Practice issue:

Client with orthopaedic injuries whose main requirement is physiotherapy.  Return to function and work is anticipated.  Past history of substance use, which resumes post-accident and begins to impact on progress as client is not following through on physiotherapy exercises or advice and progress is halted, with complications when wound also begins to break down.  Case manager referred the client on to other professionals to support wound management and for support with substance abuse, as well as advocating for some additional support to enable the client to follow through on physiotherapy and rehabilitation between sessions and afford the best chance of recovery from the injuries.

Case Management Actions:

  • CM referred on to district nurses regarding wound management and advocated for regular visits when it became apparent the client would not effectively self-monitor.
  • Liaison with physiotherapist regarding substance abuse relapse
  • Collaboration with physiotherapist and client to adjust goals and set achievable objectives
  • Implemented paid support to proactively follow through on exercise and stretching between appointments when it became apparent the client could not self-direct this.
  • Referral to substance abuse service to support with the relapse and involve them in MDT decisions with the client.

Skills used from competency 2- Strategy

  • 2a assessment and goals setting
  • 2b planning
  • 2c Integration

Positive indicators demonstrated:

  • Client needs addressed with relevant goals set
  • Clear rehabilitative plan
  • Responsive to new information, with a flexible approach used to adjust plans according to the changed circumstances and needs
  • CM oversees all aspects of the plan and programme to ensure client is able to maximise their potential
  • All relevant professionals involved in MDT

Bear traps avoided:

  • Deterioration of wounds and function- with a potential consequence of not returning to work and full function
  • Assuming that the client had chosen not to engage, when in fact more complex issues underpinned the rehabilitation programme and their participation in it

Competencies demonstrated:

  • Strategy
  • Monitoring
  • Duty of care


BABICM Competencies for case managers and standards for case management practic

Practice reflections:

Through proactive monitoring and maintaining a relationship with the client, with an understanding of the past history, the case manager ensured that the risk of complete breakdown of physical recovery was avoided. Due to the case manager responding in a timely way, by reacting to the client’s changing situation and altering the plans according to the client’s specific needs, this gave the client the best opportunity to gain a positive outcome.