Miss Rianne Kocken

: Physiotherapist

: PH75599

: Final Hearing

Date and Time of hearing:10:00 26/10/2017 End: 17:00 17/11/2017

: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Hearing has not yet been held

Allegation

During the course of your employment as a Physiotherapist for Kent Community Health NHS Trust, between May 2012 and March 2014, you:

1. In relation to Patient A on or around May 2012:
a. did not adequately conduct and/or record the following assessments:
i. holistic;
ii. vestibular;
iii. range of movement;
iv. sensation, coordination and/or proprioception;
b. did not formulate a working diagnosis based on the patient's presenting condition;
c. did not adequately formulate and/or document the patient's goals;
d. did not complete any adequate records in that you did not record the outcomes measured on 2 June 2012 and/or the care plan-review on 6 June 2012 in the SOAP notes.
e. Did not complete the SOAP (Subjective, Objective, Analysis, Plan) notes to reflect Patient A's complaint of dizziness;
f. Did not make an onward referral for a medical assessment to identify the cause of Patient A's complaint of dizziness;

2. In relation to Patient B on or around 2 October 2012 you:
a. did not obtain and/or record adequate information during the holistic assessment;
b. did not conduct and/or record a physiotherapy assessment;
c. did not conduct and/or record a falls assessment;
d. did not adequately assess and/or record an assessment of Patient B's shoulder pain.

3. In relation to Patient C on or around October 2012 you:
a. did not obtain and/or record adequate information during the holistic assessment;
b. did not record adequate information regarding:
i. Patient C’s condition;
ii. any assessments undertaken with Patient C.
c. used Tinetti as an outcome measure which was not supported by clinical reasoning;
d. did not identify and/or record a baseline for Patient C's treatment.

4. In relation to Patient D on or around 23 April 2013 you:
a. did not adequately assess and/or record an assessment of the altered sensation in Patient D's limbs;
b. did not adequately assess and/or record an assessment of:
i. back pain;
ii. pain in the back of the left knee and/or
iii. the cervical spine;
c. did not set complete SMART goals and/or identify treatment in relation to the patient's complaint of dizziness;
d. did not identify any treatment in respect of the pain in the back of the patient's leg;
e. did not include a copy of the balance exercises provided to the patient in the patient's records;
f. did not use clinical reasoning to consider what factors were contributing to the patient bumping into objects.

5. In relation to Patient E on or around 2 May 2013 you:
a. did not assess and/or record an assessment of:
i. muscle strength;
ii. proprioception;
iii. foot positions;
iv. range of motion;
b. did not recognise the cause of the patient's dizziness following your assessment;
c. did not identify any treatment in respect of the patient's balance deficit;
d. did not complete any or any adequate records in that you:
i. did not record the patient's complaint of dizziness other than in the goal sheet;
ii. did not complete the falls assessment with sufficient detail or at all.
e. Did not identify a treatment plan using the SMART (Specific, measurable, achievable, realistic and timely) objective in that you suggested Tinetti exercises to treat the patient which did not correlate with or address the problem identified by the Otago assessment.

6. In relation to Patient F on or around 14 May 2013:
a. recorded a baseline in relation to balance which was not measurable and/or SMART;
b. did not follow up and/or record a plan to address the patient's weight loss.

7. In relation to Patient G on or around 14 and 21 May 2013 you:
a. did not obtain informed consent in that you asked Patient G to sign the BI Overview Booklet without providing an explanation as to why their signature was required;
b. did not ask pertinent questions of the patient to inform your assessment;
c. did not review and/or record a review of the patient's medication;
d. did not recognise and/or have sufficient knowledge of the effects of the patient's medication;
e. Did not adequately assess and/or required prompting to assess:
i. proprioception;
ii. leg length;
iii. abductor strength;
iv. leg pain;
f. did not review and/or record a review of the patient's leg pain;
g. prepared an incomplete goal sheet in that it did not reference the patient's goal to walk outdoors.

8. In relation to Patient H on or around 9 and 14 May 2013 you:
a. did not promptly refer the patient to wheelchair services;
b. required prompting to assess the patient's muscle tone in varying positions;
c. did not adequately progress the patient's treatment in that you did not set any exercises and/or tasks relevant to their goal.

9. In relation to Patient I between February and 20 May 2013 you:
a. did not complete and/or record a falls assessment;
b. did not review the patient's medication prior to 20 May 2013;
c. did not prioritise the assessment and/or treatment of the patient's ankle;
d. did not routinely remove the patient's ankle boot during assessment;
e. did not identify and/or set any goals in relation to the patient's ankle;
f. set the patient an unrealistic goal based on their condition.

10. In relation to Patient J on or around 23 May 2013 you:
a. did not assess and/or record an assessment of transfers from the bed to chair;
b. did not accurately assess and/or record the assessment of the patient's lower limb strength;
c. did not set and/or provide the patient with any exercises in relation to stiffness;
d. set and/or provided the patient with an unrealistic activity/exercise based on their condition.

11. In relation to Patient K on or around 30 May 2013 you:
a. inaccurately assessed the patient's balance;
b. set the patient an unrealistic goal based on their condition.

