Referral form and criteria to Specialist Occupational Therapy

REFERRAL CRITERIA FOR SPECIALIST PALLIATIVE CARE O.T.
Telephone queries are welcome to discuss possible referrals
1) Patient must have life threatening or life limiting disease and who require specialist support for
complex physical and psychological needs that cannot be met by existing OT service alone.
2) Patient must have a GP in the Selby and York locality of the North Yorks and York Primary
Care Trust
3) Patient requires input from specialist Palliative Care OT (needs are not able to be met by other
OT services)
Referrals are only accepted from Health and Social care professionals on a written referral form
Examples of possible intervention which specialist OT could offer:
• A functional rehabilitation programme to enable patients deal with the complex difficulties
associated with their condition (e.g. fatigue, anxiety, breathlessness, pain, balance or memory
problems)
• Assistance to participate in activities related to study or work, including advice regarding return
to work
• Lifestyle management advice to cope with fatigue or altered level of independence
• Advice regarding coping strategies for dealing with cognitive dysfunction
• Facilitating psychological adjustment to loss of function
• Support and education to carers resulting from patients changing level of functional and/or
cognitive ability
• Assessment for and prescription of standard self propelling wheelchair
Exclusion criteria
Patients requiring general OT assessment of functional performance and intervention as required
In these circumstances referral should be directed to existing OT services:-
• For patients in hospital contact the OT team linked to the consultant the patient is under
• For outpatients either
o Local Authority OT service (phone council the patient pays their council tax to) or
o OT service linked to Virtual Wards
• North / East – tel (72)1122 )
• South / West / Central – tel (72)4625)
• Selby – tel 01904 (72)4276 )
Please use existing
Community Outreach referral
form and contact locality team
for forms and fax numbers
Owners: Carole White – Clinical Specialist Palliative Care OT Tel 01904 (72) 4476
Brian Teskey-King OT Team Leader and Specialist Palliative Care OT, Selby Locality
Dated Sept 2010
These criteria will be regularly reviewed and revised as appropriate in the light of experience
C:\Documents and Settings\paul.twigg\Desktop\PDF\Policies\Referral to OT form criteria for specialist OT flow chart 09 10.doc