in mind, so if you were stood next to a commissioner in a lift you could quite happily deliver your message.

My service is…

Delivers to this population…

Based on this Evidence…

At this price!!

So you might be thinking where do you go from this… So the next steps might be..

  • Why do you need to change?
  • What will you do differently?
  • When?
  • How can you improve?
  • Who will you influence?

This will give you a starting point for change !


In the afternoon the Physio Works team did a great job in setting up mini workshops to get us thinking about innovative ideas which could form part of our future NHS!  We looked at regional health profiles, developed  ideas and then presented them to the group. There were some great ideas being thrown around the room and it was an effective way which made everybody feel ready to go and talk about how versatile the profession of Physiotherapy really is.

The East Midlands (@CSPEastMidlands) and Yorkshire and Humber (@CSPYorksHumber) Regional Networks did a great job in organising the event and are always looking for more members to attend regional meetings, I would actively encourage you to attend. More information can be found here:

http://www.csp.org.uk/nations-regions/east-midlands

http://www.csp.org.uk/nations-regions/east-midlands-regional-priorities

http://www.csp.org.uk/nations-regions/yorkshire-humber

http://www.csp.org.uk/nations-regions/yorkshire-humber-regional-priorities

http://www.csp.org.uk/your-health/physiotherapy-works

 

Thank you again for taking an interest in my blog. As always please feel free to leave a comment below or tweet me @LCphysio.

Finally the first part of my campaign was to get my Mr to make a pledge!

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Respiratory Rotation Tick!!

This post has taken me so many attempts to write, I am not sure if it is because the last couple of weeks have been a bit relentless mainly with me flapping thinking “Oh God this week I am on call”. It doesn’t matter how much prep you do or how much everyone tells you that you’ll be fine you still don’t feel ready. Being quite a reflective person I like to analyse every possible option before doing something (which I think enhances my anxiety of on call thinking will I ever make a decision!), however, I am also a born pragmatist which means once I know what I am doing I get things done and with the fab support I have had from my team during supervision sessions and clinical work I now feel I could reason through my options and make a sound clinical judgement! So this post is going to look back on some of the success’s and challenges I have faced on this rotation. I am now on-call competent and I have just completed my first on call (pheeewww) so I will try to explain the things which were going through my head and how I came out the other side!!

So Firstly the competencies, to be competent on call there are certain skills which need to be reviewed to ensure safe practice is maintained. These include:

  • Understanding of Arterial Blood Gases.
  • Interpretation of Auscultation
  • Interpretation of Chest Xray’s
  • Understanding of Oxygen Therapy
  • Ability to use cough assist and clearway
  • Ability to use Intermittent Positive Pressure Breathing.
  • V/Q matching and positioning
  • Humidification
  • Use of Manual Hyperinflation
  • Suctioning
  • Assessing an acutely ill patient
  • Tracheostomy care
  • Time on ITU/Paeds/Surgery/HDU/Medical Wards

I have to say I was glad to see the back of them, doing more work after work meant sometimes feeling mentally and physically exhausted but I had great support from my supervisor Emily Stranney and team throughout which made things a hell of a lot easier. I am not going to go into each competency as I will be here all night but these are some of the things that would be expected of you at Derby.

I think one of the best ways for me to sum up my experiences is to give you my Top 10 tips on how to survive your respiratory rotation. For me I was fortunate to have experience on ITU on placement and when I worked in Birmingham but I can understand how daunting it can be if you were going in blind. For example on my first day of my the rotation I was quite happily being showed around to familiarise myself  when one of the nurses called us over to say a patient needed urgent chest physio… So off we went straight into a emergency situation good job I had already had experience in suctioning and my supervisor was taking control…way to break me in gently or throw me into the deep end I am not quite sure :-). So my tips based on my experience on medical respiratory wards and I hope some of them may be useful.

1. Take a 24 hour approach to your patients. For patients with long term respiratory conditions they may physically be able to complete the tasks separately but when you put everything together washing and dressing themselves, making breakfast, walking to the shop even they may be exhausted for the rest of the day or even the next. This is where you may need to liase with occupational therapists, oxygen nurse, rehab coordinators or pulmonary rehab to assist with formulating a seamless discharge for your patients.

2. If they need oxygen therapy have you considered it as a tripping hazard? Many patients will be elderly and you don’t want a long line of oxygen tubing to be another reason for another admission to hospital. So maybe trial a long lead of oxygen as part of your treatment session to carry out a risk assessment?

3. You sometimes need to wait a bit longer before you pick up a physio referral. For example sometimes some of the COPD patients come in with type 2 respiratory failure and they need  NIV to rectify blood gases before you start pushing their exercise tolerance to the limit. (This may not always be the case speak to the nurses are they productive of sputum or not?)

4. If opportunity allows opt to do some joint treatment sessions with more senior physiotherapists and get them to compare what you are auscultating etc to see if your treatment plans match up. Different physiotherapists work in different ways so it is good to work with a variety to aid your own clinical reasoning.

5. Get into the habit of checking patients Chest Xray’s, if a recent one has been taken to help guide your treatment. Also the more practice you get the easier they will become to interpret… as no one wants to be scratching their head at 3am in the morning.

6. Know your indications and contraindications for treatment this will help formulate your treatment plan. I would advise to carry around a notebook with these in because if your mind goes blank you have something to back you up. My on call book has useful phone numbers, door codes, equipment locations, indications and contraindications for treatment, typical patients for each treatment and some of the useful values you may need as part of an assessment.

7. Break each respiratory patient down simply. What is the main problem? Sputum retention? Reduced Lung Volume? or Increased work of breathing? What can you change or help with and this will formulate your treatment options.

8. As always don’t be afraid to ask questions or your seniors or Doctors question their clinical reasoning so you are understand why you are doing something. You will be amazed at how many times as a physiotherapist you are the first one to notice that a patients target SpO2 need adjusting.

9. Like with anything in physiotherapy if something is outside of your scope of practice ask for help. For example I have been faced with the situation where a patient has aspirated on their vomit and I asked for my senior to treat the patient with me because I had never dine nasal suction before. ( You are not seen as incompetent you are seen as safe)!

10.Be aware of the neuro-muscular patients, they have the potential to go off spectacularly due to poor lung volumes and cough effort. And just because you can’t hear anything doesn’t mean secretions aren’t lurking. The likelihood is that secretions can’t be heard due to poor lung volume creating turbulence.

Finally just relax… easier said than done I know, but, you are better to take a deep breath take your time and reason through what you are doing.

I hope some of these tips will be useful, I feel so much more confident with my respiratory skills post rotation and I would advise anyone to develop the skills as you never know when they may come in handy ( it will probably be me reviewing the odd respiratory patient when I move to T+O next :-S)

So those were my top 10 survival tips for your respiratory rotation. I will now go onto my first on call situation and some of the tips which brought me out the other side.

