Saudi Occupational Therapy Association

Occupational Therapy Internship

Guide
In King Abdulaziz Medical City
Riyadh

Introduction

Welcome to king abdulaziz medical city for ministry of National Guard rehabilitation department.
We look forward to you participating in your education and development during your internship.
King Abdulaziz Medical City for Ministry of National Guard Health Affairs (KAMC- NGHA) is a
big city for all patients services with huge different departments.
One of those departments is Rehabilitation department, which includes physical therapy and
occupational therapy. Occupational therapy is also divided into several units such as: (Burn unit,
intensive care unit (ICU), orthopedics & medical acute, acute Neuro, Neuro rehabilitation unit
(NRU), and Neuro out patient).
The following information is to act as a guide for you during your placement.

Professional conduct
Your internship act as training for your eventual employment as an occupational therapist, as
such, you will be expected to behave in a professional manner at all times. This includes
adhering to normal staff working hours, policies and procedures.
Working hours: 8:00 to 17:00 Sunday to Thursday.
Lunch break: 12:00 to 13:00

Uniform: a lab coat should be worn, with slacks or scrubs underneath, and you should comply
with hospital dress codes. Closed toe shoes should be worn, open toe shoes or heels are not
acceptable and pose a safety hazard. Excessive jewelry is also not appropriate due to safety
and infection control standards. Your ID badge must be current and clearly displayed on your
person whenever on hospital grounds.
Mobile phone: should be turned off or on silent during working hours, and should not be used
in front of patient. Some critical care areas require your phone turned off for safety reasons.
Paging system: All clinical staff within the hospital can be reached within the pager system. To
page someone, dial 70 from any hospital phone, wait for beep, enter pager no, wait for beep
and hang up. If they are available, the staff member will call you back on the same extension
no.
Attendance: is recorded in sign in sheet at main department( or with preceptor if in satellite
areaL. Late attendance or absenteeism without prior approval or notification is not acceptable,
and will be reported to supervisor and training and development.
In the unavoidable event that you are unable to attend, or will be late, the secretary or your
preceptor should be informed at 8:00.
Time off: upon the discretion of your preceptor and intern coordinator, you are eligible for one
time off (half day) per month. Any appointments etc. should be scheduled during this time so as

to minimize time away from your internship. Please note- this privilege will be removed if there
are any concerns over intern performance or behavior.
Sick leave: if you are absent due to sick leave you must still inform the secretary/ preceptor by
8 a.m. and provide a sick leave certificate the following day
Attached to intern and leave request form. This will be forwarded on to training and
development extended sick leave should be discussed with training and development, as there
may be need for you to repeat part of your internship.
Leave: During your internship is not encouraged. The department will grant you a maximum of
five days leave during your 6 month internship aside from this, dependent upon your University
policy, leave is generally only granted for your wedding or birth of a child. All leave must be
applied for at least two weeks in advance, by completing the intern leave request form, which
must be signed by your preceptor and intern-coordinator.
Patient rights and privacy: patients deserve their privacy and our respect. You must introduce
yourself and display ID badge at all times in line with Hospital policies (see patients rights and
responsibilities booklet available in all treatment areas), patient should only be discussed with
Hospital Personnel in the context of their treatment or management personal information about
patients should not be taking home, nor should information be left lying around gym, ward or
office areas where it may be accessible by non hospital Personnel. Please do not photograph or
video patients unless discussed with your preceptor. The patient or legal guardian must sign a
consent form, and photos are only to be used for work-related activities example: development
of information brochure, or positioning picture to assist with patient/ family education.
On your internship, no additional leave will be granted without written approval from your
university to training and development. Short notice requests will only be granted under
exceptional circumstances. Please note, if it is felt that such leave may make it difficult for you to
successfully complete your placement, leave may be declined. In the event that you have taken
leave and are not passing your placement by the end of rotation, you may be asked to extend
your placement to reach a passing level.
All absences other than above mentioned 5 days leave will be recorded on your final evaluation
for university.
Reporting structure and contact information
Any concerns regarding day to day practice should be raised with your immediate Preceptor, if
they are unable to answer or resolve the issue, you will be referred onto the intern coordinator
who will in turn contact training and development or head of the department when necessary.
Please note all leave must be discussed with preceptor and intern coordinator.
If calling from outside the hospital please call 01180 11111 followed by the extension number.
Name
Position
Contact details
Kellie Mackenzie
Intern coordinator- main hospital
Ext 13190 pager 2274
Yassir AlAsiriy

Intern coordinator- occupational therapy

Ext 11269 pager 4707
Roselle Ignacio/ JB Udaundo
Main hospital secretary
Ext 13358 pager 12674

Safety Standards
During your internship you will be expected to adhere to all Hospital policies and procedures.
The following guidelines regarding safety standards are important for you to be familiar with for
your own safety and that of the patient. Your preceptor will inform you of any extra standard
present to your area of work.

