Practical Guides # 2: Taking the heat out of kitchen assessments

Hello readers
I’m sitting here trying to justify not going the gym, when really it’s because it’s cold outside and I don’t really feel like it. So I thought I would write a blog post to alleviate the guilt, because at least I’m doing something productive. This time, I would do another practical guide to another OT basic that you’ll probably be asked to do on placement; this time it’s kitchen assessments. Again, this is a very basic guide; I think it’s useful to start simple: you wouldn’t teach someone to be a racing car driver if they’ve not yet learned to drive!

Practical guides word of warning:

As with the post about toilet equipment, This is intended a rough guide only and should only be used in conjunction with a qualified OT. If you are not an OT or competent Therapy Assistant do not use unless you are supervised by a qualified person.

Also all patients should be assessed with the equipment before issueing (don’t just dish it out, it may not be suitable).

If you’re not an OT or aspiring OT and you’re reading this I would always advise getting professional assistance when purchasing any equipment. I’ve known people pay privately for aids that then haven’t been suitable. Expensive mistakes have been made, people have used things incorrectly and can put people at risk.  Don’t do it. OT’s take lots of things into account to make that piece of equipment work for the person in question, adjust it to the correct height and educate people on it’s proper use.  You may have a local independent living centre that can assist with this if you do want to purchase things privately. I know a good few in my area that advise members of the public on equipment. This guide is intended for OT students and is not a replacement for seeking professional advice. It is not intended to help you purchase privately equipment and you could risk the safety of the person you are purchasing it for. Again, you’ve been told. If you’ve got something from an OT and you’re wondering why you’ve not been issued a different piece of equipment that’s been discussed here, there will be a reason for this (often based size and health conditions of the person and taken into consideration the environment they live in.).

Please be mindful that I am a recently qualified OT so I am still learning too. These are meant to be basic guides, not exhaustive and I try to keep things simple. Always refer to your educator or supervisor in the first case.

Purpose
A kitchen assessment is a functional assessment, like washing and dressing and shopping assessments. Quite simply you’re working out (assessing) whether they can do it (function). A kitchen assessment may be used to predict whether the person should be independent and safe in meal preparation once discharged home (Laver-Fawcett, 2007). OT’s also use kitchen assessments to assess people’s cognitive skills such as; initiation (starting something), sequencing (doing things in the correct order), planning, and awareness of safety.

Quite often you’ll make tea and toast with the patient; kitchen assessments can be very time consuming and often take about an hour, so anything more complicated uses more of your limited time. Anyway just something as simple as tea and toast, you can extrapolate to other meals,  such as mobility around the kitchen, standing balance, range of movement (reaching into cupboards), operating kitchen equipment, hand function (e.g. using cutlery), exercise tolerance and fatigue. On occasions I have done different meals with people, for example I saw a lady with limited hand function in her dominant hand. At home all she made was ready meals. I wanted to specifically see whether she could operate the microwave, peel off the protective film on the ready meal and eat it one handed.

The set up
Set up the kitchen how you want it. Take the water out of the kettle and leave the kettle unplugged on the worktop. Check you’ve got the food you need and the equipment. I put a perching stool near the worktop in case people want a seat during the assessment. Leave a kitchen trolley in the room so it’s on hand if needed. Leave everything needed in the cupboards, drawers, fridge and bread bin. Don’t try and be helpful by getting everything out on the worktop (unless someone does this for them at home).
On the ward
The day before give the patient some notice so they can mentally prepare. Do they want to make tea, coffee, or something else? Is making toast OK? What kind of kettle do they have? Do they use a teapot or pour the water straight into a cup? This is so you can simulate their environment at home and have the correct ingredients needed. I’ve been caught out by people who still use loose-leaf tea!

On the day, tell the nursing staff that you’re taking the patient, in case they are trying to find them later on and they think that they’ve made a run for it. If they walk with an aid, make sure you take it to the kitchen with you. If they normally use a kitchen trolley at home, make sure you have one for the assessment. If they are walking with a Zimmer, you may need to assess for a kitchen trolley as you can’t carry anything when you’re holding a Zimmer (don’t try). A kitchen trolley is similar to a wheeled Zimmer with shelves to carry stuff. Please see the comments at the bottom of the page for a discussion about this.  I’m not going to include assessing for a kitchen trolley in this post and will do a seperate post on walking aids and the like. Please refer to your educator/supervisor about kitchen trollies.

kt

Kitchen trolley

wheeled zimmer frame

wheeled zimmer frame

You’ll want to check in their notes or ask the nursing staff if they are well enough for the assessment. Never take anyone in a side room if they have been isolated for infection control reasons; you’ll spread the infection. Check if they need oxygen andif they usually walk with it at home.