I can honestly say this day had been looming for a long time…. but I kept thinking oh it’s fine I’ve got ages yet (it won’t happen to me)! To oh wait I am on call tomorrow oh Cr*p!! The night before I definitely did not sleep at all waking up every hour thinking am I meant to be on call tonight? when I wasn’t. So the day finally arrived, I had arranged to stay with a colleague as we have to be at the hospital within  40 mins, so from Chesterfield I would be pushing it! I was lucky in someways to be completing my first on call during my time on respiratory as it meant I had the opportunity to talk things through with my supervisor and also suss out if there was any poorly people lurking about on the wards. Through the week there had been no call outs so I was testing my luck not to be called out but I guess I kind of wanted to be called in just to get the whole thing over and done with. So I settled into bed about 9pm… set my alarm for the morning, straightened out my uniform next to bed alongside my on call book and a pen. As I did the night before I wasn’t sleeping well looking at the clock every hour…. but by the time I got to 3AM I thought you know what maybe I have been saved and tonight is not the night so I drifted off to sleep.

04.30AM The phone rings!! ” Hello this is the switch board can we direct a call through to you”

Me: “Urghh urghh Yes hold on let me just find a pen”

“Hello its the registrar …. The patient has this, this, this and this can you come in for emergency physio”

Me: ” Hold on a second  can you just repeat that I have just woken up” So by this point I had found my little book and was able to take some details down. One thing I would say is make sure you take the time to slow the referrer down and clarify the patient in your head (Don’t forget to find out the patient’s name and location as you don’t want to be running round the hospital at night)

So I had got the details I needed, got dressed, got in my car and drove to hospital all the time thinking should I be doing this or this. By the time I had made it to the hospital I headed to the patient’s location took a deep breath went through the notes, looked at their Chest X-Ray, asked if they were for escalation for a higher level of care, checked blood results and then started to conduct my assessment. I went through logically my treatment options and formulated my treatment plan. As a first on call it wasn’t really a physio problem to solve but it allowed me to reason this through and at least I got called out and lived to tell the tale.

So my top tips for on call based on my limited experience:

1. Make sure you are competent! There is a reason we are set competencies and this is to make sure we are safe and clinically effective.  So take the time to put the work in so when it comes to being called out at 3am in the morning you are prepared.

2. Be organised! Have everything ready so that the only thing you have to do is get dressed and turn up at the hospital.

3. Don’t be afraid to challenge the referrer for the reason for the call out. Not all call out’s need a physio so you may be able to offer advice over the phone to rectify the problem.

4. Take your time read through the notes, check the patients observations, check blood results (INR and platelets especially), check recent X-Rays and breathe.

5. Familiarise  yourself with your environment, take the time to have a walk around the areas you don’t normally work in. Or if it is area you haven’t had much experience in ring the ward physio’s in the morning and see if they have any patients you might want to treat before you are on call to get to know them.

Finally breathe, the best piece of advice I have been given on the run up to my on call is to look at it as you are only offering an opinion. At the end of the day it is the consultant who has the final say on the patients care and sometimes as a physiotherapist you cannot do anything more and have to step away.

I hope this piece has reassured physio students and new grads that being on call isn’t as terrifying as you think and the hardest thing is just that initial thought of waiting to be called out!! But once you have done it you have a real sense of achievement  that you have been able to help someone in need and the fear disappears. I mean if I can come out the other side then anyone can!!

So my next rotation takes me to Trauma and Orthopaedics in a couple of weeks time. I have only ever done T+O outpatients so I am intrigued to learn more about it and see where it takes me. My next blog post will focus on the recent Physio Works locally event I attended in Nottingham for the CSP and I hope to share with you some of the keys themes of the day!

Thank you again for taking an interest. Any comments please feel free to leave one below or tweet me @LCphysio.

This time last Year!

How crazy around this time last year I was starting to write my blog. Now a year qualified looking through my posts it is crazy to think how much I have achieved in that time. So this blog post is going to update people on my progress through rotations and will also touch on a recent course I have been on for Strength and Conditioning combined with Physiotherapy.

Currently I am working within the Specialist Medicine team at Derby, covering one of the acute respiratory wards and the High Dependency Unit. My first impression of starting my respiratory rotation was although respiratory physiotherapy isn’t my comfort zone, it was a skill I needed to develop. I naively thought “well at least I won’t have the same level of social sort out as elderly medicine….” (How wrong I was). You forget that elderly people may also have a respiratory condition and even if they are not elderly you may have to deal with breathlessness management, oxygen requirements and anxiety to prevent people being readmitted to hospital. Initially I found myself being very slow with my assessment an acute ward is very different from ITU. On ITU a lot of the patients did not necessarily have predisposing respiratory conditions (not all of them) or they were intubated so management was focused on chest clearance and early rehab. Whereas on an acute ward you are looking at how patients will manage at home with ADL’s, the need for long term oxygen therapy, occupational therapy involvement and  the need for social services involement. On the ward we work closely with the OT, one of the things we look at is equipment to help with energy conservation, as this can help to maintain a patients’ independence.

On the ward we have around 28 beds including a 4 bed High Dependency Unit. The high dependency unit has 1 nurse for 2 beds and is mainly for patients who are needing Acute NIV, Tracheotomies who need regular management, patients who have the ability to deteriorate who need escalation to ITU and patients who have reached there ceiling of care on HDU (so they are not for escalation to ITU if they deteriorate likely because their respiratory function is limited due to predisposing lung condition). The sort of patients I have been exposed to on HDU are Spinal cord injuries, Stroke, Neuro-muscular conditions such as GBS , acute exacerbation of COPD, vasculitis and severe pneumonia (So a range of conditions to get stuck into). In HDU all the patients have the ability to go off quickly so you have to keep your eye on the ball, however, it is worth noting that not all of the patients in HDU need physio. For example the patients dependent on NIV who do not have sputum retention normally just need time for their blood gases to normalise so we would hold off unless they need us for mobility Ax.

So objectives I have set myself on Respiratory:

1. To be able to carry out a Subjective and Objective Assessment on a:  i)Critically unwell patient ii)Ward Based patient iii) create a problem list and Rx plan.

2. To be confident using different Rx techniques and demonstrating clinical reasoning. i) Mechanical devices ii) Manual techniques iii) Suction iv) Advice and Education v) Postural Drainage.

3. To be confident in interpreting observations i) HDU charts ii) Auscultation iii) ABG’s

4. Prioritisation of a respiratory ward. i) HDU II) Ward Management iii) Discharge planning.

5. To be on call competent and safe

Through this rotation I will spend half of my time on the ward with HDU and half of my time on a general respiratory ward. To become on call competent through supervision sessions I am slowly working through my competencies. So far I have been fortunate for the experiences I have gained which will set me up for going on call.  However, I don’t think you can ever be prepared for the adrenaline kick of an on call situation. I think the best advice I have been given is always to go back to basics and question why someone has ended up in the situation they are in. What can we have an effect on? And what can’t we have an effect on? What is the main problem: Lung volume, Sputum or work of breathing or both? (This is how I would look at my patients but obviously everyone has different methods you would also complete a thorough respiratory assessment to reach your conclusion).

So slowly but surely my confidence with respiratory is slowly increasing and I am hoping to be ready for the September rota eeeek!! I will try to keep you updated with my progress.

