Room 421 May 14, 2019 oral abstract
Service Enhancement Presentation 14:30 - 15:45

Clinical Safety and Quality Service I

Pilot Ward Pharmacist Service in Tseung Kwan O Hospital – Optimizing Resources of Physicians and Nurses and Enhancing Pharmaceutical Care
14:30 - 14:40
Presented by : Ting San FONG

Introduction

Public hospitals are facing increasing challenge in service demand; to relieve heavy workload of doctors and nurses and to enhance medication safety, Tseung Kwan O Hospital piloted Ward Pharmacist Service on a medical ward on 5th March 2018. Ward pharmacists would station on ward and manage drug-related issues throughout patient journey.

Objectives

To reduce workload of frontline doctors and nurses, enhance pharmaceutical care and medication safety and improve overall service quality and efficiency of discharge process.

Methodology

Ward pharmacists would station on an acute medical ward Monday to Friday from 9:00am to 1:00pm. Upon patients’ admission, pharmacists would perform medication reconciliation and compile patients’ “Best Possible Medication History” by reviewing medical records and performing patient interview. Pharmacists would communicate with doctors and nurses if unintentional discrepancies were identified. During inpatient stay, pharmacists would review patient progress, verify IPMOE orders on ward and provide on-site clinical pharmacy support to doctors and nurses when needed. At discharge, pharmacists would assist doctors by preparing discharge prescriptions in advance in CMS for doctors’ endorsement so as to free up their time for other clinical activities. For prescriptions prepared directly by doctors, pharmacists would perform discharge medication reconciliation. Pharmacists would also provide bedside discharge counselling to patients.

Results & Outcome

Till 31st December 2018, ward pharmacists served 201 half-days and reviewed 894 cases. Unintentional discrepancies and compliance problems were identified in 143 cases (16.0%) during admission medication reconciliation. Pharmacists prepared 173 discharge prescriptions (38.9%) out of 445 discharge cases handled during service hours. From the remaining 272 prescriptions prepared by doctors, pharmacists identified unintentional discrepancies and other drug-related problems in 96 cases (35.3%). Overall, pharmacists made 979 treatment recommendations and 928 (94.8%) of them were accepted by doctors. Among all the cases reviewed (n=894), pharmacists made recommendations for 366 (40.9%) of them. The service was well accepted by ward staff. Over 90% of them agreed that pharmacists can reduce unintentional discrepancies and save doctors’ and nurses’ time in discharge process. They also agreed that Ward Pharmacist Service should be extended to other wards. Ward pharmacists could enhance patient care by providing on-site clinical pharmacy support, reducing workload of doctors and nurses and improving medication safety by reducing unintentional discrepancies.

 

 

The Decennium Changes in Primary Health Care Wound Clinic – Safe, Quality & Efficient
14:41 - 14:50
Presented by : Annette LAM

Introduction

The aging people and on time discharge minimized prolong hospitalization, in order to face with the increasing demand and complexity of wound care in Primary Health Care. Before 2009, there is lack of standardization on wound assessment, planning, training and referral system, resulting in unnecessary dressing frequency and heavy workload.

Objectives

To provide safe and effective wound care in primary health care.

Methodology

A structural referral system was launched in 2009, from frontline to wound specialist which frontline nurses are responsible for screening and assessment. Wound link nurse in each clinic would devise a wound management plan and monitor the progress on healing. Wound specialist would initiate advanced investigations and interventions when healing is delayed. Knowledge & skill transfer like wound information update via Department Intranet, Wound Assessment Quick Guide and new wound products sharing class can facilitate frontline staff to tackle the wound problems. Through patient empowerment program (Leg Club and Walk with Diabetes - Foot Care), and a series of poster and educational pamphlet on burn & scald care, varicose, fallacies of wound care and ingrown toe nail care, etc. can arouse the awareness on patient immediate care on wound. Also local Evidence Based Studies on wound pain control and wound shower could build up the confidence on both patients and nursing staff.

