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  • North Bristol NHS

    NHS Trust

    North Bristol NHS Trust

    Orthotic Services

    Good Practice Guidance

    North Bristol NHS Trust

    Royal United Hospital NHS Trust

    Mendip Primary Care Trust

    Bath & North East Somerset Primary Care Trust

    South Gloucestershire Primary Care Trust

    Bristol North Primary Care Trust

    North Somerset Primary Care Trust

    Version 1.2 : August 2004

  • Version 1.2 August 2004

    Contents

    Section A

    Statement Orthotic Service Standards Fitting and footwear Developments Activity Communication Appointment times

    Section B

    Record keeping Essential information Legal implications Referral for assessment and advice Information required Multi-disciplinary clinics record Access legal implications Ownership Patient held record Computer held records

    Section C

    The Patient

    Section D

    Orthotist Clinician guidelines Individualised approach Informed consent Assessment Transfer of core Communication with patients and carers Patient and Clinician safety Equipment safety

    Section E

    Patient core information

    Page 1

  • Version 1.2 August 2004

    Section A

    Statement The following guidelines represent the aims of the service and will require the help and support of the service providers clinicians, referrers and product suppliers if they are to be achieved. They are intended to reflect good practice to ensure that the practitioners involved with delivering orthotic care within the North Bristol Orthotics Service achieve and maintain the highest standards of professionalism and effectiveness in patient care whilst achieving best value for money

    Orthotic Service Standards The National Agreement for the Provision of Orthoses and the supporting agreements, provide national standards for maximum delivery times for the provision of orthoses, however the service has established the following minimum standards for other core product ranges.

    Response Time and Standards In order to ensure a timely response for product supply it is vital that orders are placed as soon as possible after assessment. This will be monitored on an ongoing basis and will form part of the routine management reports. The response time is considered to be from the time of assessment to the time of satisfactory supply to the patient.

    Orthoses Critical. Discharge dependent

    Clinically dependent. High Risk

    Routine Number

    of fittings

    Standard Orthoses AFOs KAFOs Spinal Fabrics & Metalwork

    2 working days 5 working days 15 working days (initially subject to review)

    1 measure, 1 fit/supply

    Bespoke Footwear inc stock with adaptations

    15 working days 25 working days

    1 measure, 1 fit 1 supply

    Stock Footwear 2 (5) working days 5 working days 10 working days

    1 measure 1 fit/supply

    Targets for routine referrals will be monitored and reviewed in 12 months.

    It is expected that these standards will be achieved 98% of the time for critical and clinically dependent requirements and 90% of the time for routine issues. Frequent management information reports will be required to ensure this benchmark target is met.

    Where the expected delivery date is not acceptable, the Orthotist must inform the Orthotics Manager.

    Page 2

  • Version 1.2 August 2004

    For some Critical Discharge Dependant patients temporary arrangements would be acceptable.

    Fitting of footwear It is expected that 75% of patients receiving stock footwear be fitted successfully with 1 fitting and 1 initial assessment (i.e. two appointments) and 60% of patients to be fitted with bespoke footwear within 2 fittings plus initial assessment. This will be reviewed in 12 months

    In the exceptional circumstances where the quality of an orthosis is not acceptable to the Orthotist or the patient within 2 fittings, the Orthotist must bring this to the attention of the Orthotics Manager.

    Individual patients who present with complex conditions or multifaceted problems that may take some time to resolve should be discussed with clinical team members and specific proposal for action to be agreed with the patient/team prior to commencing work on the orthoses. This should be indicated on the referral sheet (Orthotists comment).

    Developments In partnership with Trusts for whom orthotic services are provided, the orthotic team will look to promote a number of developments. These will be agreed with all parties and may be added to this Guide as they evolve.

    1. Development of outcome measurement and quality reviews

    Activity Most of the patients are seen as outpatients, usually by appointment.

    In addition, there is demand from consultant outpatient clinics, referrals from wards, frequently to facilitate discharge. Domiciliary visits may, from time to time, be required but will be infrequent and determined on a case by case basis.