Infection and prevention control

Standard precautions to prevent infection transmission.
These infection control practices should be applied to all body fluids, non-intact skin and
mucous membranes, and should be used for all patients regardless of their diagnosis or
presumed infection status. See infection prevention and control manual for more details.
1.
Hand hygiene- strict hand hygiene (when, why, and how).
Limitation of alcohol-based hand rub (ABHR): ABHR is inactive when hands are visibly dirty and
when dealing with spore forming bacteria
2.
Use of PPEs (personal protective equipment).
Put on in this order: hand Hygiene, mask, goggles or face shield, gown, and gloves.
Remove in this order: gloves, wash or clean hand, mask, face shield or goggles, gown, masks
or respirator.
3.
Use of aseptic technique for all invasive procedures and any procedure requiring
asepsis.
4.
Safe Handling and disposal of Sharps.
5.
Proper handling of contaminated items.
6.
Collection and handling of lab specimens (these are considered infectious at all times).
7.
Respiratory hygiene and cough etiquette (cover the nose /mouth when coughing /
sneezing; use tissues to contain respiratory secretions; dispose the tissue in the nearest waste
disposal; and then, perform hand head hygiene.
8.
Use the appropriate color code bags.

Emergency coding system

APP 1428-16
You should be aware of emergency codes within the hospital. In case of emergency, dial
appropriate extension number and clearly State type of code and location. Follow your
preceptor or senior staff members instructions.
The following information, act as guidance on how to deal with all the requirements of
assessments and treatments of each unit.

Burn Unit.
Burn is one of the main services provided in Occupational therapy department at NGH.
Areas that are covered by OT in burn:
Outpatients burn clinics Main hospital.
Inpatients Burn ICU
When to admit pt to burn?
Types of scar
Scar management
Wound care
When to admit to the burn unit?
It is depending on:
A.
Type of burn
B.
Depth
C.
Inhalation injury
D.
Age
E.
Accompanied problem
F.
TBS
A-Types of burn
1.
Scaled= liquid (if its location in the hand, face, genital the pt should be admitted).
2.
Frostbite.
3.
Chemical any exposure to chemical will lead to 3ed degree, full thickness.
4.
Thermal: (flame, contact, friction).
5.
Electrical: (there must be input& output).
B- depth
Skin layers:

Epidermis

Dermis

Subcutaneous

Degrees of burn:
1st degree 1st layer superfacial
2ed papilary superfacial partial thickness
3ed reticular full thickness
4th, classic 3ed layer going to the bone, musclestc)

C- Inhalation injury like smoke

D- Age
E- Accompanied problem
F- TBS (Role of nine)
Types of scar
1.
Keloid scar: the scar is aggressively healing, that extend beyond the original area.
2.
Contracture scar: the scar is tight, so even the skin, it might limit the movement.
3.
Hypertrophic scar: it is similar to keloid, but it is red in color and with boundaries.
4.
Acne scar
Scar management
When the scars go a lot?

Near to joints, very active muscles, scapula, and sternal area.

Prolongation of wound healing (severity, persist of bacteria).

Age middle ages more.

Area palm, penis, sole of the foot are the least.

Race Asian and dark people more.

Scar management

Positioning

Splinting

Silicon

Skin mobilization

Pressure garment: (Coban, interim, ACE bandage, tubgrip, costum made garment)

Psychosocial
Scar management (Silicon)
1.
Transparent silicon cicacare
2.
Mepiform
3.
MZ silicon
4.
Elastomer: (it is like a splint in the function, good with wounds, for contractures).
5.
Thickdeuderm = hydrogel: it is not a silicon base, however we use it if the skin allergic to
other types*Coban: (Correct deformities, burn, edema, ankle sprain, amputation)

Wound care
Wound healing process:
Inflamatory hemostasis phase days
Prolifration weeks
Maturation months

ICU team covers ER, ICU units.

