Prioritising so that safety is put first

Whilst on my RITH placement I initially found it hard to get used to the different environment set up (the massive increase in safety risks and things that could go wrong), the lack of senior/specialised people to solve the problems for you and the fact that no matter how easy the referral looked, the patient would always have more than that one simple problem.

Eventually I got used to going to peoples homes, I improvised by using a couch or bed and learnt to kneel down or get onto their bed nice and close, NOT try lean over and politely avoid going on their bed (most clients didn’t care if you asked first). I used paths around houses to get the patient to do their walking and ganged up with daughters, sons and spouses to get the patient doing the exercises and taking the precautions. Basically I learnt to do it with just another physio student and our two inventive brains. But for some reason I wasn’t planning my sessions perfectly enough for my supervisor, I would try treat their problem as a physio, for example if they had gone into hospital for a fall I would be positively itching to test muscle strength and balance and ROM…. But my supervisor kept pushing that as a RITH physio you have to go safety in the home/functional first and in subjective, you have to ask OT and social worker related questions which I had no experience with before. It took me quite a while to get this right where I wouldn’t panic inwardly and waste time if the person had dizziness problems or multiple falls or COPD (I had just come from a COPD community placement) that wasn’t on their transfer list and feel the need to fix those problems on the initial visit.

I finally got a set up in my mind where you check their function and safety around the house (walk around with them and watch them get in and out of the shower and on and off their toilet, bed and chairs) no matter how silly it feels asking them to do it. Then you go all gun ho with physio treatment/assessment with the time left and on that first session decide how you are going to discharge.

I now have firmly implanted in my head, when you have a set schedule and traffic to deal with, how to prioritise right after your subjective, on the spot. It doesn’t matter if you take a few minutes to do it and there’s that awkward silence while you write something down and sort everything out in your head. The only thing that matters is that you leave knowing that person is safe and now has a lower risk of readmitting into hospital because of your visit.