The Use of the Statistics at Modilon General Hospital

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The Use of Statistics Gathered at the MGH Physio Unit from 2005 – October 2006 By Marie A. Balangue, VSO Physiotherapist at MGH Physio Unit

I. Patient Attendance

A. Summary of Monthly Attendance of 2005 & 2006 & Implied Trends B. New and Continuing Patients & Implied trends in Treatment C. Segregation of Patients according to:

1. Age 2. Sex/Gender 3. In/Out/Hospital Staff

II. Physiotherapy Treatment

A. Frequency of Treatments B. Frequency of Treatments per Number of Patients C. Treatments Available at the Unit

III. Management Concerns

A. Caseload (per Physio Unit worker) for Occupational Health and Safety B. Patient Load for Occupational Health and Safety and Patient Care C. Conditions seen & Trends of Conditions for Patient Care D. Causes of Disability E. Financial Management

IV. Operational Concerns

A. Activities done per Physio Unit Worker (*including Volunteer’s Activities) B. Patient Recording C. Physio Workers’ Attendance D. Recommendations

V. Schedule Planning

A. Vision B. Yearly C. Monthly D. Weekly E. Daily

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I Patient Attendance

A. Summary of Monthly Attendance of 2005 & 2006 & Implied Trends

Figure 1. Monthly Total Number of Patients in 2005

May was the busiest month, with 78 patients treated. This coincided with the visit of

the USNS Mercy (May 14-20). During this month, the highest number of patients per day was 26, the caseload shared between the 4 members of the Physio Unit.

Soft tissue injuries, followed by fractures, were the usual cases.

Figure 2. Monthly Total Number of Patients in 2006 Seemingly, the busiest month is October with 57 patients treated, however, when

Sports Medical Support was provided at the National Soccer Championships in September, 128 patients were treated by two physiotherapy staff members assigned at the field, while 3 were at the hospital.

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Figure 3. Monthly Total Number of Patients for 2005 & 2006

From the above figures, there is no trend that is consistent. The total number of patients do not increase or decrease in a period or month of the year. Further data gathering is necessary to see whether August, September, and October are the busiest months in the year.

B. New and Continuing Patients & Implied trends in Treatment

Figure 4. Patients in 2005

Conditions that required continued treatment were the following:

Amputations Arthritis Clubfoot Delayed Development

Milestones Diabetes Mellitus Fractures

Meningitis Osteomyelitis Pott’s Disease Recurrent Back Pain Spinal Cord Injury Stroke Tuberculosis

The implication for knowing these conditions is that the Physio Unit Treatment Protocol

book should have the management for these cases. This trend was seen in 2006 as well.

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Patient Categories

New Patient Continuing Patient

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Figure 5. Patients in 2006

From the above figure, there was a general increase in continuing patients, from 2005.

The conditions that required continuous treatment were, from most common to least:

Recurrent back pain (5 cases)

Tuberculosis of the Spine or Pott’s Diseas (4 cases)

Knee injuries

Stroke (3 cases)

Rheumatoid Arthritis

Spinal Cord Injury

Fractures

Tuberculosis (2 cases)

Meningitis

Cerebral Malaria

Achilles tendinitis

Hip dislocation

Lateral epicondylitis

Tumor

Note that the following cases (1 each) were treated with the O&G Ward:

Neonatal sepsis

Retained placenta

Erb’s palsy

Clubfoot (diagnosis upon birth)

Arthrogryposis

Comparison of Patient Categories in 2005 & 2006 (in percentage)

Figure 6. New Patients in 2005 and 2006

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There were more new patients seen in 2005 than 2006. This may be attributed to awareness for Prevention of injuries done in the Community outreach projects with the DWU Business Studies Department in Jomba Parish. Further studies with the HEO and LSN programs towards “A Healthy Village” will be necessary to come to such conclusion.