ImageImageImageImageImageImage

 

So very much away from respiratory physiotherapy. I recently attended a course: The Integration of Strength & Conditioning and Athletic Screening to the Management of the Sporting Client: Recreational to Elite Level. The course was run by Harborne Physio and was taken by Simon Noad (West Brom Physiotherapist) and Ray Jackman (S+C coach based on Uni of Birmingham). I wanted to attend this course because there is a known gap between physio and S+C. We should be working in partnership to help athletes or clients achieve their goals. So I wanted to gain a bit more knowledge of S+C and how this would fit into my practice. Just to say people may have differing opinions regarding this process this is just one example. How I have written this up may be a bit jumpy because I have jumped through different principles discussed on the course.

The course was fantastic and it is the first combined S+C/ Physio course in the UK. Simon and Ray were great teachers and explained the principles and practical elements very clearly. The course highlighted that we should be focusing on training athletes not specific “Footballers, rugby players or runners”. The process of S+C is to help develop an individual to perform at the best of their ability.Obviously you will reach a point where you need to be looking at sport specific requirements but we must create foundations first. Is the athlete fit to undertake a training regime without breaking down. There are many elements which must be incorporated into a training regime to account for this for example: Nutrition, Speed, Strength, Power, Recovery,RSA, Endurance, Injury prevention, Flexibility, Anaerobic, Research. If we just breakdown recovery we should be looking at: Sleep (10 hours for an athlete), Hydration, Nutrition, Foam rolling, Mobility work, compression, ?Ice Baths so all of the elements can be deconstructed to create a comprehensive Ax and Plan.

So back to athletic profiling things to consider?

1: When do we screen:Pre season, End of season, following significant injury, return to training or objective Ax. There is no right or wrong answer.

2. Where?: Where do you work, what are you trying to measure?

3. How?: Single station, multi-station, single practitioner or multiple, number of athletes.

After devising a plan we should be doing a medical screen, if you do not have  medical support. This may highlight risks such as Cardiac problems which may need to be screened. http://www.c-r-y.org.uk/ . If in doubt refer to a Doctor or advise client to seek GP advice. (No your scope of practice).

The Screen

Habits/ Daily activities- may lead to motor control restrictions. This links to Poor training regimes which may cause soft tissue restrictions and finally previous injuries which may lead to movement dysfunctions linking back to habits.

How we are born to squat

Some of the things we may include in a initial screen are a Squat, Lunge, Single leg dip, box drop, forward hop and a combination. We should be marking these against normal movement to pre-empt restrictions and weakness. The testing must be standardised and you don’t have to include all of the movements to get what you want (look at the specifics of the sport).

Then we would move onto NMSK assessment some of the tings you might look at. (Not an extensive list)

  • Spinal position
  • Spinal AROM
  • Ankle ROM
  • SIJ mobility
  • Prone internal rotation
  • Thoracic Spine AROM
  • Hamstring AROM
  • ITB length
  • Hip flexor lengthon
  • Groin Strength
  • Quadriceps length
  • Hyper mobility
  • Motor/Core Control- looking at timing of muscle activation

There was a lot of practical elements looking at exercise prescription and how you would take your data forwards into a profile. The process I will incorporate into my practice will look at:

  1. Mobility
  2. Motor Control
  3. Functional Patterning.

We can incorporate this method into practice to formulate a comprehensive treatment or exercise prescription. It is difficult to demonstrate this in a blog post but basically the rational for this is because quality stability is driven by quality proprioception. And Quality functional movements cannot occur with restriction. So we should be addressing restrictions in RX, fire up the NMSK system and then consolidate learning with functional patterning.

For mobility we should be addressing myofascial length and Joint Range this links back to muscle slings which may impact of an athletes training. I am not going to go through the different slings and predisposition to different injuries as I will be here all day but some good examples can be found here: http://www.mobilitywod.com/#[/

or in the book “How to become a Supple Leopard”

After Mobility we can address motor control which is looking at stabilisation working in the new range of movement you have achieved. Some of the things which may be included are: Rolling, Dead lifting and chop and lift. This element demonstrates perfectly how much of MSK physio can relate to Neuro physio.

Finally we look at motor patterning using new control and range and incorporating them into functional movements. Something people might want to read around is Reactive Neuromuscular Training.

Your client should now be ready for S+C training however the whole process falls under the broad umbrella of S+C so there are links between the two, highlighting the need for more integration and a holistic approach.

The second part of the course focused very much on the principles of S+C incorporating RAMP principles into training. Work by Ian Jeffery’s comes into this. Elements we should be including within S+C are :

  • Needs Analysis: Requirements of the sport, movement Ax and Physiological Ax.
  • Warm Up: Raise- Increase HR etc, Activate- key muscle groups, Mobilise- look at movements not muscles and  Potentiate- sport specific drills.
  • Have an understanding of SPORT and FITT principles (not just giving 3x sets of 10)

So this was just a whistle stop tour of the course and this blog is not an exhaustive program of what you would consider but may give you some prompts to look at different elements of your practice. The main learning points I took away from the course are:

  1. When, Where and How to conduct an athletic screen and profile.
  2. The importance of looking at Mobility>>Motor Control >> Functional Patterning
  3. RAMP principles
  4. The importance of specific and tailored training regimes.
  5. The importance of understanding the needs of your athlete.

Thank you for taking an interest in my blog.  Next week I will be attending the CSP industrial relations committee meeting at CSP head quarters so my next blog is likely to be centred around that.

If you have any comments please post to my wall or tweet me @LCphysio

Create Foundations First!

It has been a while again since my last blog! I have been very busy with work, gym and trying to tame a new ex racehorse I have obtained!! Most people who know me know I like to keep myself busy! The last time I wrote my blog I had just started my job at Derby Hospitals NHS FT, moving onto elderly medicine. I am now talking to you on my second to last day oN my rotation and I am now going to talk a little bit out my progress and some of the things I have come to realise on my journey!

From past experience working at the Queen Elizabeth hospital, on a medicine ward. I had identified I needed to continue to develop my ward prioritisation and management skills to be successful on my new rotation of elderly medicine. It was difficult coming to Derby because having only experienced physiotherapy in Birmingham there were different policies and procedures to follow. For example in the morning we have a daily board round to discuss patients with the MDT whereas in Birmingham we had a weekly MDT meeting. I have found the board round has worked quite well because it creates an opportunity to discuss problems and identify patients earlier who are becoming medically fit for discharge. Although I am from Derbyshire, I never realised how huge the county is, so figuring out where patients are located was initially a challenge however this was made easier with the fantastic nurses completing  inpatient rehab forms for us after completing goals (what a luxury!).

So I wanted to talk about some of the things I have learnt along the journey which I hope will be useful to all physiotherapists not just students and graduates. My opinions are not gold standard they are just an opinion so please formulate your own clinical reasoning.

Prioritisation 

This is a skill I have really had to refine. In day to day life I am a very organised person however  my problem in terms of the ward management were I wanted everyone to have daily physiotherapy sessions. But unfortunately i realised this is not always possible due to the complex busy caseload . I Initially I found it difficult to lead the caseload partly because there was more than one physio  on the ward, my supervisor (which is great for learning). So we tried not to tread on each others toes. Further more I also lacked confidence and experience to challenge some of the views of the MDT with regards to discharge planning which hindered my initial development. With the complexity of some of the cases on the ward it took me a bit of time to demonstrate my full prioritisation skills, but over the last 4 months I have progressed to the point of feeling confident that I could transfer my ward management skills to any acute ward based setting. 

