A Day in the Life of Laura Hawke

Specialist Palliative Care Occupational Therapist/Blue Badge Assessor West

Read about Laura's Day 

8.30am: Arrive at my desk, boot up my laptop and check my emails and plans for the day with a quick coffee.

9am: Handover on the inpatient unit. I like to attend as many as I can to make sure that if anyone needs any equipment to go home with then this is sorted out in time for discharge. I have a kitchen assessment with a patient booked in today so I check what time it would be good to do this with the lead nurse; assessments need to be fitted around the ward routine.

9.30am: Touch base briefly with one of our Multi-Disciplinary Team Assistants (MDTAs); we have two in Taunton and three in Yeovil and they work alongside myself, the physios, the social worker and the community nursing team to deliver holistic assessments and interventions to our patients. The role has only been up and running for a few years, but the impact of it has been fantastic in allowing more OT work to be done in the community. One MDTA has a query about putting in some rails around a non-standard bath so we discuss some options and agree that I will revisit with her next week if our initial idea isn’t successful.

10am: Out on my first visit of the day, one of my clients is still working and works on the fifth floor of a tower block; he stays in his powered wheelchair all day and uses the lifts, but there is some concern over him safely transferring into an evacuation chair to be taken down the stairs if there was to be a fire. Worked with the health and safety officer and my client to practice the transfers and make some suggestions to make it as safe and easy as possible. Everyone is satisfied and reassured that we’ve come up with a sound solution.

11am: Back to the hospice to do a kitchen assessment with a patient from the ward. He had been very muddled when I carried out the assessment last week so I wanted to repeat the assessment as he has now been treated for an infection and seemed a little better. Unfortunately he still struggles to make a hot drink safely, so it does seem that his metastatic disease is causing a permanent change in his cognition rather than this being a temporary state.

12pm: Write up my notes from my assessments this morning and eat some lunch. 

1pm: Catch up with a client in the Sunflower Centre to see how they’ve been getting on with the equipment there and some new items that I’ve given them to try at home.

1.30pm: Send a request for permission to order an expensive specialist chair for a client who I saw yesterday; I have a cost limited equipment budget and need to apply for authorisation for certain products. Also send some emails regarding some teaching sessions that I’ve got coming up later in the year. Part of my job is educating other therapists and students therapists about palliative care and the occupational therapy role within this so I regularly do voluntary lecturing and run events and provide student placements to promote this.

2pm: In-patient MDT with the ward staff, medical team, physiotherapy, social worker and spiritual care teams. We discuss the patients on the ward and make plans for their care and support over the coming week.

3pm: Pop into Millbrook in Wellington to pick up some equipment and scout out a new shower commode for another client; we have a huge store of recycled bespoke stock that can be used, its like an Aladdins Cave of activity of daily living equipment! I need something with tilt in space and lateral supports and find just the thing I need. I order it and agree a visit date for next week.

3.45pm: Carry out a home visit (I cover a patch reaching down to the Devon border, over Exmoor to Minehead and as far north as Burnham on Sea so I can spend a lot of time travelling). She has just had a wheelchair delivered so I check it over and then set up her new portable ramps. We practice self-propelling in the wheelchair down and up the ramps. I give her some recommendations and safety advice and we agree that I will visit again next week. Some clients I see only a few times, but she needs weekly visits at present as her condition is changing quite quickly.

5pm: Finish my visit and drive home.

A Day in the Life of Tamsin Webb

Specialist Palliative care O.T.

Read about Tamsin's Day 

9.30am: Arrive at the Hospice.

9.30am: Join a Handover meeting with the discharge liaison nurse, Social worker and Physiotherapists to discuss potential discharges from the ward that may require OT input. Environmental assessments are often beneficial to ascertain that the access to the property is manageable, such as for a client who needs to manage steps to ensure that wheelchair access is provided or assess if there is access for a stretcher from an ambulance. Often I provide a home visit prior to discharge where the environment is assessed in conjunction with their current functional needs and anticipated future needs. A clear discussion can be held with the family members directly involved outlining what can be provided (equipment, adaptations and care), what the limitations will continue to be and giving uninhibited time to discuss the family’s fears and concerns in their own space.

Three current inpatients are highlighted as requiring potential OT input.

9.45 am: At desk check emails and phone messages. Often messages are left by clients and their family with updates or potential referrals from the District Hospital (Nurses and Therapists), Independent Rehabilitation Team, Care Agencies or District Nurses. Need to call these messages back to take further details.

Checks are made on Crosscare, the Hospice’s electronic patient record system, to see if there have been any changes or out of hours calls to the St. Margaret’s Hospice 24hr advice line (run by the Hospice) that may have a direct impact on the clients that I am due to see that day.

10am: Travel to first visit. It is a new client that has been recently diagnosed with a brain tumour.

Discussed her current needs and changes that could be made to her environment to improve her safety and to retain her current level of independence for as long as possible. Anticipating changes to her balance and vision as a direct impact of her brain tumour we discussed her seating (which is currently high risk as it swivels and rocks constantly), access to the property and stairs as the main priorities.

Midday: Travelled to my next visit. (I cover Yeovil and its surrounding area to Chard, to the Dorset border and the Mendips including Wells and Glastonbury) to visit a couple of whom the husband was discharged home from the Hospice three weeks previously and is now no longer able to weight bear to transfer. Transfer boards have not worked and the couple are not wanting to have a care package to support, as his wife wishes to continue to manage herself. Being unable to get to the commode or to sit out of bed is extremely distressing for them both.

Discussed and devised a plan to enable the couple to continue managing without external support but to offer easier and safe access to toileting from the bed which was their priority.

13.45pm: Returned to Hospice to order appropriate equipment for both cases and document visits and outcomes.

Made phone calls to book future visits from referrals received and calls made to two clients on caseload visited last week to see how they are finding the changes that were made.

14.15pm: Finish.