Figure 7. Continuing Patients in 2005 and 2006 Notice that the maximum number of patients continuining their physiotherapy treatment is 47%. There were 53 patients treated for more than a month (or 20% of the total number of patients treated). The maximum number of months of continuous treatment was 6 months (1 case). Majority of those continuing treatment took 2 months (24 cases or 45%). This may mirror success of treatment in the given amount of available treatments or frequency. Further research should be done to see whether this trend may be decreased (resulting in decreased number of days of patient stay in hospital), how many of the patients are in-patients and how many are out-patients (for community outreach activities), etc.

C. Segregation of Patients according to: 1. Age

Figure 8. Pediatric and Adult Patients in 2005

The most common diagnosis for children treated were the following:

Fractures Meningitis Delayed Development Clubfoot

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Patient Age Groups

Pediatric Adult

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The most common diagnosis for adults treated were:

Fractures/Dislocations

Soft Tissue Injuries

Back Pain

Pre-post operation

Stroke

Spinal Cord Injuries

Meningitis

Pulmonary Tuberculosis

Figure 9. Number of Children and Adults seen in 2006

The common diagnosis for children in 2006 were:

Meningitis and other neurological cases causing spastic paralysis, such as SSPE

Soft tissue injuries, including contractures, inflamed muscles

Fractures

Cerebral malaria, cerebral palsy

Respiratory cases

Arthrogryposis

The common diagnosis for adults were:

Soft tissue injuries

Back Pain

Other conditions not classified in previous format

Tuberculosis of the spine or Pott’s Disease

Stroke

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Comparison of 2005 and 2006 figures:

Children or Pediatric:

Figure 10. Children treated at the Physio Unit for 2005 and 2006

The common diagnosis remained, just with different frequency seen: fractures, meningitis, developmental delays, and clubfeet. Arthrogryposis emerged, though patient family history shows no geographic significance.

Adult:

Figure 11. Adults seen at the Physio Unit for 2005 and 2006 Common conditions seen were much similar between the years. The new classification for diagnosis increased the unregistered conditions, with soft tissue injuries as the most common, followed by back pain, tuberculosis and its complications (Pott’s Disease or tuberculosis of the spine, CNS tuberculoma), and stroke.

Further awareness programs on preventive measures should be done to prevent these

conditions. It is of vital importance that children be vaccinated with BCG-DPT to help prevent

tuberculosis.

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2. Sex/Gender

Figure 12. Sex/Gender Segregation of Patients in 2005

Incorporated in the 2005 individual Patient Record were the sex/gender segregation of patients

because some non-government organizations provide assistance to victims of gender related issues.

More males access the services of the Physio Unit throughout the year, with the exception of November. The most common diagnosis were the following:

Fractures Meningitis Soft Tissue Injuries Low Back Pain Amputations

Females access the Physio Unit for the following conditions: Fractures Back Pain (Cervical, Lumbar, and Sacral areas) Soft Tissue Injuries

Whether these conditions were brought forth by domestic violence is not documented. No patient records were kept in the unit, all information is found in the clinic book of the patient or the medical records. Thus, such information must be incorporated in the data gathering at the Physio Unit.

Figure 13. Sex/Gender Segregation of Patients in 2006

In 2006, 4 months (April, June, September, and October) have females accessing the Physio

Unit more than males. Common conditions were strokes, Pott’s disease, and low back pain. Only 2 were victims of domestic violence. Twenty-two identified trauma, with 1 caused by a motor vehicle accident. Further studies on trauma may be done.

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Segregation of Patients according to Sex

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Segregation of Patients in 2006 according to Sex

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3. In/Out/Hospital Staff

Figure 14. Patient Classification in 2005

The patient audit done in 2005 enabled classification of patients as In-patients, Out-patients, or hospital staff. The latter classification took note of occupational health and safety issues for the staff. In 2005, most staff came to the Physio Unit for low back pain. In July of 2006, a study on the prevalence of low back pain among health workers was done and presented during the Annual Medical Symposium (held in Divine Word University in 2006, co-hosted by Modilon General Hospital).

