The Comfortable Position - Quality Improvement Clinic · ‘The Comfortable Position’ Positioning...
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‘The Comfortable Posion’ Positioning of the Stroke Arm Quality Improvement Project 2. Size of problem On average 10 out of 36 patients require good arm positioning. Almost 1/3 stroke ward patients. 1. Problem Observation of poor inconsistent position of patient ’s arm for patients who had suffered significant paralysis following a stroke. Approximately 70% of stroke patients have altered arm function (RCP, 2012). Evidence Shoulder pain prevalence estimates as high as 84%, occurring from 2 weeks to several months (NICE, 2013). Good arm position can help to prevent pain, contractures, 3. Aim All patients unable to independently move their stroke hand to their mouth to have their arm positioned correctly whilst in bed. 7. Summary Staff more aware of the good arm position, with each section evenly scored and 4 out of 5 points achieved. Specialist cushions might promote better positioning of the stroke arm. Carl Adams Trainee Consultant Practitioner in Cardiovascular / Neurological The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust 4. Baseline Measure 5 point checklist scale (Yes/No) developed from SIGN management of stroke guidelines (2010). 6. Results / Run Chart: Average Total Score 3.80 3.50 4.60 2.00 3.00 4.00 5.00 SEP-15 OCT-15 NOV-15 DEC-15 JAN-16 #5a PDSA Purpose Education #5c PDSA Specialist Cushion #5b PDSA Best Practice Guide 1. Trunk straight and in midline 2. Affected Shoulder protracted 3. Affected Shoulder abducted (aligned with body) 4. Affected Arm bought forward 5. Fingers extended Reference: Scosh Intercollegiate Guidelines Network (SIGN) (2010). Management of Paents with Stroke: Rehabilitaon, Preven- on and Management of Complicaons and Discharge Planning Publicaon 118. Edinburgh: NHS Quality Improvement Scotland. Best Practice to Positioning the Affected Arm “ My arm is more comfortable in this position 1 5 4 3 2 Contact details Email: [email protected] Twitter: @CJadams80 References Scosh Intercollegiate Guidelines Network (SIGN) (2010). Management of Paents with Stroke: Rehabilitaon, Prevenon and Management of Complicaons and Discharge Planning , Publicaon 118. Edinburgh: NHS Quality Improvement Scotland. Royal College of Physicians (RCP)(2012) Naonal clinical guideline for stroke, 4th edion Intercollegiate Stroke Working Party, England. Naonal Instute for Health and Care Excellence NICE (2013) Stroke rehabilitaon in adults, Clinical guideline, England. 5. PDSA’s ACT Purposeful education DO Measure hourly for one day #5a PLAN Identify the problem areas STUDY 3/5 achieved, with only 41% scored 100% (5/5) ACT Best Guide poster above patients bed & in Newsletter STUDY Even when 3/5, position lasted up to 2hrs DO Repeat measure for a day #5b PLAN Assess effect of purpose education STUDY 1 part of cushion used. Improved ave score to 4.6/5 DO Used specialist cushion for 1 week & measure ACT Recommend similar specialist cushion #5c PLAN Assess effect of specialist cushion
Transcript of The Comfortable Position - Quality Improvement Clinic · ‘The Comfortable Position’ Positioning...
‘The Comfortable Position’ Positioning of the Stroke Arm
Quality Improvement Project
2. Size of problem
On average 10 out of 36 patients require good arm positioning. Almos t 1/3 stroke ward patients.
1. Problem
Observation of poor inconsistent position of patient’s arm for patients
who had suffered significant paralysis following a stroke. Approximately
70% of stroke patients have altered arm function (RCP, 2012).
Evidence
Shoulder pain prevalence estimates as high as 84%, occurring
from 2 weeks to several months (NICE, 2013).
Good arm position can help to prevent pain, contractures,
3. Aim
All patients unable to independently move their
stroke hand to their mouth to have their arm
positioned correctly whilst in bed.
7. Summary
Staff more aware of the good arm position, with each section evenly scored and 4 out of 5 points achieved.
Specialist cushions might promote better positioning of the stroke arm.
Carl Adams
Trainee Consultant Practitioner in Cardiovascular / Neurological
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
4. Baseline Measure
5 point checklist scale (Yes/No) developed from
SIGN management of stroke guidelines (2010).
6. Results / Run Chart: Average Total Score
3.803.50
4.60
2.00
3.00
4.00
5.00
SEP-15 OCT-15 NOV-15 DEC-15 JAN-16
#5a PDSA
Purpose Education
#5c PDSA
Specialist Cushion
#5b PDSA
Best Practice Guide
1. Trunk straight and in midline
2. Affected Shoulder protracted
3. Affected Shoulder abducted (aligned with body)
4. Affected Arm bought forward
5. Fingers extended
Reference: Scottish Intercollegiate Guidelines Network (SIGN) (2010). Management of Patients with Stroke: Rehabilitation, Preven-
tion and Management of Complications and Discharge Planning Publication 118. Edinburgh: NHS Quality Improvement Scotland.
Best Practice to Positioning
the Affected Arm
“
My arm is more
comfortable in this position
1
5
4 3
2
Contact details
Email: [email protected] Twitter: @CJadams80
References Scottish Intercollegiate Guidelines Network (SIGN) (2010). Management of Patients with Stroke: Rehabilitation, Prevention and Management of
Complications and Discharge Planning , Publication 118. Edinburgh: NHS Quality Improvement Scotland.
Royal College of Physicians (RCP)(2012) National clinical guideline for stroke, 4th edition Intercollegiate Stroke Working Party, England.
National Institute for Health and Care Excellence NICE (2013) Stroke rehabilitation in adults, Clinical guideline, England.
5. PDSA’s
ACT
Purposeful
education
DO
Measure hourly
for one day
#5a
PLAN
Identify the
problem areas
STUDY
3/5 achieved,
with only 41%
scored 100%
(5/5)
ACT
Best Guide
poster above
patients bed & in
Newsletter
STUDY
Even when 3/5,
position lasted up
to 2hrs
DO
Repeat measure
for a day
#5b
PLAN
Assess effect
of purpose
education
STUDY
1 part of cushion
used. Improved
ave score to
4.6/5
DO
Used specialist
cushion for 1
week &
measure
ACT
Recommend
similar specialist
cushion
#5c
PLAN
Assess effect
of specialist
cushion
