PDSA

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PDSA

• Richmond Hospital

Presented by Bev Adamson (PT) Stephanie Chung
(OT)
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PDSA Confidence PLAN

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

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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

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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.

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PDSA Confidence STUDY

• Data Collection
• ? Oct 06 to Jan 07
• ? THA patients 70
• ? Confidence rating /10 2-10
• ? Average rating/10 8.74

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PDSA Confidence STUDY

• Data Collection cont
• ? TKA patients 97
• ? Confidence rating /10 5-10
• ? Average rating /10 8.74

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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

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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

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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

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PDSA LOS 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

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PDSA LOS 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

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PDSA LOS 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

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PDSA LOS 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

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PDSA LOS 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 bedslonger LOS

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PDSA LOS 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

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PDSA Pre-op PLAN

• Background 25 are from out-of-town
• Locations
• Quesnel Parksville Maine Isl.
• Massett Sayward Victoria
• Sandspit Bella Bella Courtney
• Hagensborg Bella Coola P. Rupert
• Nanoose B. Williams L. Kamloops
• Nanimo Shawnigan L. Pemberton

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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

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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

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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)

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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
• 
  
  
  
  
  
  
  
  
  

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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

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PDSA Pre-op STUDY

• 1) Package Pre-op Teaching

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PDSA Pre-op STUDY

• 2) No Package Pre-op Teaching

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PDSA Pre-op STUDY

• 3) Package No Pre-op

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PDSA Pre-op STUDY

• 4) No Package No Pre-op

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PDSA Pre-op ACTION

• Limitations
• ? Small sample size
• Lesson Learned
• ?Importance of Pre-op class
• Future Steps
• ?Earlier Pre-op booking
• ?Satisfaction Questionnaire

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Ortho Rehab Team

• Bev (PT)
• Ronda (PT)
• Steph (OT)
• Morag (OT)
• Rachel (RA)

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Ortho Nurses