 

So below are some of the things I have learnt along the way:

  • Everyone has different methods for prioritising, but the way I have gone about it in a simplistic view due to the many factors which interplay : Respiratory patients not managing their own secretions, new patients who need a full assessment (prioritising patients who are requiring chest physio and those coming up to be medically fit for discharge), patients who are medically fit for discharge without a plan for discharge, patients at risk of deterioration if they are not seen and finally patients who are being monitored on the ward.
  • Prioritise patients who require assistance of  2 to ensure staffing can match the need in the afternoon.
  • Unfortunately when you want to see patients on the ward most of the time they do not always fit in your specific time slot so you have to be flexible with your management. 
  • Don’t be afraid to delegate you are not alone (hopefully). If you work with a physio assistant is there any patients that they could see for you on their own? Is there any admin needs they could complete for you?
  • And finally relax! You can only do what you can do! You are not superman or woman! (although I try to be),,, you are better to complete assessments thoroughly to create a plan rather than coming out of your assessment thinking what information have I gained from that?

Multidisciplinary Team Working

I have been very fortunate on my ward to work with a fantastic MDT who are very pro therapy to facilitate discharge. Coming onto my ward I initially felt the high bed pressures looming! However, this has encouraged me to devise a plan earlier and ensure I was continuously liaising with members of the MDT to create a discharge plan with the aim of preventing readmission. Working with the Frail elderly you will be presented with some complex cases such as patients at risk of falls, cognitive impairment, patients refusing social services or patients who do not meet social services funding, patients with complex commodities and finally patients with varying conditions.

Sometimes you are presented with some very emotive cases and you can feel as though you are playing with peoples lives. From our point of view we can only recommend what a patient should do to maintain there safety. However, if patient has capacity to accept risk or go home ignoring recommendations then that is their choice to make. We should be facilitators not dictators. I sometimes felt quite stressed with some of the situations I was faced with, with some patients being border line whether they are safe at home or not. However that stress is important because it ensures I am conscious of my decisions to strive for the best care for each individual patient. I think if you don’t have some form of internal stress and are going through the motions in your job this may come back and bite you in some point of your career. For patients we should be assessing them holistically and taking a 24 hour approach to theIR discharge…. Are they able to manage hygiene needs between care calls? Are they able to sit between care calls? Do they have any pressure sores? Do they have a cognitive impairment? Are they safe with there mobility? Are they able to complete bed/chair and toilet transfers? and finally Are they any safety hazards or risks for the patient returning home? These complex discharges cannot be completed seamlessly without an MDT approach so get to know your team and start communicating!

Preceptorship

It wasn’t long ago I was talking about starting my preceptorship! I am pleased to say I have now completed it to 6 months and have gathered evidence throughout my rotation to support my objectives, The objectives I was set were:

Working with patients and groups: I demonstrated this through joint sessions with my supervisor and a self evaluation form,

Working with colleagues and other agencies: I demonstrated this through a complex case study with a reflective piece and copies of some of my record keeping demonstrating liaison with different members of the team.

Written Communication: I demonstrated this by taking 5 sets of notes and analysing what was good and bad about them.

Using Local and clinical policies relating to working practice: I completed a reflection on infection control and completed a notes audit for the team.

Aside from my preceptorship I was set rotation objectives which interlinked with the programme. It might be a bit geeky but lets face it not many people spend time to document their experiences like me anyway ,but, the preceptorship process really did hone my reflective skills which will support a career long commitment to reflection and CPD in future practice. 

I have loved my time working with the elderly medicine team and I have had ample opportunities to develop my clinical reasoning, prioritisation and overall ward management. I now feel confident that I can transfer these skills to another acute ward based setting, to deliver a quality service to my patients. It was fed back to me that I sometimes set my expectations too high of myself. This has been the case for many years but it is the driving force which allows me to strive for the best. On the other hand, I realise that it is important to get the foundations right first to  develop a solid base for development and that there is no need to rush, at the end of the day I am only still in my 1st year of graduating :-S!

 

Action Plan and the Future.

So in the pipe line for me…. next Tuesday I will be starting on my respiratory rotation (eek), I have completed the 2 week intensive training given by the trust so it is now up to me to get my head in the books to get my head back into respiratory management! Aside from this you may be aware from my last post I wanted to find a mentor to help refine my leadership skills…. well I am pleased to say I have found one and not just anyone. Sarah Bazin OBE has happily agreed to help me and we will be meeting next week :-). Sarah is the current chair of the European Region of the World Confederation for Physical Therapy (ER-WCPT) so I am honored to be working with her over the coming months!

My latest action plan…

  • Revisiting my respiratory assessments
  • Thinking of objectives for my respiratory rotation
  • Creating a 5-10 year plan with the help of Sarah as appropriate

I think that will be enough to keep me going for now. Thank you for taking an interest in my blog! Please feel free to leave a comment or Tweet me @LCphysio . 

The end is only the beginning!

Merry Christmas everyone!! Well how quickly time fly’s I feel I have only just started a new post and  I am now moving on. On the 6th of January I will be starting my new permanent band 5 post at Derby Hospitals NHS Foundation Trust and I can’t wait! As promised I wanted to give everyone an idea of what my first experiences were as a band 5 . I have been fortunate in some respects because although I have not yet completed a full rotation, I have had 2 mini ones, which has meant I have seen and learnt a lot in a short space of time. The downside to this is I have learnt a little about a lot and I now need to build on my experiences to progress my development.

So starting from the beginning my first rotation was on Critical Care Rehab. It was difficult coming onto this rotation as it had only just been made available to band 5’s and it was ideally suited to someone who had done a rotation on ITU previously. Luckily for me I had been on the same area as a second year student so at least I knew some of the team. The rehab team mainly worked with patients who had been ventilated for more than 10 days or who were likely to be a slow wean. Due to me not having completed my respiratory competencies it was difficult for me to be just given a caseload and the majority of patients we were working with were complicated rehabs. At the beginning of the rotation my senior and I set realistic objectives to be achieved by the end of the 6 weeks (It was almost like having another placement except I was qualified and no one to countersign my notes).

The sort of objectives we set were:

To be able to carry out a basic baseline respiratory assessment of a ventilated and non ventilated patient.

To have an understanding of the complex needs of critical care patients during and post admission.

To be able to formulate a problem list, treatment plan and goals for rehab patients.

To be able to develop competencies on specialist equipment.

It doesn’t seem like I had many objectives but I had to be realistic in the time I had. Throughout the rotation I was fortunate to attend weekly in service training, one to one teaching sessions with my senior and I was able to observe more senior physiotherapists in practice as well as treating my own patients. I found the one to one teaching sessions very useful as it gave me the opportunity to clarify points in my own mind. When initially setting my objectives I was asked on a scale of 1-10 how confident  I was  in carrying out a respiratory assessment which I answered 4/10. I find respiratory quite difficult because the problem is internal and not particularly visual. However following completion of my rotation I am now able to take a backwards step from my patient and work through my assessment systematically.

