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Room 421 oral abstract Service Enhancement Presentation
May 15, 2019 09:00 AM - 10:15 AM (Asia/Hong_Kong) Switch to local time
20190515T0900 20190515T1015 Asia/Hong_Kong Service Enhancement Presentation 5 - Clinical Safety and Quality Service III

Clinical Safety and Quality Service III

Room 421 HA Convention 2019 hac.convention@gmail.com

Clinical Safety and Quality Service III

Spasticity Management to enhance functional recovery for patient with Stroke.View Abstract

09:00 AM - 09:10 AM2019/05/15 01:00:00 UTC - 2019/05/15 01:10:00 UTC

Introduction

According to the Seven Brunnstrom Stages of Motor Recovery (Brunnstrom 1970), stroke patients go through stage of flaccidity to some spastic tone, marked spasticity and synergistic movements in the first 4 stages. At stage 5, spasticity fading with synergies gradually reduced and develop coordinated and complex movement and back to normal. However, it is the most challenging task for therapists to help stroke patients who have developed mark spasticity to revert to regain normal movement from adapted synergistic movements. Sunnerhagen et. al., 2016, reviewed some predictors of post stroke spasticity. Based on Neuro-IFRAH approach, Occupational Therapy in Kowloon Hospital has been working in previous years to prevent and reduce spasticity for patients with stroke. The application is from sub-acute to out-patient phases. It involve in/out patient phase patient and care taker education on handling and positioning for shoulder protection and spasticity risk factors, stratified treatment in early trunk control, facilitative upper limb training, application of flexor tone inhibitory splints and home programs.

Objectives

(1) To prevent and reduce severe spasticity development in stroke survivors. (2) To enhance better upper limb and self-care function for patients with stroke.

Methodology

A retrospective review of stroke outcome data from CDARS is compared for in and out patients in the period of 2016 to 2018. For cases who had received intensive OT training together with botox injection or TMS treatment by Rehab Specialist, a pre-test and post –test design was used to compare the efficacy of intervention in spasticity, upper limb function and self-care function.

Results & Outcome

The retrospective review of inpatient data showed significate different of Functional Independence Measurement (FIM) gain for stroke patients (p< 0.001) in 2014/15 (n=803) average gain is 8 while 2016 to 2018 (n=2869) FIM gain is 11.1. From 2016 to 2018 CDARS data, Functional Test of Hempilegic Upper Extremity (FTHUE) gained average 0.5 (in-patients), and average 2 (out-patients). The intensive OT anti-spasticity program was also collaborated with two intervention of TMS and Botox injection by our Rehab Specialist in Kowloon Hospital also reflected positive outcomes in terms of FTHU, FIM active, passive range of movement and spasticity.

 

 

Presenters
DC
Dora CHAN
Cross-functional Program: Improving Anti-Embolism Stocking Application in Neurosurgical Unit with Lean and Six Sigma FrameworkView Abstract

09:11 AM - 09:20 AM2019/05/15 01:11:00 UTC - 2019/05/15 01:20:00 UTC

Introduction

Lean and Six Sigma is widely used in healthcare system to improve quality of care. Proper Anti-Embolism Stocking (TED) application is crucial to avoid patients suffering from deep vein thrombosis as a result of immobility. The author adopted Lean and Six Sigma framework to enhance effective application of TED in Neurosurgical Unit, PWH.

Objectives

(1) To Identify the root causes of inappropriate application of TED (2) To make a sustainable improvement of TED application in Neurosurgical Unit.

Methodology

The Lean and Six Sigma framework included: (1) Define phase, a multidisciplinary team included neurosurgical nurses and physiotherapists was formed in Neurosurgical Unit, PWH. A project charter was created to set the goal and scope of the program. Literature review about updated TED usage and monitoring was done. (2) Measure phase, for assessing staff performance, physiotherapists were invited to conduct pre-audit in collaboration with a Six Sigma Leader (Author). Moreover, nurses' and supporting staff knowledge was assessed with questionnaire. (3) Analyze phase, members performed data and graphical analysis to identify the root causes which were inadequate training and staff knowledge. (4) Improve phase, training sessions on proper TED application were held by nurses and physiotherapists. The video of training session was shared on electronic mobile platform for easy retrieval. In addition, the post-audit of TED application and staff knowledge assessment were conducted. (5) Control phase, a control plan included new staff orientation, regular internal audits were established. To make the improvement more sustainable, signage was designed and posted up to increase staff and relatives' awareness. A video was produced for educating relatives on the usage and care of TED, which would be broadcasted during visiting hours.