Figure 15. Patient Classification in 2006

It is recommended that a continuous study for hospital staff be carried out as this chart shows that no staff came to the Physio Unit for January and February, usually when recreational leaves have just been taken. Perhaps, a stress reduction program is necessary to ensure that the hospital staff are fit and ready for work. When the patient load increased, the incidence of hospital staff coming for treatment for back pain increased (2nd to 4th quarters).

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In Patients Out-Patients Hospital Staff

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II Physiotherapy Treatment

A. Frequency of Treatments

Figure 16.Total Frequency of Treatments done in 2005

Frequency refers to the number of sessions a patient is treated. In 2005, the highest number of treatments coincided with the month with the highest number of patients.

The highest total number of patients treated per day is 29, with only 2 staff members sharing

the patient load. Records show that during that day, 26 hours of treatment were performed during the 8 hour duty. This highlights one factor that must be considered when planning for staff additions. With very little equipment, and most treatment relying on massage and exercises, physio unit members also tire and may become de-motivated.

Figure 17. Total Frequency of Treatments done in 2006 The highest total of frequency of treatment in 2006 was 205. Compared to 2005’s figure of 389 (in May), research (specifically medical record analysis) must be done to find out whether the following factors affected the frequency:

More physio workers in 2006 (5 to 7/day – due to the addition of Resident Physiotherapist and students on Clinical Placement) meant less patients per physio and thus more time for treatment of a patient on the day, resulting in faster recovery

Improved methods of physiotherapy

Community participation in treatment

Other factors

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B. Frequency of Treatments per Number of Patients

Based on the MGH Client Database, the least number of times a patient was treated at the

Physio Unit was once. This may mean any of the following:

The Physio treatment given at that time was very effective

The Physio treatment was not effective, resulting in the patient not returning for treatment

Wrong referral

Community participation in treatment

No money for the patient to come back for treatment

It is recommended that further research be made on this – from the cases that could be treated once, to the treatment given, and what other issues happened. Also, the maximum number of times a patient was treated at the Physio Unit was 23 times/month in 2005 (Pott’s Disease, In-patient, Female adult), followed by spinal cord injured patients. In 2006, the maximum number of times a patient was treated was 22 times/month in 2006 (Pott’s Disease, In-patient, Male adult), followed by spinal cord injured patients. This indicates that Pott’s Disease and spinal cord injuries have the longest rehabilitation times at the hospital. This may not be conclusive as stroke patients are brought home once they either have a wheelchair or can get out of bed. The latter situation would then require extensive rehabilitation at home and/or extensive teaching of watchman/meris for the rehabilitation at home.

Figure 18. Average Frequency of Patients seen at the Physio Unit

On average, the number of times a patient was treated at the Physio Unit was 5 times in 2005 and 3 times in 2006.

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C. Treatments Available at the Unit

In October 2005, a new form for patient records was tried at the Physio Unit. (See attached Appendix A & B). This enabled an audit for the services done at the Physio Unit and its implications. The following table shows the results for October 2005 – October 2006:

Services Done: IMPLICATIONS

A. Evaluations Initial Evaluations - 189 Re-evaluations - 77 Home-Evaluations - 1

Needed: Standard forms Training: Updates on quick assessments Documentation responsibilities

B. Education Patient education - 172 Family/Caregiver education - 73 Community Education - 0

Needed: Patient space for education : Time for community education Training: Caregiver training

C. Chest Physiotherapy - 36 Needed: Re-check client base with Ward 2 Nurses doing a good job! Training: Student nurses trained for CPT

D. Cryotherapy - 48 Needed: Ice packs (currently only 5 at unit)

E. Aquatherapy - 11 Needed: Pool area (?)

F. Jobst compression & Elevation - 5 Needed: Equipment

G. Electrotherapy TENS - 38 ES - 7 NMES - 0 Interferential Currents - 1

Needed: More equipment (Only 1 TENS machine – owned by HSaweni)

H. Heating Agents Ultrasound - 59 HMP - 61

Needed: More equipment (Currently only 1 Ultrasound machine & Hot packs used are IV bags.)