  • Firstly what has lead the patient to end up on critical care?
  • If they are post surgery did they have any risk factors pre- surgery i.e. Past medical, smoking, obesity, trauma, previous exercise tolerance.
  • Were there any complications during surgery?
  • Were they an emergency admission and is there any contraindications to my treatment?

So this is the sort of stuff going through my mind before even reaching the patient. Next I would spend time to read the notes thoroughly to see what lead them to be on critical care. After reading the notes you can already hypothesise reasons contributing to the patients condition.

Reduced FRC

  •  Anesthetic- reduced mucocilliary clearance
  • Pain- are they reluctant to deep breathe
  • Sputum- due to past medical condition or due to reduced mucocillary clearance
  • Position
  • lung consolidation
  • lung collapse
  • respiratory muscle weakness
  • Drowsy from sedation or opioids

So what can we help with?

  • Analgesia for pain and assistance with supported cough.
  • Sputum- ACBT, manual technique, suction etc..
  • Re-positioning to assist with V/Q matching
  • Ventilator support
  • reduction of sedation.

So we have a few things we can adopt as treatment options and this list is not exhaustive.

On critical care patients are normally under hourly observations so the next step of my assessment would be to interpret them. When writing my first initial assessment I would document:

Subjective

  1. Presenting Complaint- what did they come in with?
  2. History of presenting Complaint- why did they end up on critical care?
  3. Past medical history. Is there anything relevant which will affect their PC?
  4. SH- What was there pre-admission state what support do they have at home?
  5. What has been said by the MDT or any critical events?

Objective

  1. Temperature- every degree increase in temperature increases the patient oxygen demand by 10%
  2. Cardiovascular system: Blood pressure,Heart Rate, CVP and MAP . Are they stable does this restrict or treatment?
  3. Respiratory- Method of ventilation what support are they using? Why are they on this mode?
  4. Respiratory rate do they look distressed or have increased Work of Breathing? Why do they have increased WOB?
  5. Oxygen Saturation. Why are saturation’s low? is it due to shunt? diffusion problem? V/Q mismatch? hypoventilation?
  6. Arterial Blood Gas . What does it show? What is compensating if any?
  7. Renal- Urine output and fluid balance. Are they in organ failure? Are they overloaded with fluid?
  8. IV drugs. Is there blood pressure or heart rate being supported? Are they sedated? Do they have an epidural need to be careful of postural hypotension.
  9. Abdomen- is the gut absorbing nutrients? Is the abdomen distended?
  10. Neuro- Glasgow coma scale?
  11. Auscultation- Air entry? Added sounds? tactile fremitus? Thoracic expansion.

Treatment

  • What is the problem? What are your treatment options?

Analysis

  • What is the patient limited by? What were the results of the treatment?

Plan

  • Physiotherapy treatment plan
  • Recommendations for staff

I have not attempted to go through modes of ventilation and treatments as I could write for days but a clear understanding of the reasoning for different ventilator modes and treatments in essential to formulate and clinically reason an appropriate treatment plan. So the above is the method I would use to assess a respiratory patient. By being systematic it means you are unlikely to miss something critical as a band 5 and with experience your clinical reasoning will become stronger.

So in summary of my first rotation I can now say my confidence has gone from a 4/10 to a 7/10 however, I think I would benefit from having a further rotation on critical care to consolidate my learning.  From completing my rotation I am now able to perform multi system assessments of ventilated critical care patients to generate problem lists and appropriate plans for treatment. I have demonstrated effective skills in the respiratory treatment of ventilated and non ventilated patients. I have also gained experience of treating longer term ventilated patients, developing rehabilitation programmes and acting as the patient’s key worker at weekly goal setting meetings.

Onto my Second Rotation Medicine. I was prepared for a change in culture but the first week really was a shock to the system. Compared to critical care we had a big case load to get through each day and there was a real need to prioritise your time. At the QE we work through a traffic light system (without having the sheet in front of me this gives a basic outline of prioritising patients)

Red= Acute respiratory, Discharges, Falls.

Amber= new patients, patients who have had a decline in mobility or those requiring ongoing rehab.

Green=  Patients safe with or without aids being monitored.

From coming from critical care this was a bit of a shock because I was used to seeing all of my patients daily but on medicine it is impossible to see everyone as the priorities must get done. So my objectives for the four weeks I was on medicine were:

  1. Effective prioritisation of medical caseload using prioritisation tool.
  2. Timely and Seamless discharge planning or patients in line with multidisciplinary team goals.
  3. Appropriate referral to other services and MDT.
  4. Appropriate use of physiotherapy paperwork and documentation in line with CSP and trust standards.

Again my objectives would be a lot different if I had been working on the area for 4 months but I had to be realistic to get the most out of it. Through the 4 weeks I have developed my skills in prioritisation ensuring all patients were seen in a timely manner, I am able to contribute to MDT meetings and I have referred patients on to relevant services. Again I believe I need another ward based rotation to consolidate my skills but I feel in the short space of time I have achieved the objectives I have set.

For anyone who is about to embark on there first physio job or to any qualified physiotherapist my top 5 tips would be:

  1. Don’t be afraid to ask questions, you’re not meant to know everything
  2. If you have a complicated patient don’t be afraid to ask your senior to review them with you remember you need to be within your scope of practice.
  3. Don’t be afraid to say no if people are putting too much responsibility on you straight away or you are feeling overwhelmed.
  4. Take up opportunities to observe more senior physiotherapists.
  5. Make sure you read patient notes thoroughly to carry out an effective assessment and treatment. You don’t want to cut corners.

Thank you for taking the time to read my blog, I will be starting my new job in Derby soon which will allow my blog posts to continue. Please feel free to leave any comments or tweet me @LCphysio

 

Decisions, Dilemmas and Diversion

It has been a while since I wrote my last post. I have been very busy since starting my new job at the Queen Elizabeth Hospital Birmingham and I have also continued to  work at West Bromwich Albion FC and Harborne Physio at Barefoot Birmingham. So I have barely had time to sit down never mind write my blog. As you may be aware from my last post my first rotation has been critical care rehab which has been incredible. I have been able to see some of the long term rehab patients who are ventilated and non-ventilated and I am getting to see some of the post operative patients which all will stand me in good stead when I come to complete my respiratory competencies. It has been great to get stuck back into respiratory as I only had the one placement in my second year and everyday my confidence is building as the team I am working with is great!! We do a lot of doubles together, teaching sessions and in service training.

Now this all sounds all well and good but the last couple of weeks have been pretty stressful for me, a couple of weeks into my job at the QE I got an email through from a manager at Derby Hospitals. As you may know from previous posts I had been for an interview there but was unsuccessful (which I was disappointed with as I had done my best on the day). The email read along the lines of:

Dear Lucy

I hope you are well.

We have had some extra movement in the trust and I would like to offer you a permanent contract at Derby Hospitals…..

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At this point I read the email about 50 times before I made sense of it! Due to my interview being within 3 months they could recruit me straight away! Of course at this point I accepted but was wary that a permanent post was coming up at the QE so I was still hopeful to remain in trust so I attended the interview to give myself options.