Results & Outcome

200 samples were collected in pre-& post-audits respectively. “Toe stick out of inspection hole” and “wrinkles” were the two most common problems. The number of improper TED wearing dropped from 148 to 69 after staff sharing sessions (95%CI, p-value< 0.001, Chi-square test). The Overall Effectiveness improved from 0.26 to 0.65 (95%CI, p-Value< 0.001, paired t-test). The SIGMA level increased from 2.4 σ to 3 σ. Staff knowledge also increased significantly, with mean score increased from 5.9 to 8.8 (95% CI, p-value< 0.001, paired t-test).

 

 

Presenters
CK
Chan Kwun Fai
Registered Nurse
Prevalence of Sarcopenia in Geriatric Day Hospital Ambulatory Patient and the Effects of 8-week Resisted Exercise Training to their muscle-related functionsView Abstract

09:21 AM - 09:30 AM2019/05/15 01:21:00 UTC - 2019/05/15 01:30:00 UTC

Introduction

Sarcopenia is a common but always underestimated condition in elderly population. According to Asia Working Group of Sarcopenia (AWGS), Gait speed < 0.8m/s and/or Handgrip Strength with Male < 26 Kg and Female < 18 Kg and Skeletal Muscle Index (SMI) with Male < 7kg/m2 and Female < 5.7kg/m2 are classified as sarcopenia. Sarcopenia in elderly is a known predictor for future morbidity and mortality. Early detection and intervention with Resisted Exercise Training are needed to augment the muscle-related functions of the sarcopenia elderly.

Objectives

1. Analyze the prevalence of ambulatory community-dwelling elderly (unaided or one handed aids) sarcopenia in Geriatric Day Hospital (GDH) 2. Evaluate the effect of an 8-week Resisted Exercise Training on muscle mass and the muscle-related functions.

Methodology

Elderly who were able to walk independently in GDH from July 2018 to September 2018 were selected. Elderly with pacemaker and metal implant were excluded. Handgrip Strength and bio-impedance body muscles composition assessment including SMI were assessed. The muscle-related functions including Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS) were assessed. They were divided into two groups. One group (conventional) attended the conventional PT training in GDH and the other group (RE) received an 8-week Resisted Exercise Training at GDH and home regime with log book. All participants received the pre assessment and post 8 weeks assessment.

Results & Outcome

Results: Among 39 elderly assessed, 54% (N=21) was classified as sarcopenia according to AWGS definition. 12 and 9 sarcopenia elderly were assigned to RE and conventional group respectively. After 8-week training, both groups (3 cases drop out in RE group) showed significant improvement in BBS (RE: p=0.0001; conventional: p=0.001; paired t-test). RE group showed significant improvement in BBS (p=0.034; independent t-test) compared to conventional group. Only RE group showed significant improvement in TUGT (p=0.007; paired t-test). There was no significant difference in SMI in both groups. Conclusion: The prevalence of sarcopenia in GDH is quite high but they are often overlooked. Resisted Exercise Training has shown to be more effective to improve the muscle-related functions. Public Implications: Early screening and intervention with Resisted Exercise Training help to augment the muscle-related functions of sarcopenia elderly.

 

 

Presenters
KC
K M CHENG
Strategies to prevent catheter-associated urinary tract infection of patients undergo colorectal resection in the zero-tolerance eraView Abstract

09:31 AM - 09:40 AM2019/05/15 01:31:00 UTC - 2019/05/15 01:40:00 UTC

Introduction

Catheter-associated urinary tract infection (CAUTI) is a major cause of hospital-acquired infection. For the Surgical Outcomes Monitoring and Improvement Programme (SOMIP) database from July 2015 to June 2016, symptomatic urinary tract infection rate in different surgical teams under HAHO, the mean score was 2.5%. However, the score in our colorectal surgical team was 5%. Cases were all systematically reviewed. Total 240 cases with colorectal resection performed during the year and 12 cases were post-operatively diagnosed of CAUTI. It was found that majority of the patients were suffered from rectal cancer and intra-abdominal pelvic surgeries were performed. The indwelling catheter should be kept at least 3 to 5 days after operation in order to close monitor the urine output and prevent from dehydration.

Objectives

1.To reduce the rate of catheter-associated urinary tract infection of patients undergo colorectal resection 2.To improve the quality of urinary catheter care in the Department of Surgery

Methodology

In order to compare the difference outcomes for difference interventions, project team planned to conduct the program into two phases within 6 months. In Phase I, five comprehensive strategies would be implemented from October to December, 2017. And in Phase II, five strategies with one more intervention would be implemented from January to March, 2018. Phase I 1.Reinforce strict aseptic technique of catheterization 2.Stop the practice of changing urometer, provide training to healthcare supporting staff and audit the practice 3.Design and use a paper card reminder for daily review catheter maintenance 4.Involve patients and carers for indwelling catheter care during post-operative period 5.Using devices to keep catheter in place after insertion Phase II Using antimicrobial 100% silicone urinary catheter in bundle with five preventive CAUTI interventions

Results & Outcome

Total of 110 patients were recruited in the program. The duration of catheterization at the period of 1/4/2017 – 30/9/17 and 1/10/17 – 31/3/18 was compared. Patients with catheterization more than 4 days (Post-operative Day 3) on 1/4/17 – 30/9/17 were 61.5% but only 34.5% on 1/10/17 – 31/3/17. It has been decreased 27%. Besides, there were total 4 patients with CAUTI during phase I of study. The percentage of CAUTI was 3.5% which was decreased 1.5% compared with the data of SOMIP in 2016. And it was shown that zero case of CAUTI in phase II after using antimicrobal urinary catheter.

