RCOT Implementation Toolkit – Audit Form

Occupational therapy in neonatal services and early intervention

Audit Form
This audit tool is to be used in conjunction with the evidence-based practice guideline
Occupational therapy in neonatal services and early intervention (RCOT 2017).

These evidence-based recommendations are not intended to be taken in isolation and

must be considered in conjunction with the contextual information provided in the full
guideline, together with the details on the strength and quality of the recommendations.
The recommendations are intended to be used alongside clinical expertise and, as such,
the occupational therapist is ultimately responsible for the interpretation of the evidence-
based guideline in the context of their specific circumstances and service users.

The full practice guideline together with implementation resources can be found on the
Royal College of Occupational Therapists website: www.RCOT.co.uk

Reference
Royal College of Occupational Therapists (2017) Occupational therapy in neonatal services
and early intervention. London: RCOT.

This Audit Form may be copied and adapted for non-commercial use.
© Royal College of Occupational Therapists 2017. The Royal College of Occupational Therapists Ltd is a registered charity in
England and Wales (No. 275119) and in Scotland (No. SCO39573) and a company registered in England (No. 1347374)
 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date

Recommendations
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Occupation-based assessment How do you evidence this? Action to be taken/by whom and when
1 It is recommended that occupational
therapists safely and appropriately
assess the neurobehavioural status of
the high-risk infant, in order to plan/
deliver developmentally supportive care.

2 It is recommended that occupational

therapists assess neurobehavioural
and neurodevelopmental status to
provide guidance and identify infants
appropriate for developmental follow-up
following discharge.

3 It is recommended that occupational

therapists liaise with community teams
and assess neurodevelopmental status
for high-risk infants in the first two
years of life to provide guidance and
implement early intervention services
where indicated.

This Audit Form may be copied and adapted for non-commercial use.
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 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Developmentally supportive care How do you evidence this? Action to be taken/by whom and when
4 It is recommended that developmentally
supportive care principles are
implemented for high-risk infants
admitted to neonatal units to enhance
short term health and developmental
outcomes.

5 It is recommended that occupational

therapists promote an appropriate
developmental environment, based on
the infant’s age and status and individual
needs.

What is your current practice? Comments

Pain management How do you evidence this? Action to be taken/by whom and when
6 It is recommended that occupational
therapists promote and support parent
provision of skin-to-skin care with their
infant during appropriate, planned, painful
caregiving procedures (e.g. heel lance).

This Audit Form may be copied and adapted for non-commercial use.
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 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Pain management (cont’d) How do you evidence this? Action to be taken/by whom and when
7 It is recommended that occupational
therapists promote the use of facilitated
tucking by all caregivers (parents and
practitioners) for pain management
during relevant caregiving procedures
(e.g. endotracheal suctioning).

8 It is recommended that occupational

therapists support parent understanding
and facilitate engagement in appropriate
pain management strategies to enable
them to provide sensitive support to
their infants and promote parent self-
efficacy.

9 It is recommended that occupational

therapists work with the neonatal
team to promote routine assessment
of neonatal pain and identification
of appropriate pain management
strategies.

This Audit Form may be copied and adapted for non-commercial use.
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 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Skin-to-skin (kangaroo) care How do you evidence this? Action to be taken/by whom and when
10 It is recommended that occupational
therapists collaborate with the neonatal
team to facilitate parent engagement
in skin-to-skin care for high-risk
infants to promote breastfeeding, pain
management, physiological regulation
and parent self-efficacy.

What is your current practice? Comments

Positioning How do you evidence this? Action to be taken/by whom and when
11 It is recommended that occupational
therapists collaborate with the neonatal
team to facilitate individualised
positioning recommendations for infants
that promote infant motor outcomes,
self-regulatory behaviours and prevent
respiratory compromise.

12 It is recommended that occupational

therapists review the selection and
use of neonatal positioning aids for
their ability to promote infant motor
outcomes, the development of infant
postural control and self-regulatory
behaviours.

This Audit Form may be copied and adapted for non-commercial use.
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 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Positioning (cont’d) How do you evidence this? Action to be taken/by whom and when
13 It is recommended that occupational
therapists use a positioning assessment
tool to support the education of
the neonatal team and promote
individualised positioning of high-risk
infants in the neonatal unit.

What is your current practice? Comments

Infant feeding How do you evidence this? Action to be taken/by whom and when
14 It is recommended that occupational
therapists collaborate with the neonatal
team to support parents in reading and
responding to infant feeding readiness
cues to promote the shared occupation
of feeding in the neonatal unit and
following transition to home.

15 It is recommended that occupational

therapists promote an appropriate
environment in the neonatal unit to
support parent/infant participation
in early feeding experiences.
Environmental support factors may
include space, seating, privacy, sensory
environment and NICU culture.

This Audit Form may be copied and adapted for non-commercial use.
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 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Parent engagement How do you evidence this? Action to be taken/by whom and when
16 It is recommended that occupational
therapists work with parents of high-risk
infants to support parenting roles and
relationships, and to provide sensitive
and appropriate parent engagement in
the infant’s care in the neonatal unit.

17 It is recommended that occupational

therapists facilitate the development of
shared occupations of feeding, dressing
and play activities of daily living with
preterm and low-birthweight infants
to ensure sensitive and appropriate
caregiving and promote occupational
performance of infants and parents.

