547 QUALITY IMPROVEMENT PROJECT IN PRESCRIBING THICKENERS POST STROKE

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii1-ii4
Author(s):  
S Abubacker ◽  
A Attia ◽  
C Alcock
Keyword(s):  
Medication List ◽  
Language Therapy ◽  
Stroke Patients ◽  
Improvement Project ◽  
Thickening Agent ◽  
Custom Made ◽  
Discharge Letter ◽  
System Improvement ◽  
Doctor's Office ◽  
Multidisciplinary System

Abstract Introduction One of the therapies that Speech and Language Therapy SALT) provide is a level to which fluids must be thickened to ensure a safe swallow. The thickening agent should be supplied by the hospital to the patient on discharge. This requires the thickening agent to be added to the electronic discharge letter (EDL) and, ‘To Take Out’ (TTO) medication list by ward doctors. Method samples of 10-20 EDLs, taken from SALT list of stroke patients between interventions. Cycle 1: SALT were initially attempting to contact the physicians responsible for writing the EDL Cycle 2: SALT kept a register of patients that they had seen the recommended thickener prescription. This list was kept in the doctor’s office. This list was mentioned in handover every morning for doctors to update EDL Cycle 3: The aforementioned list was continued, and responsibility for transfer onto EDLs was delegated to the on call Senior House Officer (SHO) Cycle 4: In addition to the above measures, custom made stickers were added to the prescription chart as an indicator to add thickener to the TTO. Results Cycle 1: 20% Prescribed (n = 10) Cycle 2: 78% Prescribed n = 18) Cycle 3: 93% Prescribed (n = 14) Cycle 4: 100% Prescribed (n = 10). Conclusion This project has built up a multidisciplinary system to a multidisciplinary problem. Through repeated cycles and system improvement, we have seen and demonstrated a collaborative effort resulting in consistent and improving results.

CONTROL OF FOREARM MODULE IN UPPER-LIMB REHABILITATION ROBOT FOR REDUCTION AND BIOMECHANICAL ASSESSMENT OF PRONATOR HYPERTONIA OF STROKE PATIENTS

2016 ◽  
Vol 16 (02) ◽  
pp. 1650008 ◽  
Author(s):  
PIN-CHENG KUNG ◽  
CHOU-CHING K. LIN ◽  
SHU-MIN CHEN ◽  
MING-SHAUNG JU
Keyword(s):  
Upper Limb ◽  
Position Control ◽  
Biomechanical Properties ◽  
Torque Control ◽  
Rehabilitation Robot ◽  
Stroke Patients ◽  
Upper Limb Rehabilitation ◽  
Biomechanical Assessment ◽  
Custom Made ◽  
Limb Rehabilitation

Spastic hypertonia causes loss of range of motion (ROM) and contractures in patients with post-stroke hemiparesis. The pronation/supination of the forearm is an essential functional movement in daily activities. We developed a special module for a shoulder-elbow rehabilitation robot for the reduction and biomechanical assessment of pronator/supinator hypertonia of the forearm. The module consisted of a rotational drum driven by an AC servo motor and equipped with an encoder and a custom-made torque sensor. By properly switching the control algorithm between position control and torque control, a hybrid controller able to mimic a therapist’s manual stretching movements was designed. Nine stroke patients were recruited to validate the functions of the module. The results showed that the affected forearms had significant increases in the ROM after five cycles of stretching. Both the passive ROM and the average stiffness were highly correlated to the spasticity of the forearm flexor muscles as measured using the Modified Ashworth Scale (MAS). With the custom-made module and controller, this upper-limb rehabilitation robot may be able to aid physical therapists to reduce hypertonia and quantify biomechanical properties of the muscles for forearm rotation in stroke patients.

