Self-service Training slides Part 1 of 2 Overview Structure of - - PowerPoint PPT Presentation

SLIDE 1

Self-service Training slides Part 1 of 2

SLIDE 2

 Overview  Structure of tool/scoring system  Scoring guidelines  Completion of NPTDA  Computer outputs  Publications

SLIDE 3

 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

SLIDE 4

 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

SLIDE 5

 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

None No intervention 1 Low Minimal intervention 2 Medium Standard intervention 3 High Intensive intervention 3.5 Interdisciplinary Interdisciplinary intervention 4 Complex Very high intensity by ≥1 disciplines

SLIDE 6

Score

• re

Level el Descr escripti tion

• n

None No inte terv rvent ntion

• n
• Intervention not relevant or
• No planned therapy at the current time

1 Low Mini nimal mal interv tervent ention

• n 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

• n 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
• r
• Standard intervention by a single therapist or
• r
• More frequent intervention, but by an assistant only

3 High Inten tensi sive inte terv rvent ntion

• n 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
• r
• Combined input from therapist and assistant (some sessions)or
• r
• Two qualified therapists for 1-2 sessions

3.5 ID Occa ccasional ional inte ter-disc scipli lina nary (ID) inte terv rvent ntion

• n (normally ≤4hours)
• One-off or occasional inter-disciplinary session/intervention

4 Complex Comple lex x inte terv rvent ntion

• n requiring regul

gular r ID inte terv rvent ntion

• n 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

• r
• Combined input from therapist and assistant (all sessions)or
• r
• Two qualified therapists from the same discipline for ≥3 sessions or
• r
• Very intensive intervention from a single therapist

SLIDE 7

 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

SLIDE 8

 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

• verall 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

SLIDE 9

 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
• ccurs 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
• r less, score 2 if more than 1 hour (there is no score of 3, 3.5 or 4 for

this items)

SLIDE 10

 Assessment can be completed at a team meeting

• r

 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

SLIDE 11

 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)

SLIDE 12

 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.

SLIDE 13

 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)

SLIDE 14

 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

SLIDE 15

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

SLIDE 16

 Generally nurses are only included if they were actively involved

in the therapy session e.g. involved in the assessment or planning process such as devising patient specific behavioural management plan.

Handover from therapy team to nurses is not included. If the intervention is part of normal nursing activities these are captured in the nursing dependency tool

 In contrast, the medical team may be involved in any of the items

within the tool and should be included

 Both nursing and medical time will need to be recorded in the

MDT/report section

 Nursing time will need to be reported in the clinic attendance

time

SLIDE 17

 Therapy Assistants

• Included as part of the overall score – see therapy level

descriptions

 Students

• Students are not included as they are in a learning role.

SLIDE 18

 Once all items have been scored on the tool the data

should be entered in to the UK ROC (United Kingdom Rehabilitation Outcome Collaborative) computer software

 During data entry changes to the “lead discipline”

should be made as appropriate to ensure therapy time is allocated to correct discipline

 Groups/clinics will need to be entered as appropriate

with number of patients, weekly time (not fortnightly) and number of staff by each discipline present

SLIDE 19



Computerise outputs can be printed or copied/pasted into other documents as appropriate



A datasheet within the software contains all the information for all assessments and has breakdown of therapy intervention by discipline and by therapy domain

Lead Score P/T O/T SLT Psych S/W Doc Diet Nurse Music Orth Play R/Eng Other Asst Vol Subtotal Doc

3 4.50 4.50

O/T

0.00 0.00

P/T

0.00 0.00

O/T

3.5 1.00 1.50 2.50

P/T

3.5 1.50 1.50 3.00 10 2.50 3.00 0.00 0.00 0.00 4.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00

Lead Score P/T O/T SLT Psych S/W Doc Diet Nurse Music Orth Play R/Eng Other Asst Vol Subtotal P/T