I. Soft Tissue Mobilizations Peripheral Joint Mobilization - 9 Manipulation - 32 Massage - 86 Stretching - 27

Needed: Proper beds Training: Students – nursing and physio students taught these techniques

J. Therapeutic Exercises Prescription - 185 Demonstration - 153 Supervision - 167

Needed: Equipment Training: More training focused on exercises

K. Diet Advice - 24 Plan - 22

Needed: Nutritionist Training: Nutritionist/Dietician

L. Others Posture Education - 12 Ergonomics - 2 Orthotics - 35 Prosthetic Assessment - 2 Gait re-education - 5 Traction - 5 Work Hardening - 0 Taping - 0* POP - 4 Neurological techniques - 10 Others - 47**

Training: Students and staff to be trained for these Note: *not accurate because of Sports Injuries not counted in records ** other treatments include positioning, PEEP bottles, wound management, giving of knee braces, ball exercises, referral to other services, reflexology, herbal medications, and giving of Vitamin B

Skills under-utilized in hospital-based Physiotherapy are the following:

1. Home evaluation 2. Community Education 3. Neuromuscular Electrical Stimulation (no machine) 4. Paraffin Wax Bath (no equipment – a makeshift was done with pan & candle wax: oil mixture) 5. Traction (no equipment) – calculations with patient’s body weight and angle of pull with the pulley

system at the unit is being done. However, physio needs to stand at the pulley system to make sure that the correct weight arm is being applied for 20 minutes

6. Work hardening (no time for office/workplace evaluation) 7. Taping – No sports tapes available 8. Neurological Techniques (need further training)

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III Management Concerns

A. Caseload (per Physio Unit worker)

Data gathered from 2005, analysed revealed the following.

Figure 19. Average Number of Patients per Working Day in 2005

From the above table, although May seems to be the busiest month with 78 patients

treated, on a daily basis, the busiest month is February, followed by May, April, January, March, July, June, August, October, November, September, and December. Implications may be that training seminars for updates or clinical research could be done during December and November. September is for the medical symposium.

Within the year 2005, the highest number of patients treated per day is 29 (February), with 2

members of the Physio Unit on duty. This signifies the need for either more manpower or job redesigning for ease of caseload.

No figures were taken in 2006 due to the management decision to have the Daily Time Records

kept at the Administration Building (and stolen thrice).

It is therefore recommended that all Physio workers Daily Time Records be available at the

Unit.

249 373 285 337 363 256 255 201 151 180 178 71

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Average Number of Patients Per Working Day

Total Number of Daily Patients Seen

Number of Working Days in the Month

Average Number of Patients Per Working Day

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B. Patient Load

Figure 20. Patient Load as seen in Weeks of a Month

The above Table shows 12 lines signifying 12 months. Although there are 4-5 weeks per month, in 2005, there were 3 weeks in the months that were “complete”. Placing the statistical data together, a trend may be seen that shows:

The second week’s Wednesday show a dip in caseload. This time may be used for In-Service training.

Usually, Fridays have low patient caseload. Currently, administrative matters are handled during this time. With the other members of the Physio Unit, though, this is a time when In-Service training could be done. A training physiotherapist may be the answer to this, to increase the knowledge base of the members of the Physio Unit. If not, a compulsory study time may be undertaken by the Physio Unit members, wherein research could be done on certain conditions that they see.

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Weekly Analysis of Patient Load

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C. Conditions treated & Trends of Conditions

Total Percentage of Conditions Seen:

Figure 21. Percentages of Conditions seen in 2005

Majority of the conditions seen at the Physio Unit were orthopedic in nature, and thus, most of the referrals were from Ward 3 and the surgeons. Most conditions were soft tissue injuries and fractures, followed by back pain and spinal cord injuries.

This trend was further seen in 2006:

Figure 22. Percentages of Figures seen in January to October 2006 Although the 2005 Madang Situational Analysis shows that the leading causes of morbidity and

mortality in PNG in 2005 are: 1. Pneumonia 2. Malaria 3. Perinatal Conditions 4. Tuberculosis 5. Meningitis

From the above charts, conditions seen at the Physio Unit do not mirror the national statistics.