On arrival
In the room while the person is seated:
• Explain the purpose of the assessment.
• Explain that everything they need is in the kitchen; they just have to look for it.
• Explain that you’re not going to assist (because they won’t have anyone at home helping usually) however you will be there all the time and will dive in (for safety reasons) if needed.
• Reassure them that it’s not a test; there is no pass or fail. You’re just checking that they are going to be able to manage with it when they get home.
• Tell them there is a perching stool which they can use if they get tired. If they do use it, you may need to order one for them if they haven’t got one at home.
• Ask if they have any questions or concerns.

Then I would let them get on with it, paying careful attention to what they are doing. You may want to make a few furtive notes so you don’t forget what you’ve seen when it comes to write it up in the medical records. Once making the tea and toast, get them to take it over to the table and to take a seat. If they normally use the kitchen trolley, invite them to use the one provided.  Let them eat the fruits of their labour if they want but remind them it’s OK if they don’t want to eat it. While they are having their tea, you can start writing your notes.

Prompting
You’ll need to pay attention to this; how much prompting do they need for certain elements of the task? Often, the instinct is to jump in immediately and assist the moment they encounter any problems, if they do have problems ask a few well-posed questions as prompts. For example;

Patient: Where do you keep the tea?
OT: Everything in the kitchen’s here, you just have to look for it.
Patient: Where’s the milk?
OT: Where would you normally keep the milk at home?
Patient: Is this kettle working? (i.e if they’ve switched it on from the kettle but it’s not plugged in at the wall).
OT: What could you do to check? What would you do at home?

If that doesn’t do the trick, make the prompts more obvious building up to showing them or assisting if needed. I know it’s hard not to jump in, us OT’s are helpful sorts, but unless you’re willing to go round and help them every time they want to make a cup of tea, you are doing them a disservice and also making a false assessment of their abilities.

Safety
You’ll need to watch like hawk during potentially dangerous situations like pouring boiling water into the cup. Be right next to the person as they do it so you can jump in if needed. If they are dangerous, stop the assessment immediately. It’s not going to get better during the assessment.

Documentation
You’ll need to say how much assistance was needed with each element of the task; you’ll want to put here words such as ‘independent’ if they can do it themselves or ‘min/mod/max assistance’ with any tasks that you’ve needed to help either physically or verbally.

During my time as a student, when doing my first kitchen assessment I struggled with what was classed as minimum/moderate/maximum assistance needed in a task. I thought an assessment from Wales had useful guidance to develop my OT ‘language’:
1. Unable to perform task item
2. Maximum assistance. Physical/verbal assistance.
3. Moderate assistance. Physical/verbal assistance required for 30-70% of task item
4. Minimum assistance. Physical/verbal assistance required for 0-30% of task item
5. Independent with or without the use of assistive equipment. No physical or verbal assistance needed. (Powys Teaching Local health Board Occupational Therapy Service, 2008)

A lot of services have their own form that you can complete which prompts you on what you should be looking for and will ask you to describe the patient’s performance. E.g there may be a section for motor skills, cognitive ability, exercise tolerance. They may have a tick box system and comments section-questions like ‘can the patient fill up the kettle with water?’ example here

If you haven’t got a form, just write your assessment in the medical notes. These are the things that I would write about:
• Range of movement: can they reach the high cupboards? Reach down to the ‘fridge?
• Exercise tolerance: can they do the full task without sitting down? Do they need to take regular breaks? Do they get breathless?
• Standing balance; can they stand up steadily? Do they need to sit during the task? Do they hold onto the worktop for support?
• Fine motor skills (small, precise movements): can the pick up the teabags and put them in the cup? Can they stir with a spoon? Can they get the plug in and switch the kettle on?
• Gross motor skills (big movements): movement and coordination of the arms, legs, and other large body parts and movements such as reaching, bending and walking.
• Mobility: are they walking around the kitchen with a stick, a zimmer or a kitchen trolley? Do they need support? Are they steady walking?
• Cognition: can they start a task without prompting? Can they problem solve? Can they work out how to use unfamiliar equipment? Can they sequence the task correctly (i.e. do it in the right order)? What’s their memory like?

Finally sum up: something like:

‘Patient X was able to make tea and toast safely and independently using a perching stool and kitchen trolley. He did require minimal prompting using unfamiliar equipment however this is not envisaged as a difficulty on returning home’,

or: ‘Patient Y was unable to complete the kitchen assessment independently due to breathlessness and fatigue’.
Things to consider
You’ll need to adapt your assessment depending on the situation. Some issues to consider:

If they have Parkinson’s disease, they will need to take their medications at a specific time. If their medications haven’t been taken at the right time or are due a dose very soon, this can really affect their performance. Be mindful that of this .

