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PDSA. Richmond Hospital. Presented by: Bev Adamson (PT) Stephanie Chung (OT). PDSA Confidence : PLAN. What: To enhance the patients’ confidence in mobility and ADL on discharge from hospital. PDSA Confidence : PLAN.

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Pdsa

PDSA

Richmond Hospital

Presented by:

Bev Adamson (PT)

Stephanie Chung (OT)


Pdsa confidence plan

PDSA Confidence: PLAN

What: To enhance the patients’ confidence in mobility and ADL on discharge from hospital


Pdsa confidence plan1

PDSA Confidence : PLAN

Why: Assessing the patients’ confidence will give:

●an outcome measurement/patient satisfaction rating on how well the program has prepared the patient for discharge

● an indication where the program needs improvement


Pdsa confidence do

PDSA Confidence : DO

●Each patient, on hospital D/C will be asked to rate (0-10) their confidence in regard to mobility and ADL (managing at home)

● If confidence of 7/10 or less, the therapist asked for the concerning issues so they could be dealt with immediately.


Pdsa confidence study

PDSA Confidence : STUDY

Data Collection:

● Oct ‘06 to Jan ’07

● # THA patients = 70

● Confidence rating /10 = 2-10

● Average rating/10 = 8.74


Pdsa confidence study1

PDSA Confidence : STUDY

Data Collection cont:

● # TKA patients = 97

● Confidence rating /10 = 5-10

● Average rating /10 = 8.74


Pdsa confidence study2

PDSA Confidence : STUDY

Reasons for confidence less 8/10:

1. “I wanted to go to the Rehab Hospital”

2. “There is no one at home to care for me”

3. “I have no banister on my stairs”

4. “I am in the middle of renovations at home”

5. The “Unknown, nothing specific”


Pdsa confidence do1

PDSA Confidence : DO

● All the reasons for decreased confidence related to lack of preparation prior to surgery.

● All staff, on POD #0, network with patient, friends, family and SW as needed to ensure a confident d/c on POD #3


Pdsa los vs standing plan

PDSA LOS vs Standing: PLAN

What: Does standing POD #0 vs. POD #1 make a difference to LOS?

How: Each TJA was audited for LOS and first day standing to see if a trend appeared


Pdsa los vs standing do

PDSALOS vs Standing : DO

●Rehab staff will get patients up POD #0 as ordered by surgeons

● After hours (after 1700hrs), the float nurse will assist patients to standing


Pdsa los vs standing study

PDSALOS Vs Standing : STUDY

● Rehab staffing till 1700 hours was inconsistent due to unavailability

● Float nurse found herself frequently too busy with late admissions to the floor to stand patients.

● Some patients did not arrive on the floor till after 2000hrs

● Some patients’ orders “up POD #1


Pdsa los vs standing study1

PDSALOS vs Standing : STUDY

●THA patients: 40 stood POD #0

27 stood POD #1

●Average LOS if stood POD #0 = 3.1

● Average LOS if stood POD #1= 4.2


Pdsa los vs standing study2

PDSALOS vs Standing : STUDY

●TKA patients: 55 stood POD #0

41 stood POD #1

●Average LOS if stood POD #0 = 3.4

● Average LOS if stood POD #1 = 4.5


Pdsa los vs standing study3

PDSALOS vs Standing : STUDY

●Statistics show a trend that LOS is shorter if stood POD #0

●HOWEVER, in checking reasons for NOT standing POD #0:

1. Increased co-morbidities

2. Longer stay in PAR (slower to floor)

3. Increased N &V and dizziness

● These patients tended to have more need for Rehab beds……longer LOS


Pdsa los vs standing study4

PDSALOS vs Standing : STUDY

●The ability to stand POD #0 may not equate to shorter LOS but to a healthier Patient

●More review with fewer random influences needs to be made to see if standing POD #0 is best practice for shorter LOS


Pdsa pre op plan

PDSA Pre-op: PLAN

Background: 25% are from out-of-town

Locations:

QuesnelParksvilleMaine Isl.

MassettSaywardVictoria

SandspitBella Bella Courtney

HagensborgBella CoolaP. Rupert

Nanoose B.Williams L.Kamloops

Nanimo Shawnigan L. Pemberton


Pdsa pre op plan1

PDSA Pre-op : PLAN

What: To enhance the preparedness of out-of-town patients for surgery

Why: Fail to attend pre-op class

Fail to obtain equipment

Unaware of the responsibilities & expectations


Pdsa pre op do

PDSA Pre-op: DO

Proposed Solution:

Education package includes:

1) "Quick Reference Guide"

●what equipment to obtain & where to get

● what to bring to hospital

● list of accommodations in Richmond area

● Richmond's inpatient rehab program

● LOS, discharge time & criteria

2) VCH Booklet


Pdsa pre op do1

PDSA Pre-op: DO

Data Collection:

Interview prior to discharge:

1) Did you receive pre-op education?

When & Where?

2) Did you receive an "out-of-towners" package?

3) Did you obtain the recommended equipment?

4) Did you bring an appropriate walking aid?

5) What are your return travel plans?

6) “How confident are you with coping and managing at home on this discharge day?"

0 (not confident) to 10 (extremely confident)


Pdsa pre op study

PDSA Pre-op: STUDY

Data Collection:

Mid Nov '06 - Mid Feb '07

THA n = 13

TKA n = 7

Total n = 20 out-of-towners

* 6 "repeat customers" excluded from study

* 6 unicompartmental knees excluded


Pdsa pre op study1

PDSA Pre-op: STUDY

4 Categories:

1) Package + Pre-op teaching

2)No Package + Pre-op teaching

3)Package + No Pre-op

4)No Package + No Pre-op


Pdsa pre op study2

PDSA Pre-op: STUDY

1) Package + Pre-op Teaching


Pdsa pre op study3

PDSA Pre-op: STUDY

2) No Package + Pre-op Teaching


Pdsa pre op study4

PDSA Pre-op: STUDY

3) Package + No Pre-op


Pdsa pre op study5

PDSA Pre-op: STUDY

4) No Package + No Pre-op


Pdsa pre op action

PDSA Pre-op: ACTION

Limitations:

● Small sample size

Lesson Learned:

☺Importance of Pre-op class

Future Steps:

☺Earlier Pre-op booking

☺Satisfaction Questionnaire


Ortho rehab team

Ortho Rehab Team

Bev (PT)

Ronda (PT)

Steph (OT)

Morag (OT)

Rachel (RA)


Ortho nurses

Ortho Nurses


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