scholarly journals Optimising the mandatory reporting process for drivers admitted to an inpatient stroke rehabilitation unit

2018 ◽  
Vol 7 (3) ◽  
pp. e000203 ◽  
Author(s):  
Shannon L MacDonald ◽  
Pamela L Joseph ◽  
Ida J Cavaliere ◽  
Mark Theodore Bayley ◽  
Alexander Lo
Keyword(s):  
Stroke Rehabilitation ◽  
Healthcare Providers ◽  
Discharge Summary ◽  
Process Mapping ◽  
Medical Conditions ◽  
Physical Medicine ◽  
Rehabilitation Unit ◽  
Standard Work ◽  
Patient Complaints ◽  
Reporting Process

Ontario physicians are legally obligated to report patients who may be medically unfit to drive to the Ministry of Transportation of Ontario (MTO). Currently at Toronto Rehabilitation Institute (TRI), there are no standardised processes for MTO reporting, resulting in inconsistent communication regarding driving with patients and between healthcare providers, redundant assessments and ultimately reduced patient satisfaction. TRI received 10 patient complaints regarding the driving reporting process in the 5 years prior to this project and a large number of patients were not being reported appropriately.The project aim was to use Lean Methods to achieve 100% reporting and optimise communication and education of drivers admitted to a 23-bed inpatient stroke rehabilitation unit. Interventions included process mapping, identification of wasteful steps and implementation of a standard work. Chart audits before and after implementation were performed.Value stream process mapping identified inconsistent reporting procedures and lack of use of the government-issued driver reporting form. Following implementation of standard work processes, use of the MTO Medical Conditions Report Form increased from 0% to 100%. Indication of whether drivers were reported to the MTO in Physical Medicine & Rehabilitation consultation notes increased from 50% to 91%. Identifying reported drivers in the discharge summary, of which patients receive a copy at the time of discharge, increased from 0% to 90%. Physician satisfaction with the new standard work process was qualitatively assessed to be high, with no negative impacts reported.Lean methodology was effective for increasing the usage of the MTO Medical Conditions Report Form, documenting driver status in the initial Physical Medicine & Rehabilitation consultation and indicating MTO reporting status in the discharge summary.Communication between healthcare providers regarding patients’ driving status has been successfully standardised, resulting in improved coordination of care and a reduction in patient complaints to zero in the 14 months since implementation.

scholarly journals Preventable adverse drug events causing hospitalisation: identifying root causes and developing a surveillance and learning system at an urban community hospital, a cross-sectional observational study

2021 ◽  
Vol 10 (1) ◽  
pp. e001161
Author(s):  
Jane de Lemos ◽  
Peter Loewen ◽  
Cheryl Nagle ◽  
Robert McKenzie ◽  
Yong Dong You ◽  
...  
Keyword(s):  
Observational Study ◽  
Adverse Drug Events ◽  
Healthcare Providers ◽  
Medication Use ◽  
Learning System ◽  
Chronic Obstructive ◽  
Action Plans ◽  
Medical Conditions ◽  
Cross Sectional ◽  
Medication Changes

ObjectivesTo identify root causes of preventable adverse drug events (pADEs) contributing to hospital admission; to develop key messages which identify actions patients/families and healthcare providers can take to prevent common pADEs found; to develop a surveillance learning system for the community.MethodsCross-sectional observational study; 120 patients and families, 61 associated healthcare providers were interviewed then root cause analysis was performed to develop key learning messages and an electronic reporting tool was designed. Most common pADE-related medical conditions and their root causes and most common pADE root causes of entire cohort are reported.ResultsMost common pADE-related medical conditions: chronic obstructive pulmonary disease/asthma (13.3%), bleeding (12.5%), hypotension (12%), heart failure (10%), acute kidney injury (5%) and pneumonia (5%). Most common root causes were: providers not confirming that the patient/family understands information given (29.2%), can identify how a medication helps them/have their concerns addressed (16.7%), can identify if a medication is working (14.1%) or causing a side effect (23.3%); can enact medication changes (7.5%); absence of a sick day management plan (12.5%), and other action plans to help patients respond to changes in their clinical status (10.8%); providers not assessing medication use and monitoring competency (19.2%). Ten key learning messages were developed and a pADE surveillance learning system was implemented.ConclusionsTo prevent pADEs, providers need to confirm that patients/families understand information given, how a medication helps them, how to recognise and respond to side effects, how to enact medication changes and follow action plans; providers should assess patient’s/families’ medication use and monitoring competency.

