Clinical Task Instruction SKILL SHARED TASK

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Clinical Task InstructionSKILL SHARED TASKS-AD05: Prescribe, train and review use of toiletseating equipmentScope and objectives of clinical taskThis CTI will enable the health professional to: prescribe appropriate toilet seating equipment to address problems and risks identified in a toiletingassessment e.g. over toilet frame, raised toilet seat, toilet surround and static commode measure and fit the prescribed toilet seating equipmentVERSION CONTROLVersion: 1.0Approved (document custodian): Chief Allied Health Officer, Allied HealthProfessions’ Office of Queensland, Clinical Excellence Division.Date: 15/5/2018Review: 15/5/2021This Clinical Task Instruction (CTI) has been developed by the Allied Health Professions’ Office of Queensland (AHPOQ) using information fromlocally developed clinical procedures, practicing clinicians, and published evidence where available and applicable.This CTI should be used under a skill sharing framework implemented at the work unit level. The framework is available dale-framework.aspSkill sharing can only be implemented in a health service that possesses robust clinical governance processes including an approved anddocumented scope of skill sharing within the service model, work-based training and competency assessment, ongoing supervision andcollaborative practice between skill share-trained practitioners and health professional/s with expertise in the task. A health professional mustcomplete work-based training including a supervised practice period and demonstrate competence prior to providing the task as part of his/herscope of practice. When trained, the skill share-trained health professional is independently responsible for implementing the CTI includingdetermining when to deliver the task, safely and effectively performing task activities, interpreting outcomes and integrating information into thecare plan. Competency in this skill shared task does not alter health professionals’ responsibility to work within their scope of practice at all times,and to collaborate with or refer to other health professionals if the client’s needs extend beyond that scope. Consequently, in a service model skillsharing can augment but not completely replace delivery of the task by profession/s with task expertise.Please check nstructions.asp for the latest version of this CTI. State of Queensland (Queensland Health) 2018This work is licensed under a Creative Commons Attribution Non-Commercial No Derivatives 3.0 Australia licence. This work is licensed under a CreativeCommons Attribution Non-Commercial No Derivatives 3.0 Australia licence. In essence, you are free to copy and communicate the work in its current formfor non-commercial purposes, as long as you attribute Queensland Health and authoring unit listed above, and abide by the licence terms. You may notalter or adapt the work in any way. To view a copy of this licence, visit u/deed.en.For further information contact Allied Health Professions’ Office of Queensland, PO Box 2368, Fortitude Valley BC QLD 4006, emailallied health [email protected], ph 07 3328 9298. For permissions beyond the scope of this licence contact: Intellectual Property Officer,Queensland Health, GPO Box 48, Brisbane Qld 4001, email ip [email protected], phone (07) 3328 9862.DisclaimerQueensland Health has made every effort to ensure that the information in this resource, at the time of distribution, is correct. The information in thisresource will be kept under review and future publications will incorporate any necessary amendments.The information in this resource does not constitute clinical advice and should not be relied upon as such in a clinical situation. The information is providedsolely on the basis that readers will be responsible for making their own assessment of the matters presented herein and readers are advised to verify allrelevant representations, statements and information. Specialist advice in relation to the application of the information presented in this publication must besought as necessary to ensure the application is clinically appropriate.In no event, shall Queensland Health be liable (including negligence) for any claim, action, proceeding, demand, liability, costs, damages, expenses or loss(including without limitation, direct, indirect, punitive, special or consequential) whatsoever brought against it or made upon it or incurred by QueenslandHealth arising out of or in connection with a person’s use of information in this publication

train the client (and carer/s or facility staff) in the use of the prescribed equipment including safetychecks and features, maintenance requirements, limitations and risks associated with use review the use of the prescribed equipment including required adjustments and evaluation of the benefitsand risks associated with its use.Note1: the local health service will determine which toilet seating equipment is included in the scope of thisCTI for an individual health professional trained to implement.Note 2: mobile commode chairs are included in CTI S-AD07: Prescribe, train and review use of showerseating equipment. Should the local service wish to include mobile commodes in the scope for the skillshare-trained health professional, this resource will assist in identifying clinical knowledge requirements andlearning resources. The mobile commode chair should then be listed under ‘other’ in the PerformanceCriteria Checklist of this CTI if not undertaking CTI S-AD07.Note 3: in this CTI the term “equipment” is used throughout the document and includes the related terms“assistive technology”, “therapeutic devices”, “assistive devices”, “adaptive aids”, “tools”, “products” etc.Requisite training, knowledge, skills and experienceTraining Mandatory training requirements relevant to Queensland Health/HHS clinical roles are assumedknowledge for this CTI. If not part of mandatory training requirements, complete patient manual handling techniques includingcompetence in the use of walk belts and assisting clients into standing from sitting. Complete CTI S-AD04: Assess toileting and provide basic/bridging intervention. Competence in or demonstrated professional equivalence in:– CTI S-MT01: Functional walking assessment– CTI S-MT07: Standing transfer assessmentand if the use of mobility aids is within the scope of the local implementation:– CTI S-MT02: Prescribe, train and review of walking aids. If the local service implementation includes performing the task in the community setting additionaltraining may also be required e.g. driver safety, workplace procedures for home visiting, occupationalviolence prevention and management. Additional training should be listed in the Performance CriteriaChecklist or included in orientation checklists and/or workplace instructions.Clinical knowledgeTo deliver this clinical task a health professional is required to possess the following theoretical knowledge: the range of toilet seating equipment available including indications for use, limitations, safety,adjustment features and maintenance requirements implications of equipment set up for continence, balance and safety methods of measurement and fit for each toilet seating equipment item within the service or defined inthe scope of this skill shared task in the local service local hip precaution protocols and client education resources local falls risk screening and mitigation strategies, programs and/or processesClinical Task Instruction-2-

