Self-service Training slides Part 1 of 2
Overview Structure of tool/scoring system Scoring guidelines Completion of NPTDA Computer outputs Publications
2 adult versions – physical & cognitive Designed for use in specialist neuro-rehabilitation settings Relevant to high intensity rehabilitation NPTDA is measure of therapy intervention (not activity analysis) Reflects therapy intervention for individual patients UK ROC software required for conversion to therapy time Part of the parallel dataset for Level 1 & 2 services
6 domains A. physical/handling programme B. Basic functions C. Activities of daily living D. Cognitive/psychosocial/family support E. Preparing for discharge F. Additional activities Groups/clinics Tick box items (dichotomous variables) for 6 areas Special facilities Medical investigation Medical procedures Specialist equipment hire Basic special equipment Highly specialist equipment
27 ordinal items 23 items scored between 0-4 4 items scored between 0-2 Each item allocated a “lead discipline” Therapy time assigned to lead discipline Lead discipline can be changed Total ordinal score 0-100 6 tick box items – no scores assigned Scores for each item 0 None No intervention 1 Low Minimal intervention 2 Medium Standard intervention 3 High Intensive intervention 3.5 Interdisciplinary Interdisciplinary intervention Very high intensity by ≥1 disciplines 4 Complex
Score ore Level el Descr escripti tion on 0 None No inte terv rvent ntion on Intervention not relevant or • No planned therapy at the current time • 1 Low Mini nimal mal interv tervent ention on or Revie iew w only ly (<1 hour per week) e.g. Single short intervention or • Brief checks only • 2 Medium Stand ndard rd inte terv rvent ntion on requiring sin ingl gle e thera erapis ist t or assi sista tant nt only ly e.g. Detailed assessment possibly in several sessions or or • Standard intervention by a single therapist or or • More frequent intervention, but by an assistant only • 3 High Inten tensi sive inte terv rvent ntion on requiring additi tiona nal time me or extra ra pair ir of skil illed ed hand nds s e.g. Increased frequency or duration of session from a skilled therapist or or • Combined input from therapist and assistant (some sessions) or or • Two qualified therapists for 1-2 sessions • 3.5 ID Occa ccasional ional inte ter-disc scipli lina nary (ID) inte terv rvent ntion on (normally ≤4hours) One-off or occasional inter-disciplinary session/intervention • 4 Complex Comple lex x inte terv rvent ntion on requiring regul gular r ID inte terv rvent ntion on or at very ry high gh inte tens nsity ty (total >4 hours/week) e.g. Two or more disciplines working in close co-ordination i.e usually together in • the same session or in very close collaboration with regularly debriefing/ discussion or or Combined input from therapist and assistant (all sessions) or or • Two qualified therapists from the same discipline for ≥3 sessions or or • Very intensive intervention from a single therapist •
Complete tool retrospectively based on previous fortnightly intervention – based on what they got All items must be scored Lead discipline can be changed as necessary (cross out current lead discipline and enter correct discipline) Most items will be scored from 0-3 Time spent does not need recording as automated in computer software Interdisciplinary items score 3.5 Time spent by each discipline needs to be entered (average therapy time spent during fortnight) Multi-disciplinary or complex intervention may score 4 Time spent needs recording (average time spent during fortnight - items 1-20 & 23) Item 21 community/home visits records total hours and not average
The NPTDA is completed fortnightly to reduce therapy burden in completion It is acknowledged that therapy intervention can vary from week to week therefore scores are based on the overall intervention of the fortnight Where inter-disciplinary or very complex (excessive time) intervention occurs requiring scores of 3.5 or 4 the time spent is averaged. For example : An SLT spent 2 hours on week 1 and 3 hours on week 2 with tracheostomy management (total 5 hours – average = 2.5) whilst the physio spent 4 hours on both weeks (total 8 hours, average 4 hours). SLT documents 2.5 hours and Physio 4 hours giving a combined total of 6.5 hours so allocates a score of 4
Rules for scoring NPTDA differ in certain areas of the tool. Most are scored from 0-3 based on level of therapy intervention and time does not need to be considered. Interdisciplinary intervention scores 3.5 or 4 depending on time in therapy Complex intervention scores 4 if excessive hours required. Differences to these rules includes: Item 21 – insert total hours for community visit not average (normally only occurs during 1 week – software will compute average time) Item 23 & 24 – insert total hours for meetings and reports. Score 1 if total hours are 1 or less. Score 2 if greater than 1 hour (there is no score of 3, 3.5 or 4 for these items) (software will compute average time) Item 25 – score 1 if attends 1 group, score 2 if attends 2+ groups (there is no score of 3, 3.5 or 4 for this item) Item 26 – describe clinic, time, number of disciplines. Score 1 if 1 hour or less, score 2 if more than 1 hour (there is no score of 3, 3.5 or 4 for this items)
Assessment can be completed at a team meeting or the paper score sheet can be stored in one location that individual disciplines can access and enter scores for the items their discipline “leads” on Enter time for items their discipline was involved in but does not lead on Direct face-to-face contact needs to be included along with patient related preparation. For example: The Speech Therapist spends1 hour one week preparing a communication booklet for patient A (patient related but not face-to-face) and then has a 4 x half hour sessions (=2hours) with patient A the following week to explain/practice using it (face-to-face session). Both these interventions need to be included when scoring Speech and language therapy. Score 2 – Medium Intervention
Therapy intervention may span several items on the tool – do not double count – score based on the main purpose of the intervention For example : The Occupational Therapist has a 1 hour session each week with patient A to practice washing & dressing. During the sessions the OT needs to use the communication & behavioural strategies suggested by SLT and psychology and the mode of mobility identified by physio for getting to the washroom. Score 2: Washing and dressing only – Medium intervention (Do not include the mobility, communication or behavioural strategies)
All items (except Medical management) may be completed by more than 1 discipline during the fortnightly reporting period. Each discipline involved needs to enter the average time spent during the fortnightly reporting period. Once all disciplines involved have entered their time then the overall score can be entered. The score will be either 3.5 or 4 depending on the total therapy time. For most items therapy time of 4 hours or less will be a score of 3.5 and more than 4 hours a score of 4. There are anomalies to this rule - these are explained in the next 2 slides.
Scores of 3.5 2 or more therapy disciplines must have provided therapy input for the item during the fortnightly reporting period This can be at a joint therapy session or Non-joint session but active therapy intervention for a specific item by more than 1 discipline during the same fortnightly reporting period Total therapy time is 4 hours or less (see next slide for anomalies to this rule) Scores of 4 Can be interdisciplinary or complex intervention for 1 discipline Total therapy time is greater than 4 hours (see next slide for anomalies to this rule)
For most items a score of 4 is allocated if the average fortnightly therapy hours exceeds 4 hours. However, there are some anomalies to the rule as follows: Score 4 if average hours exceed 5: Item 1 – Medical intervention Item 4 – Physical therapy Score 4 if average hours exceed 2: Item 7 – Dietetic hours Score 4 if total (not average) hours exceed 6: Item 21 – Community home visit If hours do not equate with a score of 4 then for inter- disciplinary items score 3.5 and for uni-disciplinary items score 0-3 depending on therapy level
Meetings Only additional patient specific meetings are included in this section (not routine weekly meetings e.g ward rounds/clinical reasoning, where more than one patient is discussed – this is already added within the computer algorithm per patient per assessment) Initial MDT assessment meeting Case conference Family meetings Discharge planning Reports Only patient specific reports are included in this section (not routine notes following a therapy session) Functional Reports Home Visit Reports Continuing health care District Nurse referral Discharge report Transfer letter Medico-legal report
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