 

 

Presenters
CL
Choi Ping LAM
Implementation of Osteoporosis Phone Direct Enquiry Service (OPD-ES) to maintain good service quality in the context of increasing patient loadView Abstract

09:41 AM - 09:50 AM2019/05/15 01:41:00 UTC - 2019/05/15 01:50:00 UTC

Introduction

The volume of patients with osteoporosis has been increasing in recent years due to multiple reasons. The frequency of follow-up for old cases in Osteoporosis Clinic has lengthened from 24+/-3 weeks in 2013 to 34+/-2 weeks in 2016. Such a lengthening is also contributed by the advanced age of osteoporosis patients as travelling may sometimes be difficult. In order to maintain our service quality, a nurse-led program, the Osteoporosis Phone Direct Enquiry Service (OPD-ES) has been implemented since Nov 2017.

Objectives

1.To enhance service quality and continuity of care to patient with osteoporosis with lengthening follow-up duration; 2.To evaluate the effectiveness of OPD-ES

Methodology

OPD-ES functions as an active communication channel between patients, their carers and health care professionals. A direct hotline operated in office hours allows patients and carers to actively seek advices from healthcare workers concerning their disease management in between their routine follow-up sessions. After addressing the enquiries immediately over the phone, nurse clinics are arranged for patients requiring individual education or counselling. All enquiries concerning patients’ medical condition are discussed in case conferences with in-charge physicians. Ad-hoc medical consultation appointment is arranged if considered necessary by the physician. The effectiveness of the service was assessed by the number of cases who used the service, and number of ad-hoc follow-up sessions arranged. Reasons of phone enquiries were also analysed.

Results & Outcome

463 (94% female) patients attended Osteoporosis Clinic from Nov 2017 to Nov 2018. All were put on anti-osteoporotic agents (Denosumab: 234, 50.5%; Bisphosphonates: 211, 45.6%; Teriparatide: 16, 3.5%; and Strontium: 2, 0.4%). 237 (51.2%) patients and/ or carers used OPD-ES. Reasons of enquiries included use of anti-osteoporotic agents (143, 30.9%), issues related to dental complaints or procedures (65, 14.0%) and changes in medical condition (29, 6.3%). 54 (22.8%) patients were arranged for education and counselling in nurse clinic, and 25 (10.5%) patients required ad-hoc medical consultation (medication intolerance: 9; new fracture: 7; deranged renal function: 5; stroke: 2; dental issue related to bisphosphonate osteonecrosis of jaw: 2). OPD-ES functions effectively to enhance good service quality and maintain good continuity of care to patients with osteoporosis who have long follow up duration. The program also empowers patients and carers to participate actively in their disease management through the service.

 

 

Presenters
CL
Connie LOONG
Palliative Multidisciplinary Breathlessness Support Service in PYNEHView Abstract

09:51 AM - 10:00 AM2019/05/15 01:51:00 UTC - 2019/05/15 02:00:00 UTC

Introduction

Refractory breathlessness is a disabling and distressing symptom that is common in incurable cancer and end-stage chronic cardio-respiratory illnesses. Non-pharmacological interventions have positive impacts on the individual’s perception of breathlessness and the self-efficacy of symptom management. A palliative one-point access multidisciplinary(MDT) Breathlessness Support Service(BSS) was started in PYNEH.

Objectives

(1)To enhance the self-efficacy on breathlessness management; (2)to alleviate psychological distress; (3)to improve the quality of life(QoL).

Methodology

This pilot MDT BSS consists of a short-term four half-day weekly sessions catering 4-6 patients. Participants are delivered the skills of breathing & physical exercises, energy conservation and relaxation to cope with ADL tasks, targeted psychological support, and home caring advice by the physiotherapists, occupational therapists, clinical psychologists and palliative care nurses. Pre- and post-intervention assessment were carried out to evaluate the outcome.

