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Clinical application of the Patient Environment Occupation (PEO) model to support TILE based M&H risk assessment.

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This article is about how as Occupational Therapists (OTs’) we must not forget what underpins our professional practice, both theoretically and philosophically. It focusses in particular on moving and handling and how I felt a strong need to better show my rationale when working with more challenging cases early in my career and how I use a model in my practice today to continue with that and also guide my practice. I also discuss how being more holistic and using a model to support a risk assessment improves care provision and efficiency in care.

A risk Assessment is required by law (MHOR 1992-as amended) when we have a person that needs to be assisted with their mobility and there is an associated risk. It can be the case that as therapists we can focus too much on the mechanical solutions not and not look at the situation as a whole. This is in part due, I believe to the risk assessment paperwork that we use day to day, which has a TILE based structure.

TILE in an acronym which stands for Task, Individual, Load & Environment and forms the basis for risk assessment templates for most social services, and NHS departments. It guides the assessor in identifying and documenting the risks associated with moving and handling an individual and an associated handling plan to show how the risks have been reduced (MHOR 1992-as amended). Although TILE as a risk assessment template is a great tool, as OTs we must consider the whole, or risk over complicating situations, or missing essential factors that contribute towards an individual’s occupations.

For this reason a model of practice is used, in this case the Person Environment Occupation (PEO) model, to ensure we stick to our professional philosophy of promoting health and well-being through Occupation (WFOT 2011). Law et al (1996) discuss the PEO model as being 3 separate domains that interact with each other. The three domains are The Person, The Environment and their Occupations. The article states that the domains have a trans- active relationship, and that occupations can be adversely or positively affected dependent on the fit between the person and the environment.

These 3 domains are clearly defined and in my experience as a moving and handling practitioner and an OT have helped me to develop an acute understanding of the relationship between a person and their environment; such as a person’s leisure activities, self-care and productivity.

In my OT Show presentation about the topic I discuss how I use a model to help guide my practice, enabling me to use a TILE based risk assessment in a timely and appropriate way. I also show how using a model of practice enabled improved care provision as a consequence of offering guidance to the multi-disciplinary team.

In my case study I show how assessing a single domain, in this case the environment highlighted areas for improvement, which in turn improved efficiency in care, less time spent on handling due to a greater understanding by the team, also care quality. This is due to the relationship between the person and the environment being improved by dealing with the environment. The  presentation also goes on to show how when using a model I was able to evaluate the outcome of my intervention based not only on the person’s improved occupations, but greater confidence shown by the staff in care provision and carer confidence. Subsequently being able to re assess the situation with a TILE based risk assessment to inform care provision on discharge and ultimately enable the person to continue with the occupations that were valuable to them.

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