3.5 1.00 0.50 1.50

SLT

0.00 0.00

Diet

1 0.25 0.25

SLT

1 0.50 0.50

SLT

2 1.00 1.00 7.5 1.00 0.00 2.00 0.00 0.00 0.00 0.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.25

Lead Score P/T O/T SLT Psych S/W Doc Diet Nurse Music Orth Play R/Eng Other Asst Vol Subtotal O/T

0.00 0.00

O/T

0.00 0.00

O/T

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Lead Score P/T O/T SLT Psych S/W Doc Diet Nurse Music Orth Play R/Eng Other Asst Vol Subtotal Psych

0.00 0.00

Psych

0.00 0.00

Psych

0.00 0.00

Psych

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Lead Score P/T O/T SLT Psych S/W Doc Diet Nurse Music Orth Play R/Eng Other Asst Vol Subtotal S/W

0.00 0.00

S/W

0.00 0.00

O/T

0.00 0.00

O/T

0.00 0.00

O/T

1 0.50 0.50 1 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50

Score P/T O/T SLT Psych S/W Doc Diet Nurse Music Orth Play R/Eng Other Asst Vol Subtotal

0.00 0.00 0.00 2 1.00 0.50 0.50 0.50 2.50 2 1.00 0.00 0.50 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.00 2.50 20.5 4.50 3.50 2.50 0.00 0.00 5.00 0.25 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.00 16.25 4.50 3.50 2.50 0.00 0.00 5.00 0.25 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.00 16.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.25 16.25 12.75

• 25. Groups/extra therapies
• 26. Clinic attendance

Subtotals Total NPTDA Score Total direct hours (excluding groups) Total direct hours including groups Total indirect hours Total direct and indirect hours excluding groups Total direct and indirect hours including groups Total therapy hours (- medic + 1 hour)

• 23. Multi-disciplinary meetings
• 24. Reports

Subtotals

• E. Preparing for discharge
• 18. Planning discharge/housing/care package
• 19. Benefits and finances
• 20. Equipment/adaptation for home
• 21. Community/home visits

Subtotals

• C. Activities of daily living
• 10. Personal/self-care
• 11. Domestic/community based activities
• 12. Vocational/leisure/computers/driving

Subtotals

• 22. Key-working

Subtotals

• F. Additional activities
• 1. Medical management
• 2a. Splinting/orthotics (inc FES) Upper limb
• 2b. Splinting/orthotics (inc FES) Lower limb
• 3. Seating/wheelchair
• 4. Physical therapy: active/passive handling

Subtotals

• B. Basic Functions
• D. Cognitive/Psychosocial/family support
• 13. Cognitive interventions
• 14. Behavioural management
• 15. Emotional/Mood
• 16. Formal family support
• 17. Emotional load on staff
• 8. Supported communication
• A. Physical/handling programme
• 5. Respiratory/Tracheostomy management
• 6. Swallowing
• 7. Nutrition
• 9. Speech and language interventions

 Once all the data has

been entered the total score and total therapy hours are calculated by the in- built algorithms.

SLIDE 20

 To obtain

• a copy of the UK ROC software
• the NPTDA tool (please state if you require the physical or cognitive version)
• further answers to specific questions about the NPTDA,

 Please email

 LNWH-tr.ukroc@nhs.net



Lynne Turner-Stokes, Asa Shaw, Janet Law and Hilary Rose, Development and initial validation

• f the Northwick Park Therapy Dependency, Clinical Rehabilitation 2009; 23: 922–937



Alexandrescu, R; Siegert, R; Turner-Stokes, L, The Northwick Park Therapy Dependency Assessment Scale: A Psychometric Analysis From a Large Multicentre Neurorehabilitation Dataset, Disability And Rehabilitation. Vol. 37, Issue. 21, 2015

SLIDE 21

 Congratulations you have now completed Part 1

self-service training slides

 This has provided detailed information on the

background to the tool and the scoring method/rules of the tool

 Please progress to Part 2 for detailed information

• n completing each item and “test yourself

scenarios”