T5 - "final" version from emma - please add comments for any amendments!!!

Therapeutic Skills Exam Card 5
Moving and handling of abdominal surgery patient 1 day post-op, leg exercises and analysis of moving and handling principles.

1st Part
Patient is in supine lying on the plinth. The task is to move the patient up the bed and into a supported sitting position.
Prep stage
Wash hands. Make sure there is no jewellery on handlers or the patient and also that clothing is appropriate for all. Raise bed to appropriate height so that you can communicate with the patient on the same level. Introduce yourself and the assistant to the patient. Explain that you are going to move them up the bed and into a supported sitting position using a sliding sheet to help them breathe and improve their respiratory function, circulation and spinal alingment. ASK FOR CONSENT - clearly: Is this ok with you?? Over time the patient should be able to do this by themselves. Check with the patient if the stitches are ok and pain in the stomach is not too bad. Give patient a towel to support the wound. Paper towels (blue roll) need to be placed on both sides of the patient for infection control. Patient should bend their knees up a little to take the tension off their stomach muscles.

Lie to sit
Ask the patient to pop their chin on to their chest and when they do this slide the medesign under their shoulders.
Lower the bed to knee height, place your leg at right angle on bed (on the paper towel). Explain that you are going to assist the patient to sit up. Grab medesign from the handhold grasp.
Patients hands on their stomach (on the towel), breathe in and ready, steady, sit.

***from this phase onwards until patient sits supported, BE AWARE POSTURE: NO TWISTING&BENDING!! also both youre own and the assistants***

Assistant supports patient from one side using knee (behind patients pelvis) and 2 hands and leans patient towards them (to the side). Physio slides phili slide underneath bottom from the other side (roll downwards and so that handhold grasps are on same line as patients bottom). Then Physio supports patient as before (swap positions) and assistant slides the phili slide under the other buttock.
Put another slide under feet, lift one leg at a time and dont lift too high.
Both handlers on either side of patient, knee on the bed next to patients hip grab the handhold grasp with the arm that is in closes to patient and have your elbow behind their back a little for support. Ready, steady, slide up the bed *controlled!*
Assistant supports patient while physio lifts the plinth head up and arranges the pillows in upside down V-shape.
Rest patient against the head of bed. Remove the slide from under feet while assistant stabilises from the pelvis.
Then pull the slide from under the bottom diagonally. Assistant remains on the pelvis
Adjust bed to normal height.
Ask patient if procedure was comfortable. Leave the sheets near the bed for nurses.


2nd Part
Patient sitting on the bed same height as you. Explain that you are going to teach them a simple regime of leg exercises to reduce the risk of post-op complications and to increase circulation which can be reduced due to sitting and lying down for long periods of time (dont go into horrific details about deep vein thrombosis etc, mentioning circulation will do). The exercises should be repeated hourly apart from the ankle plantar/dorsi one which should be done every 15 mins.. Legs should be kept uncrossed at all times. ASK FOR CONSENT TO TOUCH THEIR FEET. When teaching movements remember to communicate to patient and ask if is comfy, if theres pain, ask how it feels etc to keep the convo going.

Wriggle toes
Plantar and dorsiflex ankles (repeat 10 times 1st, build up to 20)
Rotate ankles (repeat 10 times 1st, build up to 20)
Inversion and eversion (repeat 10 times 1st, build up to 20)
Flex knees and hips (i.e. bend knees) as far as is comfortable, use phili slide under feet 1st to reduce friction and movement easier (repeat 5 times)
Push the back of the knee down against the bed (repeat 5 times 1st, build up to 10)
Tense glutes to relieve pressure exerted on the buttocks (repeat 5 times 1st, build up to 10)

3rd Part
Analyse and articulate to the examiner the moving and handling principles that were used in the procedure. Use your models.
Prep stage:
Risk assessment
Tell the examiner you have undertaken risk assessment and considered what the task was (...”The task is to move the patient up the bed and into a supported sitting position”...)
You broke it down into stages
1. Sitting patient up
2. Handling equipment (phili slide, handling sling)
3. Position of patient and handlers
4. The movement up the bed
You also considered the following:
-assistance available (you have 1 assistant and patient can do a little to help)
-made sure everyone involved was appropriately dressed (observed)
-was aware of the pain the patient is likely to be experiencing (by asking them about the stitches and the wound and giving them a towel)
-considered drip and drain attachments and cleared area around the bed (observed)
-also patient might be reluctant to move due to pain but as a part of your risk assessment you have come to the conclusion that due to your duty of care it will be of greater advantage to the patient’s ventilation cycle to sit them up rather than let them remain in slumped position.
-communication – bed height was appropriate for communication (”on the same level”) and physio didnt twist their body when turning to speak to patient but turned around fully to be face to face. Patient was reassured and explaineded all the different phases of the procedure.

Lie to Sit:
-Reduced interabdominal pressure by flexing knees
-Used paper towel for infection control purposes
-Medesign allowed patients weight to be distributed equally between 2 handlers rather than wrenching from arm(s) etc -> no draglift!!!
-Phili slide allowed load to be distributed between two handlers

-Friction was used
* To reduce unwanted movement:
-Rougher side of phili slide against patient for extra friction
-Friction between patient and bed stops them from sliding down
* To make movement easier
-Philislide was used to increase friction and move patient horizontally rather than vertically (slide rather than lift)

-Therapist lifted knee on bed for:
-wider BOS
-knee placed near the patient’s hip for greater stability
-line of gravity in the middle
-symmetrical posture

-Stayed close to patient (load)
-Whole procedure carried out in the same plane – Critical: avoid twisting!
-When medesign used Physios had to reach out of their BOS and so centre of mass changed and was stabilised by holding on the handling sling. Handlers bring load (patient) towards them and have the load at the end of the lever (use the whole trunk and sit back on your leg rather than stay standing up and pull with your arm) – this is the riskiest part so need to communicate clearly and work together
-Patient has a very wide BOS at the start: their body supine lying on the plinth&plinth on the floor
-When patient is sitting up the BOS is smaller and therefore has to be supported by Physios
-When patient being supported by physios they should have their knees behind patients pelvis for added stability and to maintain line of gravity within BOS and symmetrical posture
-When bed head put up, need to stop the patient from sliding down the bed by stabilising the pelvis.