Areas that are covered by OT in ICU:
-

Surgical ICU (SICU)

Traumatic ICU (TICU)
Intermediate care unit (IMCU)

CCU

OT Goals in ICU:
Preventing contractures.
Maintain the functional position as possible.
OT intervention in ICU:
Contracture management.
Splinting (hands, elbow and knees)
Positioning: abductor wedges, blue boots and heel lift.
Stretching intervention for ULs and LLs.
Functional re-training.
Equipment prescription.
OT devices used in ICU:
Hand splints.
Knee extension soft splint.
Elbow extension soft splint.
Blue boots
Heel lift
Abductor wedge
Important to know if you are in ICU:
Normal Vital signs:
Blood pressure: 120/80 mm/hg
Spo2: 100
Heart rate: 60-100 beat per minutes
Respiratory rate: 12-18 breathes per minutes

MOOD: the method of inspiration that used.

PEEP: positive end expiratory pressure, it causes the alveoli to remain open.
PSV: pt. initiates the breath and the ventilator deliver support==> it is to maintain respiratory
rate.
Fio2: fraction inspired O2.
SPo2: the O2 saturation.
MAP: meaning arterial pressure (60-120).
EF: ejection fraction, measurement of how much blood pumped from the heart to the body.
AF (arterial fibrillation): irregular and rapid heart rate and it can increase risk of having stroke.
Modes of ventilation:
ACVC+ ACVC ACPC PSV ATCCV
ACVC+ = the worst mood of ventilation.
PSV= pressure support ventilator.
ATC= assistive tracheal control.

CV= chronic ventilator

Important scales:
GCS = Glasgow coma scale
Best eye response
4=spontaneous open eye.
3=open with verbal commands.
2= open to pain.
1=none.
Best verbal response
5= oriented.
4= confused conserved but able to answer.
3= not appropriate response.
2= incomprehensible speech.
1= none.
best motor response
6= follow commands of move.
5= purposeful movement of pain.
4= withdraw from pain.
3= abnormal flexion (decorticated).
2= extensor rigid (decerebrated).
1= none.
Edema scale
0 No pitting edema
1+ mild pitting edema, 2 mm, disappear quickly
2+ moderate pitting 4mm, disappear within 5 to 10 sec.
3+ moderate to severe 6mm, disappear within 1 min.
4+ sever pitting 8mm stays up to 2 min.
MAS= Modified ashworth scale
0= Normal
1= slight increase of muscle tone at end of the range (catch and release)
1+= slight increase of muscle tone throughout the range.(catch and followed by minimal
resistance)
2= moderate increase of tone throughout the range.
3= passive movement is difficult.
4= rigidity.
Medication
Sedations
Fentanyl, Propofol, Midazolam, Precedex, Haloperidol, Lorazepam
Inotropes
Norepinephrine, Noradrenaline, Dopamine, Dobutamine, Phenyliphrene, vasopressin, Digoxin
Anticholesterole
Atrovastatine, Clapedogrel

Anticoagulant
Heparin, Warfine, Fondaparinox , Enoxparin, Aspirin
Antihypertension
Metoprolol, Propranolol, Atenolol, Amlodapin, Fusamide
AntiEpilipsy
Phenytoin, Gabapentine , Carbamezapin
Antiarrethmia
Amidarone, Metoprolol, Milrinon
Pain Killer
Acetaminophen, Morphine, Tramadol
Antipsychotic
Haloperidol, Resparidon, Citalopram, Lorazepam, Lorazepam

Orthopedics & Medical acute OT

In this subspecialty in OT department, most cases and conditions handled are:
Bone fractures.
Osteoarthritis.
Amputation.
Post-joint replacement.
Referral received from:
Internal medicine
Vascular surgery
Orthopedic surgery
General surgery
Podiatry
Endocrine.
Pulmonary.
Nephrology.
Areas that are covered by Ortho& medical team:
Ward 7-40 except ward 21 (rehab ward).
Services that Ortho& medical provide:
Acute OT care.
Adaptive& assistive equipment provision

Acute Neuro Rehab Unit

Common conditions:
(TBI, SCI, Stroke, Guillain Barre Syndrome, MS, Brain tumors, Epilepsy, and many other
neurological diseases
Areas that covered by Acute Neuro team:
Ward: 15,16,18,19,20,21,22,23,24,25,36,37.
Assessment: theres a specially designed form, which contains:
-Social history:
-Type of house (apartment, villa).
-Access (number of internal and external stairs).
-Number of people who are present in the house with patient all day.
-Type of bathroom and shower.
-Type of bed.
-Previous level of independency in ADLs.
-Equipment at home.
-Physical assessment:
-Bed mobility (rolling, supine to sit, sitting balance, sitting to stand, standing balance, and
walking).
-Manual Muscle Testing.
-Range Of Motion.
-Coordination (finger to nose test, heel to chin, alternating supination and pronation).
-Sensation (light touch, pain).
-Proprioception (finger position in space).
-Hand function test (Jepson Taylor Test).
-ADLs assessment according to FIM (wearing and taking off socks, opening bottle of
water).
-Pain assessment (Pain Numbers Scale).
-Transfers. (Pivot, hoist, large transfer board, hoist, sliding board).
-Cognitive assessment:
-Standardized assessment (MOCA, Mini Mental State Examination).
-Non-standardized assessment:
*(Orientation to time, person, and place).
*(Memory by repeating 3 words after 5 mins).