I turned up at the QE interview consciously fine, I went in sat the written paper which asked questions on Chronic non-specific lower back pain and what the management would be? Prioritisation of a list of patients, a respiratory patient assessment, treatment with relation to the on call rota and another question which I can’t remember. I came back to sit down after the paper feeling relatively calm and waited to be seen for the individual interview…. I was being interviewed by the head of therapies and a band 7. I went in and the first few questions were absolutely fine and then it hit me….. My nerves suddenly took over me and I couldn’t physically speak the further questions weren’t particularly ambiguous and if you had asked me later that day I could have gone on for hours but instead I felt like I was outside my body looking in and couldn’t do anything to help myself…. So unfortunately I can’t recall any of the questions from that interview and you can guess I didn’t get the permanent contract…. however they were very understanding of how much the job meant to me on the day and did extend my contract if I wanted.

Now for most people this would be a simple decision to take the permanent contract, but for me not so much. I really had to sit down and right the pros and cons of each hospital and location which did keep me awake most of the night. In the end I chose the permanent contract although I have settled into the QE and I love the hospital I had to be selfish in thinking about my further development…. so I opted for continuity. So as you can imagine I am ecstatic!!! I am now a proud owner of a permanent band 5 contract and all the events and opportunities that have lead to this day have sometimes been hard but totally worth it in the end. I just wanted to say that if you are newly qualified physiotherapist looking for an NHS job don’t give up! I have had several interviews which have been unsuccessful but you can’t take it personally and you have to move on to the next one. Eventually something will come your way and it will be the reason you didn’t get the previous jobs you applied for, because everything happens for a reason.

So since I have now got a permanent band 5 post as promised I wanted to give students and new grads tips on how to write their supporting information. So firstly here are my top 10 tips for writing an application and attending an interview:

1. Read the PERSON SPECIFICATION….. this is the point all managers come back to that applicants haven’t done what they have asked. Sometimes there will be hidden questions to how they want you to approach the application. Basically don’t give them a reason to turn you away, use buzz words that are included in the person spec.

2. Make it personal to the trust, show them how you meet their vision and values if you don’t do this you might as well not even submit your application.

3. Demonstrate your transferable skills. If you have been involved in other activities outside of physiotherapy… what skills have you developed and how can you transfer them into practice.

4. Include your HCPC number and CSP membership number at the top. This means the recruiters don’t have to look through your application when it is staring them in the face.

5.Make sure you review the NHS jobs website daily. The website sends emails of new jobs at the end of the day not when a job goes out.

6. Get your application in early some NHS jobs can close within a couple of hours like the QE. Have a basic template for your application ready so you are ready to go when the job goes live.

7. Don’t make it any longer than 2 pages A4 treat it as a CV otherwise the recruiters will get bored if you are not keeping everything concise.

8.Attend interviews that you don’t want, you might change your mind when you get there and have a look around (and lets face it we can’t be fussy). Try and book an informal visit before the interview as this is something you can talk about during the face to face interview if you have one.

9. Prepare but don’t over prepare. Try and practice questions by answering them out loud as this is how you will be responding in the interview. But try to relax at the end of the day it is not the end of the world if you don’t get the job, nobody died and it is their loss.

10. Finally take in your CPD folder and make it relevant to the post you are applying for, that way they know you are dedicated to that specific post.

I can’t give you any real tips for interviews as they are all different but it is a skill you do develop…. so if you have a shocking one don’t beat yourself up about it. Below I have posted one of my applications with the name of the trust removed, I hope some of you may find it useful.

Physiotherapy BSc: Class 1 (Hons)

HCPC Registered: PH101564

Full member: Chartered Society of Physiotherapy.

Full driving license.

As a very enthusiastic, driven, and dedicated person I believe I would provide a valuable contribution to the teams within X Hospitals NHS Foundation Trust. I believe X Hospital would facilitate me to achieve excellence, whilst allowing me to gain a firm grounding for a successful career in physiotherapy.

I wish to emulate the trusts vision of “……”. I believe I am a very personable, polite and enjoy taking the time to take a holistic approach with my patients. I feel the best outcomes are achieved when patients feel empowered and listened to. On clinical placement one of my patients lacked confidence and I felt by taking the time to understand their goals, this aided my treatment and their outcome. Conversely, I had a situation where I had to break bad news to a patient. The gentleman was likely to remain wheelchair bound due to him demonstrating no improvement over several months. Although I was presented with the harsh reality of stroke, the process was made easier due to the patient and family trusting me as I always aimed to answer any of their concerns and provide information when they required.

Through clinical placements I have been fortunate to gain experience in Intermediate Care, Acute Stroke, MSK x 2 and Orthopaedic Outpatients, Intensive Care at a major trauma centre and Elderly Rehabilitation. During this process I have been able to demonstrate my strengths in communication, time management and ownership of my own caseload, whilst also ensuring I am providing patient-centred care. This has been evidenced by feedback from my clinical educators in my CPD portfolio.

On my last two placements I demonstrated safe, effective and autonomous caseload management in an inpatient and outpatient setting. In both cases I was responsible for discharge planning and referral to appropriate services following MDT meetings or by written communication. I have been able to successfully demonstrate this through positive feedback received from educators, patients and from the wider MDT.

Clinical placement has allowed me to develop my problem solving skills. This can be demonstrated from my experience on intensive care. Coordination of care is essential in all settings; however, in intensive care it is vital due to patients being prone to fatigue. To ensure the MDT were working in a coordinated way I helped to implement the idea of writing a treatment timetable.  The timetable allowed for patients to feel empowered by them deciding when they wanted to be seen and it allowed staff to work together efficiently.

Data protection and patient confidentiality is a requirement for any practicing physiotherapist. I have demonstrated my awareness of this in my portfolio following completion of information governance modules: Patient Confidentiality, secure handling of confidential information and Records management and the NHS codes of practice.

At University I have maintained my manual handling training which I have applied to a practice setting. An example of this was when a patient had slipped out of her chair. To resolve this I autonomously worked with a physiotherapy assistant and used a slide sheet to ensure safety and dignity was maintained by the patient.

With the new changes being implemented in the NHS, it is important for physiotherapy services to provide evidence of positive outcomes. In light of recent failings in the NHS, it is essential for a practicing physiotherapist to adopt clinical governance to ensure patient safety remains the priority. Furthermore, I understand I have a personal responsibility to provide a clinically effective service by basing my practice on evidence and working within my scope of practice. As part of my elderly rehabilitation placement, I conducted a documentation audit using the quality assurance tool and presented this to staff. The audit highlighted shortcomings in record keeping which needed to be addressed, as it had the potential to impact patient outcomes. If I was to gain this post, X NHSFT would gain a physiotherapist dedicated to the profession who is flexible, proactive and who takes a positive approach to managing change and challenges.

Alongside clinical experience, I have been an active member of the CSP. For the last 4 years, I have been a student representative and I have served as Midlands Regional Coordinator for the Student Executive Committee (SEC) from 2011-2013. This role required the ability to organise and coordinate meetings between student reps at Coventry, Keele, Nottingham, Leicester and Birmingham. The meetings discussed relevant physiotherapy issues within the student population and ensured student input was applied to the wider society. Through this role, I have had the opportunity to present at conferences, contribute to policy, sit on the West Midlands Regional network and set up an Unemployed Graduate Scheme. The scheme was set up by myself to provide free evening CPD lectures for new graduates who were in the transition between graduation and employment. These opportunities have allowed me to develop my leadership, communication, organisational and presentation skills. My contributions to the society have been recognised this year as I was nominated and received highly commended CSP student representative of the year 2013.

