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PDSA

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

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  1. PDSA Richmond Hospital Presented by: Bev Adamson (PT) Stephanie Chung (OT)

  2. PDSA Confidence: PLAN What: To enhance the patients’ confidence in mobility and ADL on discharge from hospital

  3. 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

  4. 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.

  5. PDSA Confidence : STUDY Data Collection: ● Oct ‘06 to Jan ’07 ● # THA patients = 70 ● Confidence rating /10 = 2-10 ● Average rating/10 = 8.74

  6. PDSA Confidence : STUDY Data Collection cont: ● # TKA patients = 97 ● Confidence rating /10 = 5-10 ● Average rating /10 = 8.74

  7. 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”

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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)

  20. 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

  21. 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

  22. PDSA Pre-op: STUDY 1) Package + Pre-op Teaching

  23. PDSA Pre-op: STUDY 2) No Package + Pre-op Teaching

  24. PDSA Pre-op: STUDY 3) Package + No Pre-op

  25. PDSA Pre-op: STUDY 4) No Package + No Pre-op

  26. PDSA Pre-op: ACTION Limitations: ● Small sample size Lesson Learned: ☺Importance of Pre-op class Future Steps: ☺Earlier Pre-op booking ☺Satisfaction Questionnaire

  27. Ortho Rehab Team Bev (PT) Ronda (PT) Steph (OT) Morag (OT) Rachel (RA)

  28. Ortho Nurses

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