scholarly journals Ten year follow-up of a randomised controlled trial of care in a stroke rehabilitation unit

BMJ ◽  
2005 ◽  
Vol 331 (7515) ◽  
pp. 491-492 ◽  
Author(s):  
Avril E R Drummond ◽  
Ben Pearson ◽  
Nadina B Lincoln ◽  
Peter Berman
Keyword(s):  
Randomised Controlled Trial ◽  
Stroke Rehabilitation ◽  
Controlled Trial ◽  
Rehabilitation Unit ◽  
Randomised Controlled

Abstract TP137: Robotic Upper Limb Therapy by a Trained Volunteer on an Inpatient Stroke Rehabilitation Unit

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lisa Spinelli ◽  
Christine Trudell ◽  
Lisa Edelstein ◽  
Mike Reding
Keyword(s):  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Rehabilitation Unit ◽  
Software Applications ◽  
Upper Limb Function ◽  
Straight Line ◽  
One Step ◽  
Safety Considerations

Introduction: Having a therapist observe patients engaged in Robotic Upper Limb Therapy (RULT) is considered inefficient use of a therapist’s time and skill. We therefore assessed the feasibility of (RULT) administered by a trained volunteer. Methods: The Volunteer had two 30-minute training sessions by an Occupational Therapist (OT) rehearsing the MIT-Manus Planar Upper Limb Robotic software applications, proper positioning of the patient, and device shut-off and safety considerations. Initial patient sessions were supervised by the patient’s OT until the Volunteer demonstrated satisfactory performance. Inpatients on a Stroke Rehabilitation Unit were referred by their OT for RULT if they could initiate horizontal gravity-eliminated movement of the forearm and could follow one step commands. They were enrolled in 25 minute (RULT) sessions based upon the Volunteer’s availability from one to three half-days per week. Functional Independence Measures and Fugl-Meyer Scores were recorded at the time of Stroke Unit Admission by the OT unaware of (RULT) score results. Statistical analyses were performed using SPSS version 11.5 and significance was attributed if p<0.05 using 2-tailed analyses. Results: A total of 28 patients were enrolled in (RULT) but 2 were unable to participate due to pain in the affected upper limb. Participants had a mean of 3 ± 1.5 SD treatments each. Both the patients and volunteer considered their involvement in the program as worthwhile and meaningful. Admission MIT-Manus Adaptive-3 treatment software data showed that the Normalized Jerk+Line+Target (Norm JLT) Score [defined as (Jerk Score/237)+(Deviation from a Straight Line/13)+(Target Distance Error/14)] demonstrated a significant Spearman-rho Correlation with admission Functional Independence Measure (FIM) upper dressing r = -0.56 p=.003; and FIM grooming subscores r = -0.415, p=.035. The Norm JLT score also predicted change in Fugl-Meyer Upper Limb scores from admission to discharge r = - .788, p = 0.000. Conclusions: Robotic Upper Limb Therapy by a trained Volunteer on an inpatient Stroke Rehabilitation Unit is easily administered, is viewed by the patients and volunteer as rewarding, and provides objective measures useful for assessing upper limb function and outcome.

scholarly journals Stroke Rehabilitation - An Overview of Existing Guidelines and Standards of Care

2011 ◽  
Vol 6 (3) ◽  
pp. 170 ◽  
Author(s):  
Richard D Zorowitz ◽  
Keyword(s):  
Stroke Rehabilitation ◽  
Healthcare Providers ◽  
Standards Of Care ◽  
Interdisciplinary Management ◽  
Stroke Survivors ◽  
Level Of Evidence ◽  
The Us ◽  
Guidelines And Standards ◽  
Complications Of Stroke ◽  
The Uk

Over seven million stroke survivors live in the US today. Despite the publication of the first post-stroke rehabilitation clinical practice guideline in 1995, many healthcare providers are unaware not only of stroke survivors’ potential for functional recovery, but also common secondary complications of stroke. This article summarises the best available evidence-based recommendations for the interdisciplinary management of stroke survivors and caregivers from five sources: two in the US, one in Canada, and two in the UK. Unique characteristics of each guideline are described, followed by a list of common clinical recommendations found in most, if not all, of the guidelines. Despite the advances in stroke rehabilitation over the past 16 years, much research still needs to be done to improve the level of evidence in stroke rehabilitation.