Acquired disorders of language and their treatment

2020 ◽  
pp. 279-290
Author(s):  
Alex Leff ◽  
Jenny Crinion
Keyword(s):  
Drug Therapy ◽  
Brain Stimulation ◽  
Main Part ◽  
Evidence Base ◽  
Language Therapy ◽  
Stroke Patients ◽  
Speech And Language Therapy ◽  
Non Invasive ◽  
Aphasia Therapy

This chapter covers the classification of acquired aphasic syndromes. It illustrates some of the speech errors aphasic stroke patients make with videos of a patient describing a picture and attempting to repeat words. The main part of the chapter assesses the evidence base for speech and language therapy (SALT) and answers the following questions: Does SALT work? What is the correct dose and intensity? And is it ever too late for SALT intervention? We then discuss two main adjuvants to SALT: one old—drug therapy; one new—non-invasive brain stimulation. Finally, we examine the role for e-rehabilitation and augmentative aids before asking what the future might hold for aphasia therapy, and wondering if it might already be here.

scholarly journals A service improvement project exploring the extent of need for allied health care professionals within neuro-oncology in Velindre Cancer Centre.

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv9-iv9
Author(s):  
Rachel Evans ◽  
Hayley Williams ◽  
Lisa Love-Gould ◽  
Owen Tilsley ◽  
James Powell ◽  
...  
Keyword(s):  
Patient Education ◽  
Health Care Professionals ◽  
Service Improvement ◽  
Language Therapy ◽  
Support Worker ◽  
Improvement Project ◽  
Cancer Centre ◽  
Future Care ◽  
Limited Opportunity ◽  
Research And Education

Abstract Given the highly complex and holistic needs of neuro-oncology patients, gold standard guidelines recommend that support is best served by a coordinated multi-disciplinary team (MDT) to provide seamless care from diagnosis to end of life (NICE 2018). Allied Healthcare Professionals (AHPs) including occupational therapy (OT), physiotherapy (PT), speech and language therapy (SLT) and dietitians (DT) are recognised as key professions within the MDT. As there is no designated AHP team at Velindre Cancer Centre, input can be reactive and fragmented with limited opportunity for patient education or service developments. The aim of the project was to scope and evaluate the level of AHP need the neuro-oncology population attending Velindre Cancer Centre. A service improvement grant funded a Band 4 Therapies support worker to conduct the project. The project involved a number of elements including the implementation of a revised neuro-oncology screening tool, strategic effort to improve patient education and self-management and engaging patients and staff to guide future service developments. The mixed methods approach yielded rich quantitative and qualitative data. The results demonstrated that whilst AHP input was beneficial to patient care, significant unmet needs were highlighted and demands for services exceeded the teams’ capacity. Therefore a designated neuro-oncology therapies team should be a central consideration for future care to enable timely, responsive, equitable and seamless MDT working. Greater AHP resource would also enable greater AHP involvement in research and education to revolutionise care in order to fully meet the needs of this vulnerable and complex patient group.

Using MRI art, poetry, photography and patient narratives to bridge clinical and human experiences of stroke recovery

2019 ◽  
Vol 46 (3) ◽  
pp. 243-249 ◽  
Author(s):  
Gabrielle Brand ◽  
Ashlee Osborne ◽  
Steve Wise ◽  
Collette Isaac ◽  
Christopher Etherton-Beer
Keyword(s):  
Health Professional ◽  
Professional Staff ◽  
Workforce Education ◽  
Reflective Learning ◽  
Stroke Recovery ◽  
Depth Of Field ◽  
Stroke Patients ◽  
Staff Perceptions ◽  
Improvement Project ◽  
Patient Narratives

Integrating co-produced humanities-based pedagogy into patient and workforce education is of growing interest. The aim of our Depth of Field: Exploring Stroke Recovery project grew from a strong commitment to use patients' lived experiences as a voice to educate new stroke patients and the health professional staff who will care for them. The aim of the initial Quality Improvement project at a West Australian Stroke Rehabilitation Unit (SRU) was to co-produce a reflective learning resource with stroke patients and their families to help navigate the stroke recovery journey. A series of artefacts (documentary-style photographs, audio-narrated vignettes, MRI images and poetry) were collected from four stroke patients and their families at differing stages of recovery over 12 months as they recounted the honest and raw reality of what life is really like following a stroke. These artefacts were used in a pilot qualitative project to explore new stroke patients, their families and SRU health professional staff perceptions towards the artefacts in order to inform the final educational resource. These findings enhance our understandings of how we can use art and patient (healthcare consumers) voice to widen the lens of stroke recovery and provides a valuable template to co-produce peer-to-peer and health professions education reflective learning resources to promote more human- centred approaches to care.