Results & Outcome

The statistical dressing attendance in General Out-patient Clinic was dramatically drop around 25.2%, from 85536 in 2008 to 63999 in 2018. However, the numbers of patient were increased around 17.6% from 15802 to 18582 respectively. The healing rate on leg ulcer, burn & scald and traumatic wound have 30-50% speed up. Statistically showed that even increasing service capacity and without any extra nursing manpower and clinic space, the performance on wound care can be effectively delivered. The well establish referral system is getting efficient in wound management. Wound Clinic can provide continuity & safety care by close monitoring and enhanced service quality of wound care in community by early detection and proactive therapeutic nursing intervention and empowerment.

 

 

Development of an OT Clinical Pathway to Facilitate Recovery and Discharge of Elderly Patients in Extended care wards of KH: Preparation for a Further Comprehensive Research
14:51 - 15:00
Presented by : Wan Fung Ruth Lam

Introduction

Working in geriatric extended care wards, occupational therapists usually come across patients with wide range of medical conditions. Bell et. al. (2016) summarized in their study that the prevalence of geriatric syndromes of hospitalized patients referred to skilled nursing facility was 90%, of which 55% got ≥3 co-existing syndromes. Labella et. Al. (2011) highlighted the importance of improving the care by screening elderly patients for the presence of common geriatric syndromes. In order to provide a better quality of care, utilization of a clinical pathway that facilitating early screening and intervention of geriatric syndrome, would enhance rehabilitation outcomes in a cost-effective way. This paper reported the development of an OT clinical practice guide that facilitating recovery and discharge of elderly patients in extended care wards.

Objectives

1. To understand and learn the different geriatric syndromes, by review of evidence, which could lead to serious complication and highly impact on patients’ recovery during hospitalization. 2. Develop a comprehensive OT clinical pathway for early identification and intervention of geriatric syndromes 3. Pilot study in 2 geri-medical wards in KH to see the severity of the geriatric symptoms of the cases 4. Enhance clinical use of the pathway by in-services training, and then followed by further comprehensive research

Methodology

Oct-Dec 2018 Literature Review Jan 2018 Finalize the clinical pathway Feb 2018 Pilot study in 5 extended care wards of KH April 2018 In-services training

Results & Outcome

The OT clinical practice pathway outlined the therapists’ clinical tasks, assessment, intervention and precaution that beginning from the admission phase, the rehabilitation phase to the final pre-discharge phase. The content was disease specific and also with emphasis on early screening and intervention of the common geriatric symptoms including, falls, pressure sores, delirium, depressive symptoms and functional decline. Liaison work to enhance multi-disciplinary input was also the focus of the clinical pathway. After the development of the clinical pathway and the pilot study, related in-services training will be conducted to all the OT colleagues in the department. The clinical pathway will be commenced to be utilized in geriatric patients of extended wards of different specialties including orthopaedic, spinal, RMD and medical geriatrics. The information collected will be as a reference for further comprehensive retrospective study.

 

 

Speedy recovery, early home! - Daily Physiotherapy benefits geriatric hip fracture patients
15:01 - 15:10
Presented by : Kim Chung MO

Introduction

Literature revealed that additional weekend and holiday Physiotherapy(PT) training is effective to improve functional recovery and reduce hospital length of stay in some patient groups. Strategic Service Framework(SSF) for Rehabilitation Services by Hospital Authority(HA) also stated the direction in providing rehabilitation service 7 day per week in selected patient group. One acute and one rehabilitation hospital in New Territories East Cluster(NTEC) launched the 7 day per week PT service for Geriatric Hip Fracture patients since 1st October 2017.

Objectives

To test the hypothesis that additional weekend and holiday PT training in in-patient phase might speed up the rehabilitation process for geriatric hip fracture patients.

Methodology

With a retrospective case-control study design, 355 geriatric hip fracture patients’ medical records were analyzed. Patients admitted Tai Po Hospital(TPH) in October 2017 to March 2018 were assigned as study group while patients admitted TPH in October 2016 to March 2017 were assigned as control group. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Category(MFAC), Elderly Mobility Scale(EMS), Modified Barthel Index(MBI) and length of hospital stay.