    Page 3

  • Version 1.2 August 2004

    Communication The Orthotics personnel that are employed by the service meet regularly as a team as agreed. All Orthotists and a relevant Manager, if appropriate, as well as representatives from the relevant clinical areas are invited to regular meetings (Trust specific) in order to promote professional practice and discuss issues pertinent to the group. This forum assists with the on-going development of the service.

    Appointment Times Each service will have its own appointment booking system, however members aim to provide the following appointment times in order to provide adequate time for patient assessment and clinical record keeping.

    Standard Appointment: CastingAssessment Multi Disciplinary Team Clinics

    20minutes 40 minutes

    20minutes 40minutes

    Orthotic Time Slot Allocations. Proposal for new 20 / 40 minute appointment slot system. (number of 20 minute slots).

    DEVICE CASTING AND NEW REFERRALS FITTINGS SUPPLY REVIEWS ALL INSOLES 1 1 1 1 FFOs 2 1 1 1 ALL AFOs 2 1 1 2* BILATERAL AFOs 2 2 1 2 KAFOS 3 2 2 2 FOOTWEAR 2 1 1 1 RAISES 1 1 1 1 CORSETS 1 1 1 1 TRUSSES 1 1 1 1 HOSIERY 1 1 1 1 SPINAL JACKETS 4 3 3 3 STOCK SPINAL 1 1 1 1 CERVICAL COLLARS 1 1 1 1 KNEE BRACES 1 1 1 1 HIP BRACES 2 1 1 1 ANKLE BRACES 1 1 1 1 * IF CASTING IS ANTICIPATED

    Page 4

  • Version 1.2 August 2004

    Section B

    Record Keeping

    Record keeping is an integral part of orthotic practice, which should aid the rehabilitation and care process. Protocols on Clinical Records are attached in the Appendix at the end of this guide.

    DNAs & FTAs The Trusts will work with Orthotic contractor towards establishing protocols designed to minimise the incidence of missed appointments, in line with Trust-wide practice for other out-patient services.

    Multi-disciplinary Clinics records When a patient is to be seen by the Orthotist and at least one other Clinician the content of the clinical record will be jointly decided and agreement will be made as to where the notes should be kept. The appropriate Clinicians will scribe and all Clinicians will sign the record.

    Because clinics are held usually to allow multi-disciplinary consideration of complex difficult cases a 45-minute appointment length may be allowed.

    Access Legal Implications The Access to Health Records Act 1990 gives patients the right of access to manual health records written about them since 1 November 1991. The Data Protection Act 1998, which conforms to the European Data Protection Directive 95/46/EC, also gives access to their computer held records. The system for dealing with applications for access is explained in the Guide to the Access to Health Records Act 1990.

    Ownership The NHS owns patient records, however practitioners (including service providers) have a duty to protect the confidentiality of those records. (Reference to Data Protection Act 1998, and Caldicott)

    Patient- Held Records Patients and parents frequently hold their own health care records.

    Computer Held Records Computer held records are easier to read, require less clerical input, and reduce the need for duplication and can improve inter-professional communications.

    Page 5

  • Version 1.2 August 2004

    Section C

    The Patient

    These guidelines have been taken from EmPowers user charter and the service members, where possible will strive to achieve these recommendations.

    Respect for the patient as an individual is central to all aspects of the treatment of care and should be demonstrated at all times.

    There should be regular opportunities for users to consult with staff and commissioners. Users should be given information about the equipment available and developments to their local services.

    As recommended by emPOWER consideration should be given to 5Cs when prescribing orthoses:

    EmPOWER Empower believes that people who use disability equipment have a number of rights. This documents pulls together those rights, published previously in emPOWERs Prostheses & Orthoses and Wheelchair Charters and emPOWERs Millennium Agenda for Independence. Users also, of course, have responsibilities.

    Rights include: User Involvement There should be regular opportunities for users to consult with staff and commissioners, ideally through a user consultative committee.

    Information Users should have a right to information about the equipment available and about developments in their local Trust and Primary Care Trust. If appropriate users should be able to test whether a piece of equipment would meet their needs.

    Choice The user should have a freedom of choice with regards to the type and style of equipment.1

    This freedom of choice should encompa

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