Results & Outcome

There were 37 participants (M:F: 27:10; 19 ONC patients, 18 MED patients) from March to December 2018. Lung cancer(43%) and COPD(32%) were the main diagnoses. The mean age was 74.2 years old(range 46-94 years). 19 patients completed the pre- and post-intervention assessments. Physiotherapy: The Six-Minutes Walk Test significantly improved from 253.0m to 312.4m(p=0.001). Occupational Therapy: Modified ADL Scale capturing the domains of personal care, domestic, physical and leisure activities recorded mixed responses. Significant better confidence was noted for the mastery of toileting(1.00±1.803, p=0.036). All ADL items in terms of “SOB”, “Exertion” and “Confidence” level could be sustained without deterioration. Clinical Psychology: Chinese Breathlessness Beliefs Questionnaire(CBBQ) reported a significant decrease on the mean scores of Somatic Focus subscale(Mdiff=4.68, SD=5.96, t(18)= 3.42, p < 0.01) and Activity Avoidance(AA) subscale(Mdiff=5.05, SD=6.20, t(18)=3.56, p < 0.01), meaning the reduction of anxiety-provoking thoughts and negative beliefs about physical activities. The self-ratings of SOB-related fear level and SOB-related anxiety level were also reduced, though statistically non-significant. The Palliative care outcome scale(POS) showed a trend towards QoL improvement (Pre-: M=8.21, SD 5.55; post- M=5.47, SD 4.81; t(18) =1.88, p=0.08). All patients rated the BSS as “excellent” in the service satisfaction survey. Conclusions: This BSS model improves the participants’ physical function, self-mastery skills on managing breathlessness to cope with ADL tasks. It can reduce the breathlessness induced emotional distress, and potentially improve the QoL.

 

 

Presenters
SS
SUNG INDA SOONG
Doctor
Carer Empowerment Program in Medical & Geriatric Convalescence ward of Tuen Mun Hospital: Enhance efficiency and effectiveness for patient in community reintegrationView Abstract

10:01 AM - 10:10 AM2019/05/15 02:01:00 UTC - 2019/05/15 02:10:00 UTC

Introduction

Patients commonly experience difficulties in personal care tasks due to the disease or deconditioning upon discharge. But the caregivers' needs are often given low priority in the management of patient upon discharge. Carer education plays an important role in preparing patients and carers physiologically and psychologically for early discharge. In the conventional intervention, an occupational therapist will conduct individual carer training skills to patient’s carer. To improve our workflow efficiency, we designed a carers empowerment program.

Objectives

(1) To equip carers with knowledge and skills for discharge planning (2) To enhance the independence of the patients; (3) To encourage sharing and discussion within the group; (4) To deliver service in a more effective way

Methodology

Occupational therapists will conduct ADL assessment to patients transferred to medical unit of TMH. Patients were stratified by their level of assistance required. Minimal to moderate assistance level patients were referred to the carer empowerment program if needed. The group was conducted by one OT and one PCA. It contained educational and practical session, assistive device and home modification were introduced. Home screening was also initiated for indicated cases. In practical session, carers were invited to participate in role-play. Carers could learn from each other interactively through feedback and discussion. Each session lasted for 30-45 minutes.

Results & Outcome

9 sessions of carer empowerment group were held from September 2017 to November 2018. 40 carers attended the groups. A satisfaction survey was conducted and majority of participants appreciated the group (Extremely & Strongly Agree: 89%). Most of them believed the group improved their knowledge and skills (Extremely & Strongly Agree: 78%) and boosted their confidence (Extremely & Strongly Agree: 78%). Most importantly, they agreed that the group facilitated future care planning (Extremely & Strongly Agree: 85%). Feedback from case therapists expressed the group could streamline the workflow and could facilitate discharge planning. Each carer empowerment group could serve 4-5 carers at the same time. When compared with conventional individual carer training around 30 minutes for each patient, the group training can enhance occupational therapist workflow efficiency. Conclusion To conclude, feedbacks from participants provided evidence in supporting the carer empowerment program. The objectives of the group were achieved through this mode of service delivery. The carer empowerment program can shorten the discharge planning time.

 

 

Presenters
KT
Ka Hei Tang
easy scroll
2019/05/15 01:00:00 UTC - 2019/05/15 01:10:00 UTC Spasticity Management to enhance functional recovery for ...
2019/05/15 01:11:00 UTC - 2019/05/15 01:20:00 UTC Cross-functional Program: Improving Anti-Embolism Stockin...
2019/05/15 01:21:00 UTC - 2019/05/15 01:30:00 UTC Prevalence of Sarcopenia in Geriatric Day Hospital Ambula...
2019/05/15 01:31:00 UTC - 2019/05/15 01:40:00 UTC Strategies to prevent catheter-associated urinary tract i...
2019/05/15 01:41:00 UTC - 2019/05/15 01:50:00 UTC Implementation of Osteoporosis Phone Direct Enquiry Servi...
2019/05/15 01:51:00 UTC - 2019/05/15 02:00:00 UTC Palliative Multidisciplinary Breathlessness Support Servi...
2019/05/15 02:01:00 UTC - 2019/05/15 02:10:00 UTC Carer Empowerment Program in Medical & Geriatric Conv...
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