10 Improving Communication About Death Between Primary and Secondary Care: A Quality Improvement Project

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Arumugam ◽  
R Laud ◽  
P Naydenova
Keyword(s):  
Quality Improvement ◽  
Discharge Summary ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Improvement Project ◽  
Lack Of Information ◽  
Discharge Letter ◽  
Death Notification ◽  
Electronic Discharge Summary ◽  
Hospital Teams

Abstract Introduction Communication between the hospital and primary care regarding the death of a patient is incredibly important. Previous literature surrounding this area has shown that it is often done poorly, resulting in substandard documentation. Furthermore, lack of information for General Practitioners (GPs) means it is difficult for them to enter discussions with families, which can negatively impact on the bereavement process. The previous expectation was that an electronic discharge summary was completed, but that this was not optimally designed to inform GPs about the circumstances surrounding the death. Reasons given that summaries were not completed included: the busy workload of junior doctors and the lack of awareness of their importance. Methods The aim of our quality improvement project was to ensure 80% of GPs received notification and information about a patient’s death by August 2018. Following an initial cycle to assess the baseline notification rates, we developed a standardized death notification letter following feedback from local GPs. This included information such as date of death, if the coroner had been informed and a brief summary of events. Following introduction of the letter, we recorded the uptake and then gained further feedback regarding the ways in which it could be improved. A final cycle was then implemented. Results Baseline data showed an electronic discharge letter was only being completed in 13.3% of cases (n=3/21). Following introduction of the new letter, 83.6% were completed (n=56/67). Conclusions In conclusion, the introduction of a simple and standardized letter template has vastly increased the notification of GPs about a patient’s death from our hospital. Limitations of our project included the varying numbers of deaths in audited periods and some hospital teams having a separate process in place.

Abstract P260: Mind the Time: A Quality Improvement Project to Increase the Percent of Ischemic Stroke Patients Receiving Intravenous Tissue Plasminogen Activator within 60 Minutes after Arrival at the Emergency Department

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Janine M Mazabob ◽  
Gerard Brown ◽  
Sarah Livesay ◽  
Sue Freeborg ◽  
Jose Suarez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Process Model ◽  
Early Recognition ◽  
Stroke Patients ◽  
Improvement Project ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Background and Purpose: Stroke is the third leading cause of death and leading cause of long term disability in the USA. Intravenous administration of tissue plasminogen activator (t-PA) is the only FDA approved medical therapy for treatment of patients with acute ischemic stroke. It is recommended by the American Heart Association that earlier treatment with t-PA within 90 minutes of symptoms may result in a more favorable patient outcome. Initiating t-PA for ischemic stroke patients within 60 minutes after Emergency Department (ED) triage is an indicator tracked by the Get With The Guidelines database. The purpose of our project was to increase the number of ischemic stroke patients receiving t-PA within 60 minutes after triage. Methods: The Six Sigma® process model was applied in order to develop an understanding of variations in the times of triage to initiation of IV t-PA data. We assembled a multidisciplinary team to develop and measure aspects of our current protocols, analyze data, investigate and identify the causes of delays and form action plans to enhance our new process. We tracked the patient flow from first responder contact to thrombolysis time. As a result the team acknowledged that it was imperative to impact the early recognition of ischemic stroke patients in the field. This led to local and regional stroke educational programs. Our neuroscience team of physicians and nurses proceeded to educate over 850 emergency responders. Results: Initial analysis of the baseline data showed that 56 % (5 of 9) of the ischemic stroke patients received intravenous t-PA within 60 minutes of triage. Once the stroke code process was implemented, 79 % (15 of 19) of ischemic stroke patients received intravenous t-PA within 60 minutes after triage. These results were obtained within 9 months of process implementation. Specific process changes included the use of a standard time clock, shorter CT scan turn around times, dedicated 24/7 ED pharmacists, quicker availability of medication administration pumps and ongoing feedback by all team members on the acute stroke process. Conclusions: The stroke team was able to identify barriers, institute process changes and ensure the implementation of change from the prehospital community setting to the acute inhospital care.