18 It is recommended that occupational

therapists working with families of high-
risk infants build a positive therapeutic
collaboration with parents to enhance
parental learning about their infant both
during and following the transition to
home.

This Audit Form may be copied and adapted for non-commercial use.
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 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Parent engagement (cont’d) How do you evidence this? Action to be taken/by whom and when
19 It is suggested that occupational therapists
explore both traditional and innovative
means (e.g. video-conferencing) of
supporting families post-discharge from
the neonatal unit as a means of promoting
parent confidence and competence
in caring for their infant following the
transition to home.

What is your current practice? Comments

Parent support How do you evidence this? Action to be taken/by whom and when
20 It is recommended that occupational
therapists support engagement in
parenting occupations in the neonatal unit
and following discharge (including, but
not limited to reading infant cues, guided
participation in care, skin-to-skin, positive
touch and holding) to promote decreased
parent stress and positive improvements
in parent–infant relationship and self-
efficacy.
21 It is recommended that occupational
therapists employ parent-focused
interventions that incorporate parental
sensitivity elements (e.g. reading infant
cues and responding in developmentally
appropriate ways) in order to reduce
the psychosocial impact of delivering a
high-risk infant, foster sensitive nurturing
behaviour and promote the cognitive
development of preterm infants.

This Audit Form may be copied and adapted for non-commercial use.
© Royal College of Occupational Therapists 2017. The Royal College of Occupational Therapists Ltd is a registered charity in England and Wales (No. 275119) and in Scotland (No. SCO39573) and a company registered in England (No. 1347374) Page 8 of 12
 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Parent support (cont’d) How do you evidence this? Action to be taken/by whom and when
22 It is suggested that occupational therapists
engage parents in brief activity-based
interventions during their infant’s admission
to the neonatal unit and that this can have a
short-term effect in lowering parent anxiety.

What is your current practice? Comments

Identifying developmental concerns How do you evidence this? Action to be taken/by whom and when
23 It is recommended that occupational
therapists should be involved in the
screening and assessment of high-risk
infants for problems related to cognitive
performance and social interaction, in
order to support the development of the
infant’s occupations, with referral to early
intervention services as indicated.

24 It is recommended that occupational

therapists should be involved in the
screening and assessment of high-risk
infants for problems related to functional
motor skills, in order to support the
development of the infant’s occupations,
with referral to early intervention services as
indicated.

This Audit Form may be copied and adapted for non-commercial use.
© Royal College of Occupational Therapists 2017. The Royal College of Occupational Therapists Ltd is a registered charity in England and Wales (No. 275119) and in Scotland (No. SCO39573) and a company registered in England (No. 1347374) Page 9 of 12
 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

Identifying developmental concerns What is your current practice? Comments

(cont’d) How do you evidence this? Action to be taken/by whom and when
25 It is recommended that occupational
therapists should be involved in the
screening and assessment of high-risk
infants for problems related to sensory
processing difficulties, in order to support
the development of the infant’s occupations,
with referral for early intervention services
as indicated.

What is your current practice? Comments

Early intervention How do you evidence this? Action to be taken/by whom and when
26 It is recommended that occupational
therapists provide early developmental
intervention programmes for preterm
infants to promote improved cognitive
performance through the preschool years.

27 It is recommended that occupational

therapists provide home-based early
intervention programmes for infants born
<30 weeks gestation in the first year of life as
this may result in decreasing parent anxiety.

This Audit Form may be copied and adapted for non-commercial use.
© Royal College of Occupational Therapists 2017. The Royal College of Occupational Therapists Ltd is a registered charity in England and Wales (No. 275119) and in Scotland (No. SCO39573) and a company registered in England (No. 1347374) Page 10 of 12
 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Early intervention (cont’d) How do you evidence this? Action to be taken/by whom and when
28 It is recommended that occupational
therapists facilitate individualised
functional motor interventions for
high-risk infants and young children
to promote engagement in early
occupations such as play, exploration
and participating in personal care
(activities of daily living).

29 It is recommended that occupational

therapists incorporate home routine/
occupation-based approaches in early
intervention programmes for children at
risk for developmental delay as a means
of promoting occupational performance.

30 It is recommended that occupational

therapists be routinely referred preterm
infants with the following co-morbidities:
septicaemia, extremely low birth
weight (ELBW), chronic lung disease,
periventricular leukomalacia (PVL) or
intraventricular haemorrhage (IVH)
(grade III–IV), for early intervention.

This Audit Form may be copied and adapted for non-commercial use.
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 Royal College of Occupational Therapists
Occupational therapy in neonatal services and early intervention
Audit Form
Please ensure that you save this PDF to your desktop BEFORE making any changes, otherwise your data will be lost

Date of audit Auditor Role

Location Review due date
(Please note, the font size will adjust automatically to fit the box)

What is your current practice? Comments

Early intervention (cont’d) How do you evidence this? Action to be taken/by whom and when
31 It is recommended that occupational
therapists working in early
intervention settings with high-risk
infants consider key elements when
building a therapeutic collaboration
with parents – promoting effective
collaboration amongst multi-agency
providers, supporting family social/
emotional needs in addition to
infant developmental concerns, and
consistency of service provision.

This Audit Form may be copied and adapted for non-commercial use.
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