Results & Outcome

[Data shown in (study group vs control group) in mean±SD] For patients from acute hospital with 7 day per week PT training, better MFAC (3.17±1.05 vs 3.05±1.254,p=0.015) and MBI (47.35±19.63 vs 42.99±20.02,p=0.042), similar EMS (3.81±3.03 vs 3.96±3.65,p=0.518) were observed with similar post-operative acute hospital stay(7.69±3.87 vs 7.41±5.03 days,p=0.192). A higher percentage of day having PT training during rehab hospital stay was shown with the implementation of new service(89.1% vs 65.9%). Comparable mobility status at discharge was demonstrated by similar functional outcomes, in MFAC (4.35±1.27 vs 4.25±1.61, p=0.788), EMS (8.19±5.45 vs 8.44±6.06, p=0.998) and MBI (63.00±23.43 vs 61.17±26.08, p=0.743) with a significant shorter rehab hospital stay(19.99±5.51 vs 24.26±9.86 days, p=0.000) in patients with 7 days per week PT training. To conclude, additional weekend and holiday PT training is effective to improve functional recovery and reduce hospital length of stay for geriatric hip fracture patients.

 

 

Physiotherapy program reduces cancer-related fatigue and improves quality of life in cancer patients with chemotherapy
15:11 - 15:20
Presented by : Sally WAN

Introduction

Cancer-rated fatigue is the most commonly reported treatment-related side effect from chemotherapy. Such symptom can be very distressing and frustrating that affect mentally, physically, emotionally and spiritually, leading to reduced physical activity, social engagement and quality of life in cancer patients. Physiotherapy plays a crucial role in the management of fatigue symptoms. Exercises in correct dosage of intensity and method enable cancer patients to increase their physical activity, reduce fatigue and improve the functional status. However, majority of the cancer patients did not notice the causal relationship between exercise and fatigue and prone to remain physically inactive and exercise less.

Objectives

To evaluate the effectiveness of Physiotherapy Fatigue Management Program on (1) promoting knowledge of cancer-related fatigue, (2) enhancing exercise habit and physical activity, and (3) improving symptom of fatigue and quality of life in cancer patients receiving chemotherapy.

Methodology

Patients who were diagnosed of cancer and underwent chemotherapy that joined the Physiotherapy Fatigue Management Program from 1 April to 30 September 2018 were analyzed. The Program included both educational and exercise components. All patients were educated on knowledge and self-management tips about cancer-related fatigue and supplemented by an educational booklet with photos illustration on home exercise program and exercise log book. The exercise component included a multidimensional program that comprised of relaxation exercise, active limb mobilization exercise, aerobic exercise, strengthening exercise and acu-point massage. Participants were advised to exercise daily and record down their compliance in the exercise log book. Outcome measures included (1) questionnaire on fatigue knowledge, (2) Brief Fatigue Index (BFI-T) to measure severity and impact of fatigue, (4) Functional Assessment of Cancer Therapy – Fatigue (FACT-F) to measure quality of life. Evaluations were done at baseline and immediately upon completion of chemotherapy. Telephone follow-ups were conducted at 1-week and 2-month post-chemotherapy to check for exercise compliance and positive reinforcement was provided if participants come across any barriers.

Results & Outcome

Twenty patients, aged ranged from 45 to 76 years old, were analyzed. Majority of them suffered from cancer in colorectal (60%), lung (15%), cervix (10%), lymphoma (10%), and small bowel (5%). Improvements were shown for all the outcome measures. At baseline, only 5% of the participants knew what was cancer-related fatigue and the related non-pharmacological management approach. On completion of education training, all participants (100%) showed understanding on the causal relationship between exercise and fatigue. At 1-week follow-up, 75% of the participants reported exercise of at least 150 hours per week. At 2-month follow-up, both the BFI-T score and FACT-F scores were significantly improved and higher (p< 0.05) in this group of participants as compared with those exercise less than 150 hours per week. Physiotherapy Fatigue Management Program was effective on promoting knowledge, enhancing physical activity and exercise habit, and reducing cancer-related fatigue and improving quality of life in cancer patients receiving chemotherapy.

 

 

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