Abstract P854: Lean A3 Project in a Primary Stroke Center Results in Improved Dysphagia Screening Compliance for Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Melanie Henderson ◽  
Susan Boesch ◽  
Kristine Peyton ◽  
Chris Hackett ◽  
Patty Noah ◽  
...  
Keyword(s):  
Oral Intake ◽  
Stroke Patients ◽  
Chi Square ◽  
Improvement Project ◽  
Charge Nurses ◽  
Before And After ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
Risk Of Aspiration ◽  
Get With The Guidelines

Introduction: Dysphagia is a common comorbidity after stroke linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia screen before oral intake to reduce the risk of aspiration pneumonia in stroke patients. Prior studies have reviewed barriers to dysphagia screens being completed or documented timely on stroke patients before giving oral intake. Through Lean A3 process, we aimed to improve overall nursing documentation, including dysphagia screen, for stroke patients in the Emergency Department (ED) at an established Primary Stroke Center. Methods: The ED Charge Nurses and the Stroke Coordinator began an A3 project in May 2019 which focused on ED nurse documentation for stroke patients. Data included was 7 months prior to A3 implementation and 8 months post-implementation using Get With The Guidelines quality “Dysphagia Screen” measure. Lean A3 process involved changes to the computer system and re-education of nursing staff in July 2019 by the charge nurses and Stroke Coordinator. The post-A3 measurement period was between August 2019 and March 2020. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of meeting or exceeding goal before and after the A3. Results: Overall compliance of patients screened for dysphagia was 87.3% (n = 379/434). After the A3 project, compliance for dysphagia screening was significantly higher than prior to the A3 implementation ((91.9% (n = 228/248) vs. 81.2% (n = 151/186), OR = 2.64 [95%CI 1.47-4.75], p < 0.001). In addition, the 90% goal for dysphagia screen compliance was achieved only 1 month of 7 (14.3%) prior to A3, but was achieved in 6 months of 8 post-A3 (75%), p = 0.04. Conclusion: In conclusion, we found that dysphagia screening documentation by ED nurses improved due to the Lean A3 process improvement project conducted in the ED.

scholarly journals Results of the Belgian Sentinel Network of general practitioners on the involvement of therapists in stroke rehabilitation

2017 ◽  
Vol 8 (4) ◽  
Author(s):  
Silke Francois ◽  
Viviane Van Casteren ◽  
Katrien Vanthomme ◽  
Liesbeth Borgermans ◽  
Dirk Devroey
Keyword(s):  
Nursing Home ◽  
Stroke Rehabilitation ◽  
Occupational Therapists ◽  
Critical Event ◽  
Rehabilitation Services ◽  
Speech And Language ◽  
Language Therapy ◽  
Stroke Patients ◽  
Sentinel Network ◽  
Sentinel Practices

This study examines which therapists are involved in the rehabilitation of stroke survivors in Belgium at different points in time. A nationwide registration of stroke patients was provided by 199 and 189 family physicians working in sentinel practices for the years 2009 and 2010 respectively. 326 patients who were diagnosed with stroke were included. Patients with paralysis/paresis received significant more physiotherapy after one month (63%) compared to non-paralysed patients (38%) (P=0.005). Residing in a nursing home was associated with higher proportions of patients receiving physiotherapy, both after one (P=0.003) and six (P=0.002) months. 31% of patients with aphasia were treated by a speech and language therapist after one month, which decreased after six months to 20%. After six months, the patients in a nursing home received significant more often speech and language therapy (P=0.004), compared to patients living at home. The proportion of patients receiving stroke rehabilitation services provided by physiotherapists, speech/language therapists and occupational therapists is rather low, especially 6 months after the critical event.

scholarly journals A Randomized Controlled Trial on Very Early Speech and Language Therapy in Acute Stroke Patients with Aphasia

2011 ◽  
Vol 1 (1) ◽  
pp. 66-74 ◽  
Author(s):  
A.C. Laska ◽  
T. Kahan ◽  
A. Hellblom ◽  
V. Murray ◽  
M. von Arbin
Keyword(s):  
Randomized Controlled Trial ◽  
Acute Stroke ◽  
Controlled Trial ◽  
Speech And Language ◽  
Language Therapy ◽  
Stroke Patients ◽  
Speech And Language Therapy ◽  
Randomized Controlled ◽  
Early Speech
Sign in / Sign up

Export Citation Format

Share Document