Stroke Patients’ Experiences in an Adaptive Healing Room in a Stroke Rehabilitation Unit

2019 ◽  
Vol 13 (2) ◽  
pp. 170-185
Author(s):  
Ifah Arbel ◽  
Bing Ye ◽  
Alex Mihailidis
Keyword(s):  
Stroke Rehabilitation ◽  
Well Being ◽  
Stroke Recovery ◽  
Structured Interviews ◽  
Stroke Patients ◽  
Rehabilitation Unit ◽  
Healing Environment ◽  
Healthcare Settings ◽  
Patient Feedback ◽  
Healing Environments

Objectives: This study evaluated the user experiences (UX) of stroke patients residing in the adaptive healing room (AHR) and compared them to the UX of patients residing in standard private rooms (SPRs). Background: Healing environments in healthcare settings can promote patients’ healing processes, outcomes, and psychological well-being. The AHR was designed as a healing environment for stroke patients and has been previously evaluated in laboratory settings. This study was the first to evaluate it in its intended context—a stroke rehabilitation unit. Methods: The UX of 10 patients residing in the AHR and 15 patients residing in SPRs were collected via structured interviews with a set of open-ended questions and analyzed using quantitative and qualitative methods. Results: The AHR design features (orientation screen, skylight, and nature view) were rated positively by most patients. The skylight emerged as the least favorable. Responses to open-ended questions revealed that UX may be further improved if patients have more control over some of the settings (e.g., light intensity and nature views), and if the system allowed for more stimulation for patients at later stages of their recovery. Additionally, the results suggest that patients in the AHR have better UX than patients in the SPRs. Conclusion: The AHR has the potential to improve UX in the stroke rehabilitation unit. Patient feedback can be used to refine the AHR before carrying out clinical trials to assess the effect of the AHR on patient outcomes (e.g., sleep, mood, and length of stay) and stroke recovery.

scholarly journals 52A Quality Improvement Initiative in the Stroke Rehabilitation Unit

2018 ◽  
Vol 47 (suppl_5) ◽  
pp. v13-v60
Author(s):  
Fiona Craven ◽  
Suzanne Noel ◽  
Rachael Doyle ◽  
Laura Bourke ◽  
Kate McCaffrey ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Stroke Rehabilitation ◽  
Quality Improvement Initiative ◽  
Rehabilitation Unit

scholarly journals Technology-assisted toilets: Improving independence and hygiene in stroke rehabilitation

2017 ◽  
Vol 4 ◽  
pp. 205566831772568 ◽  
Author(s):  
David Yachnin ◽  
Georges Gharib ◽  
Jeffrey Jutai ◽  
Hillel Finestone
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Stroke Rehabilitation ◽  
Bowel Movement ◽  
Assistive Devices ◽  
Stroke Patients ◽  
Rehabilitation Unit ◽  
Full Protocol ◽  
Perineal Region

Background and Purpose Dependence on assistance for toileting is a widespread problem for persons receiving healthcare. Technology-assisted toilets, which hygienically wash and dry the perineal region, are devices that could improve toileting independence in a variety of patients. The objective was to investigate whether technology-assisted toilets improve toileting independence, quality of life, and whether technology-assisted toilets can provide sufficient toileting hygiene in stroke rehabilitation. Methods This pilot study was carried out in a stroke rehabilitation unit. Thirty participants were recruited. Participants had a bowel movement and cleaned themselves using the technology-assisted toilet on one to three occasions. Participants rated their toileting before using the technology-assisted toilet and after each technology-assisted toilet use with the Psychosocial Impact of Assistive Devices Scale (PIADS). After each session, participants were rated for cleanliness. Results PIADS scores were analyzed from eight individual participants, five of whom completed the full protocol. PIADS scores were significantly higher with the technology-assisted toilet than with the participants’ regular toileting routine (p < 0.05). Technology-assisted toilets cleaned effectively in 73% of cases (16/22, p < 0.05). Conclusion Technology-assisted toilets improved stroke patients’ psychosocial outcomes compared to standard toileting and completely cleaned participants in the majority of cases. A larger study should confirm technology-assisted toilet’s benefit in stroke rehabilitation through improved independence and hygiene.

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