equipment hire, purchase protocols, processes and schemes e.g. the Department of Veterans’ Affairs(DVA), Medical Aids Subsidy Scheme (MASS), workers compensation or local service.The knowledge requirements will be met by the following activities: review of the Learning Resource receive instruction from the lead health professional in the training phase read and discuss the following references/resources with the lead health professional at thecommencement of the training phase:– local falls risk screening and mitigation strategies, programs and/or processes– local equipment hire/purchase protocols, processes and schemes including DVA and MASS– local equipment supplier details and relevant processes including the type of equipment, pricing anddelivery processes.Skills or experienceThe following skills or experience are not specifically identified in the task procedure but support the safeand effective performance of the task or the efficiency of the training process and are: required by a health professional in order to deliver this task:– nil relevant but not mandatory for a health professional to possess in order to deliver this task:– competence in the prescribing, training and reviewing of bathroom grab rails and/or showeringequipment.Indications and limitations for use of skill shared taskThe skill share-trained health professional shall use their independent clinical judgement to determine thesituations in which he/she delivers this clinical task. The following recommended indications and limitationsare provided as a guide to the use of the CTI but the health professional is responsible for applying clinicalreasoning and understanding of the potential risks and benefits of providing the task in each clinicalsituation.Indications The client has participated in an assessment for toileting and problems with sitting on or transferring offthe toilet have been identified i.e. CTI S-AD04.OR The client has a hip precaution restriction i.e. 90 hip flexion/knee below hip in sitting. If a client hashad a hip replacement and has current hip precautions, they may also require access to additionalequipment to assist with other activities of daily living including bathroom seating and long handleddressing aids. Implement local processes to access this equipment in addition to the planned toiletseating equipment.AND The skill share-trained health professional has determined that there is an indication for trialling toiletseating equipment and a suitable option is available to trial as per Table 1: Clinical reasoning guide tochoosing toilet seating equipment in the Learning ResourceClinical Task Instruction-3-

Limitations Limitations listed in CTI S-AD04 apply. Additional limitations include:– The client’s planned toilet environment is not appropriate for toilet seating equipment i.e. currentfixtures including grab rails inhibit the fitting or effective use of the equipment. The skill share-trainedhealth professional should consider a static commode placed in an alternative location such as thelaundry and liaise with a health professional with expertise in the task prior to undertaking theprescription process.– The client requires prescription of bariatric equipment. This may be due to the safe working load ofavailable seating equipment being exceeded or the client’s body shape requiring the dimensions ofbariatric equipment. Additional environmental considerations may need to be included as part of theprescription process e.g. floor safe working load requirements, door widths to fit equipment or homemodifications. The skill share-trained health professional should liaise with a health professional withexpertise in the task prior to undertaking the prescription process.Safety & qualityClientThe skill share-trained health professional shall identify and monitor the following risks and precautions thatare specifically relevant to this clinical task. As toileting requires good dynamic balance, close supervision of the client is required at all times. If theclient needs to void, privacy should be provided without compromising safety e.g. client holds the grabrail during voiding whilst the skill share-trained professional stands outside the door and the client waitsfor supervision prior to attending to perineal hygiene. Skin and seating surfaces should be dry prior to transferring to reduce friction and the risk of pressureinjury. If the client is at risk of pressure injury or skin shearing, include frequent visual inspection duringthe task. Increased risk occurs if the client has frail skin or is malnourished, incontinent or has limitedmobility. If an injury occurs, cease the task and inform the healthcare team of any new wounds. If theclient has an existing pressure area/skin tear ensure the wound is covered with a dressing prior tocommencing the task. If the injury is to be in contact with the seating surface, liaise with the healthcareteam regarding any limitations to sitting duration and monitor the client’s pain. Cease the task if limits areexceeded. Shoes should be worn prior to the client standing up. Shoes should be enclosed, well-fitting and withgood traction. If in the client’s home, conduct the assessment with the client’s usual footwear e.g.slippers, socks or bare feet. This should be noted in the chart entry with any recommendations for safetye.g. replace slippers or provided grip socks.Equipment, aids and appliances Perform an equipment safety check ensuring that the safe working load is suitable for the client, theheight is adjusted to meet any restrictions or functional requirements and the dimensions canaccommodate the client’s body shape without skin shearing. The safe working load for toilet seatingequipment is generally 110-125kg. Clients above this weight range should be considered for bariatricequipment.Clinical Task Instruction-4-

Ensure all equipment is clean and in good working order as per local infection control protocols. Refer tothe manufacturer’s guidelines for specific maintenance requirements e.g. check rubber grips have notperished and rubber stoppers are in place and have tread. As the client may require assistance to complete the task, it is advisable to either wear gloves or havethem readily available.Environment As this task includes observation of the client trialling toi