I am an active learner and seek out any opportunities to further enhance my professional development. An example of this was applying to work with the University Rugby League team as their pitch side support .To enable me to take on this position I had to complete a pitch side first aid course and show further evidence of CPD activities related to the post. During this role I have had to work alone in high pressure situations which have enhanced my lateral thinking skills. I have had to negotiate with players and coaches on a regular basis to ensure players who were unfit to play remained on the side line. This role has highlighted my diplomacy skills to achieve ‘win win’ situation.

Outside of physiotherapy I have a passion for horse riding, which has continued through University. For the last 2 years I have been elected as 1st Team Captain, for the University Equestrian Club, and I have represented the University at British University and College Sport over the past 4 years. This role has enhanced my leadership and teamwork skills and has demonstrated my dedication to activities I am involved in as we were crowned national champions in 2013.

I enjoy being challenged in my work and I believe that physiotherapy should remain a seven day service for the benefit of the patients. Recent news discussing how patients who have elective surgery on a Friday are more likely to have complications highlights this. I would be willing to be flexible in my work as I believe my time management skills have ensured I can create a work life balance, evidenced by my commitment to my hobbies.

As a newly qualified graduate, I am aware of my scope of practice; which includes recognising personal weaknesses and critically appraising my performance and learning. I welcome the opportunity to discuss cases with colleagues, to share best practice and further develop my clinical reasoning skills. I am excited about the new learning opportunities X NHS trust would bring.

Thank you for this opportunity and I look forward to hearing from you.

And that is really it I hope to keep you all updated with my progress as a new band 5 at Derby. Thank you to everyone who follows the blog, the support has been great and has really kept me going when times have been tough.

Feel free to leave me a comment or tweet me @LCphysio

Putting things in perspective!

This week I started my new job at the Queen Elizabeth Hospital Birmingham and I survived!! My first rotation is on critical care… which for most new band 5’s, who have never done a placement on ITU I am sure would be petrifying! Especially since the QE has the biggest co-located ITU in the world holding 100 beds! …. Luckily for me it is the area I did on placement so it is not all new! (Though jogging my mind on respiratory has been quite as a task, as I last did respiratory placement in my second year). But I am happy as I know quite a few friendly faces which has been reassuring.

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So not only have a started a new job this week I have also moved into a new house, which means I can walk to work! I wouldn’t necessarily recommend doing both at the same time as it has been quite stressful getting everything organised, but everything seems to be back on track now 🙂 . On my first day I went to meet my line manager for an initial induction, I remember walking down to road with butterflies in my stomach and clammy hands wondering what the day would bring! I was given so much information in the morning regarding booking onto mandatory training and different contacts I needed… my brain had turned to mush and I had dates in my diary I couldn’t even relate to any more. But I figured it’s not worth worrying about as everything will get sorted in the end (I just hope I progress to a permanent contract after doing all of these training sessions!!)

Mid morning I got to go up onto the Unit. It didn’t feel too scary as I had been up there before so all the noises of monitors beeping and staff bustling seemed quite normal to me. I am currently on the rehab team on ITU which means I get to work across all the areas of intensive care which are Renal, Trauma, Neuro and Cardiac I think…. So as a new band 5 it is great opportunity to see all the weird and wonderful things! My team consists of two band 6’s and one band 8 so I am in a great environment to learn. We are currently involved in a research trial looking at early mobilisation in ventilated patients to see if this decreases patient length of stay in hospital. It is a very rewarding first rotation but I am due to rotate again in November  😦 (as I started mid way through), so I plan to write some objectives in line with the preceptorship scheme to achieve before I finish. At the QE we have an in service every Wednesday… so it will be a good opportunity to share my learning experiences each week as I won’t be able to share patients stories for confidentiality’s sake. 

From just doing my first week on ITU, it really puts life in perspective. Although I have had a few things going in my personal life recently, compared to what some of the patients and families are going through it is nothing and it really makes you view things completely differently! 

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So back onto a positive note a permanent post has just become available at the QE so I have applied for that! I have had feedback from my last interview so fingers crossed it might lead to something else if I get an interview as there is a chance they might randomly select 🙂 (but now I have met the interview panel hopefully they won’t seem as scary :-S). 

Over the weekend I am at Physiotherapy UK so I am sure I will have a lot to talk about, I am really looking forward to catching up with friends and CSP student Reps! New grads can still go on a student rate and it is great 2 day conference of CPD. See the link below if you want more information:

http://www.physiotherapyuk.org.uk/

Thanks again for taking the time to read my post. Any questions or comments please feel free to contact me on here or tweet me @LCphysio .

Grab Opportunities With Both Hands!

I just wanted to start this post by saying a massive thank you to everyone who has taken an interest in my blog. So far, I have had over 4000 views which is amazing and totally appreciated.

So this week I went to the CSP West Midlands Regional Network Study day in Worcester (Keep looking on the CSP website for the presentations under West Midlands Regional Network). I am going to discuss what I took from the event. See a few pictures below.

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When I was a student I was the student representative on the West Midlands Regional Network, which I have now passed onto Daniel Jackson (3rd Year Keele who kindly provided the photos). The West Midlands is a very active network and I have continued to have some involvement since qualifying which will be easier now I am staying in Birmingham. At the moment my role on the network is part of communications team which involves engaging members (mainly new grads with what goes on). The network are very welcoming and always like to know what is going on in your work place, so any issues can be fed back to the CSP through our chair Janet Davies or Rep to Council Philip Hulse. The study day kicked off similarly to a normal network meeting, so work place reports were discussed and key points in the CSP council papers and key messages were highlighted (For more information and minutes please go the West Midlands Regional Network http://www.csp.org.uk/nations-regions/west-midlands. The network meetings are great to find out what is happening in the real world of physio (for students)  and it is great way to share good practice or discuss work place issues for (qualified). For me the network meetings are a great opportunity to network and to find out first hand what issues are facing our profession.

I have highlighted presentations in bold so you can pick and choose which sections you read as there is quite a lot to talk about.

Presentation 1-“Professionalism in Today’s Regulatory Climate” Sue England who is the CSP Treasurer and Council Representative (@SueEngland10)

I believe slides will be put on the CSP website. I am not going to discuss everything in the presentation but this is what stuck with me: Firstly discussion of what defines your Scope of practice. Sue suggested it was a good thing to actually write down your scope each year. So what are you trained and competent to carry out? This changes with experience so it is good to know what the limits of your practice are. For me personally by writing down my scope this will highlight areas I need to focus my CPD to aid my career progression.

Secondly was the fact that as a physiotherapist you are an autonomous practitioner, this means any clinical decision you make you must be able to justify whether during assessment, clinical reasoning, treatment plan or record you are involved in. The first line of defense you have if you are pulled up by the HCPC are your notes, this mean they must be accurate, comprehensive and comprehensible ! As a full CSP member you have comprehensive public liability insurance (if you are working within your scope of practice). CSP membership is a bit like RAC/AA cover you don’t want to have to use it but that time you do the costs that would be covered would be equal to a lifetime cover so personally I think it is a small price to pay (fingers crossed I never have to face this!!)

