A three steps “SAFE model: Screening, Checking and Monitoring”, to prevent change of patient’s condition during training in physiotherapy department in Shatin Hospital

Introduction

There has been an increase in frequency of changes in patient conditions during training in physiotherapy department due to frailty, multiple comorbidities and more acute status of patients that may endanger patients’ safety. Patients’ safety is always first priority in delivering treatment to patients.

Objectives

To derive a systematic, practical and sustainable system to minimize the occurrence of change of patient condition in physiotherapy department

Methodology

Root cause analysis was conducted for the “change of patient condition” data (10 cases happened for 15148 patient attendances) in first 10 months in 2017. It included patient’s medical record review and staff interview. Major information reviewed including screening of patients’ medical history, any checking and monitoring of vital signs for those patients. Major causes were postural hypotension (60 %) and poor blood pressure (BP) control (10%). Practice of monitoring of vital signs was inconsistent amongst different therapists. In addition, focus group was formed with physiotherapist team in-charge in different specialties, to gather opinions on safety measures. A three steps “SAFE” model: Screening, Checking and Monitoring” was implemented in January 2018. Step 1 “Screening” was a procedure that using standardized screening checklist, which included contra-indications and precautions for screening of medical conditions and unstable vital signs. All physiotherapists needed to conduct this procedure. Step 2 “Checking” was checking patients’ vital signs (using reference range from screening checklist) before training in physiotherapy department. Staff needed to sign a checking record, with regular audit by senior staff. Step 3 “Monitoring” was monitoring of vital signs during training if the patients’ vital signs was within borderline range (regarded as precautions in screening checklist).

Results & Outcome

After implementing the procedures of “Screening” and “Checking”, percentage of patients cancelled due to unstable vital signs was 2.2% (482 out of 21909 patients booking) in 2018. Unstable vital signs included fever (58.5%), unstable BP (27.8%) and unstable pulse rate (3.7%). Together with the measures of “Monitoring”, the occurrence rate of change of patient condition in physiotherapy department showed a marked decreasing trend (decrease 64.1%) from 0.92 incidents per month in 2017 (out of 18178 yearly attendances) to 0.33 incidents per month in 2018 (out of 21424 yearly attendances). Staff evaluation questionnaire showed that all staff agreed that the 3 steps “SAFE model” could increase staff awareness on patients’ safety and decrease occurrence of change of patient condition in physiotherapy department. Continuous data collection and evaluation, and regular safety measures review are necessary to enhance patients’ safety in future.