Enhancement and evaluation the patient monitoring program during physiotherapy treatment

Abstract Description

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Authors (including presenting author) :

Leung TY(2), Lai WK(1),Lam SL(1), Wong SY(2)

Affiliation :

(1) Physiotherapy Department, Shatin Hospital (SH) (2) Physiotherapy Department, Cheshire Home Shatin (SCH)

Introduction :

In previous practice, Physiotherapy staff referred to the standard value of blood pressure (120/80) and heart rate (range 60-100, mean 80) to detect the abnormal observation in the vital signs of patient attending treatment sessions. This practice was not sensitive enough to detect early deviation of blood pressure and heart rate from the norm in our clinical practice.

Objectives :

In order to enhance the sensitivity of early detection of abnormal observation in vital signs, the Yellow/ Red criterion of integrated observation chart was adopted in this program. It was a two tiers monitoring system with the Yellow Criterion and the Red Criterion to monitor systolic blood pressure and heart/pulse rate. This approach provided systematic method to monitor the vital signs of patients.

Methodology :

1. The patient vital signs records form was reviewed. 2. The new monitoring system was introduced to staff by in-service training. 3. The blood pressure and heart rate of all patients attending Physiotherapy gymnasium exercise sessions would be measured and recorded. For the Yellow criterion, the systolic blood pressure is 91-100mmHg or 180-200mmHg and/or heart /pulse rate is 40-45 or 111-130 beats per minute. For the Red criterion, the systolic blood pressure is ≤90mmHg or ≥200mmHg and/or heart/pulse rate is heart rate/pulse ≤40 or ≥131 beats per minute. 4. The data of patient vital signs records was reviewed and analyzed.

Result & Outcome :

A total 2270 patients attended Physiotherapy treatment sessions from November 2017 to April 2018. For systolic blood pressure, 3.70% of patients was in the Yellow criterion and 1.98% was in the Red criterion with overall 5.68% of patients fell into both Yellow and Red criteria. For heart/pulse rate, 0.18% of patients was in the Yellow criterion and 0.04% of patients was in the Red criterion with overall 0.22% of patients fell into both Yellow and Red criteria. High risk cases are identified through this two tiers monitoring system. In response to the detected deviation of the vital signs, optimized measures were implemented to enhance patient safety accordingly: 1. If patient has one or more Yellow criteria detected, alert physiotherapist. 2. Compare the measurement to previous patients’ record. 3. Keep close observation to patients during exercise sessions. 4. Increase frequency of monitoring during exercise sessions. 5. Transfer patients back to ward as indicated and handover to ward staff. Staff’s feedback was also collected in January and April 2018. All staff of the Physiotherapy Department agreed that this monitoring system was more effective than previous practice and it could also facilitate the monitoring to those patients with communication problem and poor insight. Further audit would be done to re-assess the effectiveness of this program in April 2019.