-Visual field:
-Standardized assessment (star cancelation test).
-Non-standardized assessment (tracking finger).
*Also read about NIH scale, Rankin scale, Glasgow Coma scale (GCS), and Barthel Index
Scale.
According to assessment either:

Equipment prescription (medical bed with air mattress, recliner or standard wheelchair
and commode, transfer board, hoist).

Follow up.

If equipment prescription: we have to teach the family how to use it.

If follow up: depends on the case

Cognitive training.
Positioning.
Sensory stimulation using the brush.
Bed mobility training.
PROM or active assisted ROM.
Bilateral hand activities.
Provide assistive devices.

Neuro - out Patient

Common conditions:
(TBI, Stroke, Gullain Barre Syndrome (GBS), cerebral palsy, orthopedic conditions such as
fractures, hip or knee replacement).
Assessment: theres especial form, which contains:
-Social history:
-Type of house (apartment, villa).
-Access (number of internal and external stairs).
-Number of people who are present in the house with patient all day.
-Type of bathroom and shower.
-Type of bed.
-Previous level of independency in ADLs.
-Equipment at home.
-Physical assessment:
-Bed mobility (rolling, supine to sit, sitting balance, sitting to stand, standing balance, and
walking).
-Manual Muscle Testing.
-Range Of Motion.
-Coordination (finger to nose test, heel to chin, alternating supination and pronation).
-Sensation (light touch, pain).
-Proprioception.
-Hand functions.
-ADLs assessment.
-Transfers.
-Cognitive assessment.
-Standardized assessment (MOCA, Mini Mental State Examination)

-Non-standardized assessment:
*(Orientation to time, person, and place).
*(Memory by repeating 3 words after 5 mins).
-Visual field:
-Standardized assessment (star cancelation test).
-Non-standardized assessment (tracking finger).
-Pain assessment (location, type of pain, degree of pain out of 10).
-Visual or hearing problems.
Intervention: depends on the case

Cognitive training.

Sensory stimulation.

Bed mobility training.

Strengthening.

Coordination activities.

PROM or AROM exercises.

Bilateral hand activities.

Provide assistive devices.

ADLs retraining.

Equipment prescription.

Neuro Rehabilitation Unit- (NRU)

Common conditions:
Stroke, TBI, Gullain Barre Syndrome (GBS), spinal cord injuries (SCI), conditions caused by
viral infections).
The session last for one hour and sometimes you have to see the patient twice a day depending
on the case.
Assessment: theres especial form, which contains:
-Social history:
-Type of house (apartment, villa).
-Access (number of internal and external stairs).
-Number of people who are present in the house with patient all day.
-Number of children.
-Type of bathroom and shower.
-Hobbies & interests.
-Previous level of independency in ADLs.
-Equipment at home.
-Physical assessment:
-Bed mobility (rolling, supine to sit, sitting balance, sitting to stand, standing balance, and
walking).

-Manual Muscle Testing.

-Range Of Motion.
-Coordination (finger to nose test, heel to chin, alternating supination and pronation).
-Sensation (light touch, pain).
-Proprioception (finger position in space).
-Hand functions (Jebsen Taylor Hand Function Test, 9 hole peg test)
-Grip strength using the JAMAR Dynamometere
-Pinch strength.
-ADLs assessment according to FIM. Actual assessment of:

Feeding.

Grooming.

Dressing.

Showering.

Toileting.
-Cognitive assessments:

MOCA

LOTCA
Intervention: depends on the case

Cognitive training.

Fine & gross motor activities.

Splinting (mostly hand resting and functional splints)

Balance training in sitting and standing positions.

Functional training (ex. Taking something out from the drawer).

Pain management (hot packs, or functional electrical stimulation)

Bed mobility training.

Transfer training.

Facial palsy exercises (theyve a special paper for that).

Home program exercises (theyve a special paper for that).

Strengthening.

Coordination activities.

AROM exercises.

Bilateral hand activities.

Provide assistive devices.

ADLs retraining (especially feeding, dressing, and grooming) using Hemiplegic

technique or one hand technique.

Equipment prescription.