You may also do a kitchen assessment if a person has dementia to assess their cognitive ability to perform the task. Bear in mind that people can function very well with dementia in their own environment so a kitchen assessment in the therapy kitchen can be confusing and it can be more helpful (and meaningful) to do this in the patient’s kitchen.

If a patient isn’t allowed out of their side room for infection control you can also do a bedside kitchen assessment. In the past I’ve got patients to:

  • stand up from the bed or chair and fill an empty jug full of water from the sink
  • walk over to the table pour it into the cup.
  • walk back over to the sink and pour it away.
  • reach up high and low at cupboard/fridge heights.

It’s not ideal but at least it gives you some idea of their ability on all the factors that we’ve considered above. If you can, it’s better to wait until they are clear of infection and do a proper kitchen assessment.

Hope this helps. I hope your kitchen assessments go well. They can be an enjoyable experience where you can get to know a patient better. It’s nice to have a chat while you’re doing it and find out more about their lives. Good luck.

References
Laver-Fawcett, A.J. (2007). Principles of assessment and outcome measurement for occupational therapists and physiotherapists. Chichester: John Wiley & Sons Ltd.

Powys Teaching Local Health Board Occupational Therapy Service. (2008). Kitchen Assessment. Retrieved 16 November, 2012, from http://www.wales.nhs.uk/sites3/Documents/501/Kitchen%20assessment.Jul%2008.doc.

Resources

http://healingoccupationaltherapy.blogspot.co.uk/2010/06/making-cup-of-tea-occupational-therapy.html
http://whenacupofteaisnotjustahotdrink.blogspot.co.uk/2011/12/using-cup-of-tea-in-assessments.html

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7 thoughts on “Practical Guides # 2: Taking the heat out of kitchen assessments

  1. Hiya, I’m an OTA in an acute hospital. I really enjoyed reading your blog on kitchen assessments – I always find that other people have ideas I haven’t thought of!!
    I was however a little concerned about your comments regarding kitchen trolleys so wanted to pass on to you what I’ve learned.

    Where you said:
    If they are walking with a Zimmer, they’ll need a kitchen trolley during the assessment as you ca’t carry anything when you’re holding a Zimmer (don’t try) and a kitchen trolley is basically a Zimmer with shelves to carry stuff;

    I have learned that you should not reccommend a trolley if a patient is reliant on their zimmer frame for support when walking. A zimmer frame has 2 ferrules on the back legs (or 4 ferrules if it doesn’t have wheels at the front!) whereas a trolley has 4 wheels, therefore if a patient puts their weight through the trolley it is likely to run away from them & can cause them to fall – we only reccommend a trolley if the frame is just used for confidence or slight balance assistance.

    Also, if prescribing a trolley, we never issue the trolley to be delivered for use as soon as the patient is home as we have to assess the home environment to ensure it is safe to use there also (some people have lots of rugs or steps between rooms which would make the trolley unsafe to use at home) so we would take the trolley out to the patient after they have returned home & trial it with them again to ensure they are safe with it before leaving it with them.

    I hope this is helpful to you. Best wishes.

    • Hi Jooles, thanks for reading the blog and I welcome your feedback.

      I try and make clear on the blog that I am a recently qualified OT, and that I am still learning too. I certainly welcome advice and feedback from others as I can always be better! I also try and point out that my blog tries to keep things simple for people that are learning. I was saving kitchen trolley advice for a separate blog post on walking aids and the like. I wanted to focus more on the act of doing a kitchen assessment so not to complicate things.I did want to point out though, that they may need to consider a KT for the patient, rather than going into how to assess for one.

      On reading it back, I think maybe that my wording may have been a little unclear. When you’re writing it can make perfect sense to you but it’s hard to tell how people may read things.

      In our trust we would assess in hospital that a person is safe with a KT before issuing. We would also assess whether they may need a weight bearing KT. On discharge, we would then send a therapy assistant out with one to deliver and assess at the home. If the assistant felt that the home environment was unsuitable or they were unsafe, we would take it back and try something else. But I’m aware practise can vary in different departments or trusts.

      Your feedback is useful. I have amended the post accordingly. I would be interested to know what your advice would be if someone uses a ZF and lives alone, what would you issue to help them transport items in the kitchen? I am always keen to learn other ways of doing things. Thanks so much, best wishes.

  2. Pingback: Practical Guides #4: bathing equipment | The OT process

  3. Pingback: Practical guides #7: How to decide on care package for a patient. | The OT process

  4. Pingback: Practical guides #8: How to do a washing and dressing assessment and introduction to dressing aids | The OT process

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