Finally I found a good link to read  is :  http://webarchive.nationalarchives.gov.uk/20130402150350/http://ahp.dh.gov.uk/2012/02/27/voicepiece-karen-middleton-chief-health-professions-officer/ . Karen Middleton, Chief Health Professions Offcier, wants AHP’s  to be transparent following recent findings from the Francis report (although most of the findings were centred around nurses, physios need to ensure we don’t miss out on funding for leadership programs or CPD opportunities) . As physio’s we generally are not very good at challenging each others practice, so Karen’s aim is to encourage AHPs to talk about the issue of professional behaviour in a more open and constructive way, which I believe was the main message behind Sue’s presentation.

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2nd Presentation: A Personal Experience of Completing the HCPC CPD Audit- Jane Toms- Communication Lead WMRN and lecturer Coventry University.

I think one of the scariest things to think about as a qualified physiotherapist is being called up by the HCPC for CPD Audit. Each year the HCPC select 2.5 % of the profession to have their portfolio reviewed. Now lets face it physiotherapists are very good at doing CPD, however, if someone was to come and raid you’re house one evening, would it be in an organised manner? If you’re like me I have 3 folders which store everything but I wouldn’t necessarily think it was appropriate to hand into the HCPC. Jane Tom’s presentation gave a great insight into the process and revealed some relieving points.

How she completed it:

  1. Read carefully what was required: Guides,videos and examples from HCPC.
  2. Look at online resources from CSP, HCPC.
  3. Read carefully what is required again
  4. Look at the assessment criteria!!!
  5. Look at portfolio and select most appropriate CPD
  6. Keep cycling through 1-5.

Jane brought in a copy of her submission and it was quite a relief to see a very thin A4 folder!!!  So what was needed in the submission.

  • 500 words about current roles and responsibilities
  • 1500 Words on how she addressed standards 1-4 with evidence to support it.
  • Standard 5 submit it!! You do not need to use all 2000 words!

So a lot less work than you thought? However, do you write the dates of any CPD activities you do?

Standard 1: Maintain a continuous up to date, accurate record of CPD: Basically write a timetable for the last 2 years of things you have done and the nature of the activity, for example formal course, discussion, peer review.

Standard 2: Demonstrate that CPD activities are varied and relevant: so link to nature of the activities you have recorded and then link to why the activities are relevant to your current role (so link this to summary of role).

Standard 3: CPD has contributed to quality of practice and service delivery: Link evidence to a form of evaluation you can do this yourself or by external feedback you may have documented. How has CPD helped your practice.

Standard 4: Seek to ensure CPD benefits the service user. Who are your service users? Basically it could be anyone you come in to contact with so patients, students, staff etc. Try to link to service user feedback eg. cards, emails, patient feedback etc… This is probably the most difficult standard.

So what would Jane do differently next time?

  • don’t feel guilty if portfolio is chaotic
  • endeavor to be less chaotic as this would save time e.g write down CPD in diary.
  • Ask people who give positive feedback to email her- emails provide dated evidence.
  • email colleagues appreciation
  • even more collecting of positive emails, cards and feedback.

Presentation should again be uploaded onto the WMRN page.

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Presentation 3 Achieving CPD Excellence- Sophie Wickens CSP Fieldwork Officer for CPD

So following the previous presentation I think the importance of CPD has been highlighted. CPD is an ongoing process. My CPD has very much focused on how my CPD activity has affected me but I haven’t integrated it into how it has affected my service users, I have said it will but I haven’t evidenced it. A way I could demonstrate my CPD in this way could be what I learnt from working with England Cricket, followed up by documenting an email from Steve McCaig who gave me positive feedback for the work I did and how the players and coaches responded to me.

What are the benefits of demonstrating excellence in your CPD?

  • encourages further learning.
  • HCPC requirement
  • Role model to others.
  • Job satisfaction
  • Become critical about own practice.
  • Make the case to employers of the benefits of attending courses. i.e. applying for funding.
  • a way of influencing commissioners.

What resources are available to you from the CSP?

  • Pebblepad/ eportfolio proformas
  • Frontline
  • ICSP- Case discussions
  • Twitter
  • Championing CPD Scheme
  • CSP Colleagues
  • CPD Champions- reflective cards
  • QA Audit Tool
  • Physiotherapy Framework
  • CPD Syd
  • Specialist physio through professional advice service.
  • Links to specialist library
  • Network meetings
  • Annual Reps Conference
  • Clinical interest groups
  • Physiotherapy UK
  • Physio Journal
  • CSP Briefing papers
  • Website.

So there are a few things to be going on with.

Presentation 4 Top Ten Things you didn’t know about NICE Naomi McVey.

I am mainly going to bullet point some of the things I learnt from this presentation as I don’t have the slides in front of me.

  1. Maybe its just me but did you know the codes on NICE guidelines symbolise the type of paper you are looking at, for example CG- Clinical Guideline QS- Quality Standards PH- Public Health.
  2. The full NICE Guideline provides an in depth report of all the evidence and a summary whereas the web format provides recommendations. Naomi advised to go to the web format first and then follow up with the full guideline if you require more detail.
  3. NICE Quality Standards provide markers of high quality care from the best available evidence, so good to use when looking to implement a quality service.

CPD Opportunities and Resources available from NICE.

Presentation 5 Moving into the driving seat- how physiotherapy can benefit from this current climate Sue Browning CSP Dep Chief Exec.

Change in the NHS is here to stay as we cannot afford to keep doing what we are doing. There is increased competition to provide services, there is a shift to primary and integrated care to promote self-management and there is an increasing demand for quality to be monitored.

Change does bring opportunity: Commissioners are looking for more efficient and better ways of working and there is strong evidence that physio is the answer to many of the major current changes. However, we cannot assume that people know the key role of physio in preventing unnecessary admissions, providing alternative pathways and keeping people independent. Therefore it is our job to go out and take control of this agenda. Everyone has a role we need to understand and look to improve our role, sell ourselves, look for opportunities round local joint strategic needs assessments (JSNA), build support with patient groups (they will be your allies), learn from others and look to the CSP website. Tell the CSP what you need to do this? As a profession we are a team and need to work together.

Finally moving into the driving seat.

  • Physiotherapy has a strong future.
  • We all have a role in creating that future from student to qualified member.
  • Services will change.
  • Seize opportunities
  • Network, network, network and access the support.
  • Regional Networks have important roles.

So as you can see I have taken a lot from one study day I hope you may find some of it useful.

Finally what is happening with me, I recently went to help out at an extra session with West Brom using Functional movement screening to assess players. This worked in my favor as I am now going to be doing some paid work for West Brom, as one of the physios was unable to cover a day so I stepped in (It shows sometimes grasping any hint of opportunity can lead to others). I will do a follow up post for all of this as I feel I have I overloaded this post with information.

Thank you again for taking the time to read my post. Again any comments please leave on the page or tweet me @LCphsyio