12. In relation to Patient L on or around 26 September 2013 you:
a. did not complete the Medication Assessment Form and/or record sufficient information regarding the patient's medication(s);
b. did not obtain and/or record the patient's MUST and/or Waterlow scores;
c. did not obtain informed consent in that you asked Patient L to sign the BICA Lite booklet without providing an explanation as to why their signature was required;
d. did not assess and/or record an assessment of:
i. balance;
ii. sensation;
iii. pain; and/or;
iv. fatigue levels;
v. the patient's use of elbow crutches;
e. did not accurately assess and/or record an assessment of:
i. range of motion;
ii. posture; and/or
iii. gait;
f. did not consider and/or act upon the patient's complaint of bruised ribs to inform your assessment;
g. devised a care plan which included an incomparable baseline and/or goal;
h. provided the patient with pre-prepared exercises sheets which were not based on your assessment and/or were not appropriate for the patient;
i. did not adequately explain and/or demonstrate the exercises to Patient L.

13. In relation to Patient M on or around 26 September 2013 you:
a. did not recognise and/or act upon relevant information obtained as part of Falls Screening Tools;
b. did not refer the patient for an osteoporosis medication review;
c. did not accurately calculate the patient's Waterlow score;
d. did not recognise and/or act upon the patient's Waterlow score;
e. did not conduct and/or record any adequate assessment of:
i. the patient's complaint of back pain;
ii. proprioception;
iii. the patient's feet;
iv. muscle strength;
v. range of motion;
f. inaccurately and/or inadequately used the Tinetti assessment;
g. inaccurately and/or inadequately used the FES-1 assessment tool;
h. recorded that there was a lateral shift of spine without assessment and/or clinical justification;
i. conducted a toilet transfer in an unsafe manner;
j. required prompting to conduct an upper limb assessment;
k. included goals in the care plan which were not SMART and/or did not progress the patient's treatment;
I. Did not fully complete the manual handling assessment section;

14. In relation to Patient N on or around 6 January 2014 you:
a. did not obtain and/or review Patient N's x-rays prior to your assessment;
b. did not conduct any or any adequate assessment of Patient N's left hip and/or pressure areas;
c. recorded Patient N's hip movement and strength when this had not been specifically tested;
d. did not use and/or demonstrate clinical reasoning to prioritise areas which required urgent assessment;
e. did not recognise and/or act upon the risk of Patient N mobilising with a kitchen trolley;
f. did not safely set-up the TUSS (Timed Unsupported Steady Stand) test;
g. did not complete the body chart;
h. set and/or provided exercises for the patient which were inappropriate.

15. In relation to Patient O on or around 27 I 29 January 2014 you:
a. did not recognise and/or advise the patient on using the Delta Frame and/or commode in an unsafe manner;
b. did not recognise and/or advise the patient regarding the use of a cover on the pressure relieving equipment;
c. did not use and/or demonstrate clinical reasoning to prioritise important areas of the assessment;
d. included goals and/or treatment in the care plan which were not SMART goal and/or did not progress the patient's treatment;

16. In relation to Patient P on or around 30 January 2014:
a. did not obtain information from the nursing home regarding Patient P's mobility and/or condition prior to assessment on 30 January 2014
b. did not adequately structure your assessment;
c. did not adequately assess the patient's hip strength and/or upper strength
d. asked Patient P to stand on multiple occasions without clinical justification.
e. did not recognise that the patient's prosthesis was not properly fitted, and therefore concluded that he was not mobile and had no rehabilitation potential;
f. did not check the skin of the patient's stump at appropriate intervals;
g. did not complete a mental capacity assessment;
h. did not undertake and/or record a Falls Screening Tool1 assessment;
i. did not complete any or any adequate records in that you:
i. did not adequately complete the body chart;
ii. did not prepare a treatment plan.

17. In relation to Patient Q on or around 6 February 2014 you:
a. did not complete any or any adequate records in that you:
i. did not obtain Patient Q's signature on the BICA Lite booklet;
ii. did not complete the body chart;
iii. did not complete a Trust Core Care Plan;
iv. did not include a copy of the exercises provided to the patient in the patient's records;
b. did not assess and/or record the MUST score;
c. did not fully complete the osteoporosis screen;
d. did not make a referral in relation to osteoporosis medication;
e. did not obtain and/or review Patient Q's x-rays prior to attending to Patient Q on 6 February 2014;
f. did not check Patient Q for pressure areas;
g. did not conduct the Nee and Hawkins-Kennedy Shoulder Impingement Syndrome tests;
h. did not formulate a working diagnosis and/or care plan.

18. The matters set out in paragraphs 1-17 constitute misconduct and/or lack of competence.

19. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

No information currently available

Order

No information currently available

Notes

This final hearing is set to take place on the following dates: Thursday 26 October - Tuesday 31 October and Monday 13 November - Friday 17 November 2017 

Hearing history

History of Hearings for Miss Rianne Kocken

Date Panel Hearing type Outcomes / Status
26/10/2017 Conduct and Competence Committee Final Hearing Hearing has not yet been held