Equipment: Is it the Answer? An Audit of Equipment Provision

Abstract

The provision of equipment and adaptations is a major part of the social services occupational therapist's role and is, therefore, an area that needs investigation to ensure that assessed needs are being met effectively and cost-efficiently. This study was an audit that investigated the longer-term usefulness of equipment and adaptations, provided by social services occupational therapists, in enabling service users to perform daily living tasks. The focus of the audit was whether the service users were still using the equipment and/or adaptations provided, and how useful they were finding them, 18 months to 2 years after provision. This was a retrospective audit of a random sample of 100 service users during a specified time scale, using a telephone survey for data collection. Fifty-seven telephone questionnaires were completed. The clearest finding was that the majority (83%) of the equipment and adaptations issued between 18 months and 2 years previously were still being used at the time of this audit, with 69% being used on a daily basis. This suggested that the equipment and adaptations provided were being used as an integral part of daily life and that they had been prescribed appropriately. It was also interesting to note that the satisfaction with the equipment and adaptations being used independently was higher than the satisfaction with the equipment and adaptations used with help from others. Conclusion The audit found that 83% of the equipment and adaptations were still being used 18 months after provision, which suggests accurate and appropriate prescription by the occupational therapy service. Small low-cost items, such as grab rails, were seen by the service users to be very useful in helping them to perform activities of daily living, frequently on their own. The audit suggests that people rate equipment or an adaptation as more useful if they are able to use it alone. This link between independent use and satisfaction is an area for further study, because it suggests that equipment can be very important to a person's sense of independence and wellbeing in the community. The reasons for non-use of equipment were mainly changes in functional ability or personal circumstances, not poor instruction or fitting. This suggests a more appropriate assessment process or more suitable equipment being issued than in the studies reviewed by Mountain (2000). There was a very high proportion of respondents who would recommend the occupational therapy service to others with similar difficulties; however, most needed prompting to remember that it was occupational therapy staff who had provided the equipment and/or adaptations. Even when prompted, they could remember the staff member but not the name of the service; publicity and clearer information provided to service users at the point of contact may resolve this issue. Recommendations Further study is needed to provide more evidence that the provision of equipment and/or adaptations can be effective in enabling independent living in the community. The expertise of community occupational therapists in enabling people to perform daily living tasks is not widely recognised because there has been little or no research in this specialist field. The process of issuing equipment follows a holistic assessment and a practical step-by-step analysis of the problems identified by users and carers. It continues with training and support to use the equipment, with constant re-evaluation of the whole process. It is interesting to note that although there was a high level of satisfaction with the service provided, there was a lack of clarity over who had provided it. This suggests that more signposting is needed to help service users and the general public to identify occupational therapy as a profession working within social services. Following on from this audit, there will be a review of systems to ensure that service users and carers are competent in using the equipment issued to them and are aware of how to contact the service if reassessment, repair or return of equipment is needed. This will complement the standard equipment review systems and ensure that as much unused equipment as possible is recovered for recycling. More investigation is also needed to find out how service users are using the equipment and adaptations: are they following the instructions and using them safely? There is some anecdotal evidence that whilst a service user may be using a piece of equipment to perform daily living tasks, this might not be in the manner intended by the manufacturer or demonstrated by occupational therapy staff. It would be invaluable to introduce a standardised outcome measure for social services occupational therapy staff to use with all service users. Heaton and Bamford (2001) stated that outcomes are increasingly important in the current policy context, with emphasis on quality, national standards, best value and evidence-based practice. If information could be routinely collected and analysed, it would provide continual statistical data to ensure a strong evidence base to the service. The appraisal of existing outcome measures and their suitability to be used as a tool for community occupational therapy will be a continuing task for the service. A future audit using the same methodology would enable performance to be measured and reviewed again, ensuring that standards are maintained, and would ascertain whether improvements in service provision have been achieved. The results of this and subsequent audits are vital to ensure that the occupational therapy service meets the challenge of using evidence to underpin practice.