...Because your best day isn't the one that counts
Most of us could pass an equipment prescription audit on our best day.
Plenty of time. Clear goals. A trial booked at school, not in the clinic. A report you'd happily hand to anyone.
But that's not the day that decides how a piece of equipment lands in a child's life. The busy week does. The week with four reports due, a cancelled trial and a quote sitting in your inbox.
So we built a self-audit for that week.
What it is
The AT Prescription Self-Audit is a free, one-page reflection tool for paediatric OTs and allied health clinicians who prescribe equipment for kids.
It takes the de Jonge et al. (2018) AT process and groups it into six questions, from referral to real life. For each one, there's a single statement. You mark it A (Always), S (Sometimes) or N (Not yet).
One rule: score yourself on a busy week, not your best day.
Nobody sees this but you. So be honest. Uncomfortable is the point.
The six questions
1. Do we need AT, and what for?
I set a participation goal, in the family's words, before I look at a single product. "Improve head control in upright sitting" is our language. "Sit at the table for dinner with her brothers" is theirs. The family's version is the one that keeps everyone focused when the brochures come out. It's also the one that holds your prescription up when funding gets questioned.
2. Which products might work?
Growth, and where this child is heading, is written into my device criteria.
Kids grow. Delivery takes months. Equipment that fits at trial can be outgrown by the time it arrives. And growth isn't only about height. Starting school, a new house, a change in how a child moves. If it's coming, it belongs in your criteria.
3. What is our preferred AT solution?
I trial every feature I'm scripting, in the environment it will be used in. Where that's not possible, I have clear, defensible clinical reasoning for each feature I've selected.
A chair that works in a clinic room can fail in a small kitchen. Trial in the real space wherever you can. Where you can't, your reasoning has to carry the weight. Every feature. Not just the big ones.
4. How do we get it?
Someone else could read my report and see why I chose this over every alternative.
This is the busy week's favourite shortcut. We know why we chose it, so we assume the report says so. Read it as a stranger would. Could a planner, a reviewer or a new OT on the case follow your thinking from goal to product? If not, the reasoning is still in your head.
5. How do we set up for success?
Everyone who uses this equipment has shown me back how to use it, and knows who to call when it needs fixing.
Showing someone how it works isn't the same as them showing you. Parents, educators, support workers, grandparents. If they haven't shown you back, you don't know they can. And if nobody knows who to call when it breaks, it will sit broken.
6. Did we achieve improved participation?
I have a review booked for every piece of equipment I've prescribed, and I know whether it's being used.'
The prescription isn't finished when the equipment arrives. It's finished when you know it's being used, and that it's made a difference to that goal from question 1.
How to use it
1. Mark each statement A, S or N.
2. Count your S's and N's. Your gaps show you where to focus next.
3. Write down one thing you'll do differently at your next equipment referral.
4. Sit with the three take home questions:
Which of the six do I skip when I'm busy?
Who checks my reasoning?
How would I know if my last prescription had been abandoned?
It works on your own. It works even better in supervision, or as a team meeting exercise. Same six questions, different conversations.
So where to from here?
Your score points you somewhere. Here's where.
Mostly A's, a few S's? You've got the process. The Kids AT Prescription Guide gives you the tools to keep it tight on busy weeks: the full six-question process, reflection questions, a generic AT scripting form with category modules and a one-page quick reference. $69 + GST.
S's around question 4? That's what Draft.Lab is for. Your report. Our eyes. Feedback on your AT justification before it goes out.
A few N's, or working with complex cases? You don't need to work this out alone. Book 1:1 clinical supervision, or join Complex.Lab, our small-group peer supervision for OTs working with complex kids.'
Download the free self-audit →
Get the Kids AT Prescription Guide →
Reference: de Jonge, Desleigh et al, 'The Occupational Therapist: Enabling Activities and Participation Using Assistive Technology' in Marcia J Scherer and Stefano Federici (eds), Assistive Technology Assessment Handbook (CRC Press, 2nd edn, 2018) 211.---