One questions whether the patients are being given physiotherapy by the nurses in the wards, and if so, this shows a successful multi-skilling happening at the hospital. If not, then the Physio Unit could do In-Service training for the conditions listed above.

Orthopaedic Conditions

63%

Neurological Conditions

20%

General Surgery

Conditions 11%

Respiratory Conditions

6%

Conditions treated in 2005

ORTHOPEDICS

52%

NEUROLOGICAL 25%

GENERAL SURGICAL

4%

RESPIRATORY 6%

PEDIATRIC 3%

OTHERS 10%

Conditions seen in 2006 (Jan-Oct)

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Trends of Conditions:

2005

ORTHOPEDICS: JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

SOFT TISSUE INJURY 2 8 6 7 16 9 8 11 7 5 0 2 64

BACK PAIN 6 7 5 3 7 2 6 6 3 5 1 3 47

FX/ DISLOCATION 11 7 7 13 17 14 14 10 7 11 1 4 91

OA 1 1 3 1 3 2 1 4 1 13

RA 1 3 1 1 1 1 1 4

JRA 1 1

OSTEOMYELITIS 1 1 2 1 4

CLUBFOOT 2 1 5 2 2 9

OTHER - ORTHO 2 1 1 2 2 1 3 9

Table 1. Orthopedic Cases in 2005

Figure 23. Percentages of Orthopedic Cases in 2005

Fractures, followed by soft tissue injuries, then back pain are the most common conditions

seen at the Physio Unit. These are fairly common during the entire year of 2005.

STI 26%

BACK PAIN 19%

FX/ DISLOCATION

38%

OA 5%

RA 2%

JRA 0%

OSTEOMYELITIS 2%

CLUBFOOT 4% OTHER -

ORTHO 4%

Orthopedic Cases

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2006

ORTHOPEDICS JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

SOFT TISSUE INJURY 1 2 3 4 5 2 3 4 3 1 22

BACK PAIN 2 3 6 4 3 2 6 4 2 11 40

FX/ DISLOCATION 3 2 3 2 3 3 2 5 17

OA 1 1 2 1 1 5

RA 1 1 1 1 1 3 5

JRA 1 1

OSTEOMYELITIS 3 3

CLUBFOOT 1 1 2

OTHER - ORTHO 3 3 2 3 2 2 4 11 6 14 45

Table 2. Orthopedic Cases in 2006 (January to October)

Figure 24. Percentages of Orthopedic Cases in 2006 (January to October)

SOFT TISSUE INJURY

16%

BACK PAIN 29%

FX/ DISLOCATION

12% OA 3%

RA 4%

JRA 1%

OSTEOMYELITIS 2%

CLUBFOOT 1%

OTHER - ORTHO

32%

Orthopedic Cases in 2006 (Jan-Oct)

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2005

NEUROLOGY: JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

CP 1 1 1 1 1 2 7

MENINGITIS 3 3 3 6 6 1 5 2 2 2 2 2 19

POTT'S DSE 2 3 2 2 1 2 1 1 1 1 7

CVA 1 1 2 1 2 1 4 4 2 3 2 1 14

TBI 1 1 2 1 5

SCI 3 4 2 2 1 1 7

PNI 2 2 4

GBS 1 1

OTHERS - Neuro 2 4 1 1 2 3 2 3 2 1 14

Table 3. Neurological Cases seen in 2005

Figure 25. Percentages of Neurological Conditions in 2005

Meningitis, followed by cerebral vascular accident and other neurological cases are the

common conditions treated at the Physio Unit. Commonly, the meningitis follows untreated tuberculosis or cerebral malaria, but data is scarce on this. Further research should be done.

CP 9%

MENINGITIS 24%

POTT'S DSE 9% CVA

18% TBI 7%

SCI 9%

PNI 5%

GBS 1%

OTHERS - Neuro 18%

Neurological Conditions

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2006

NEUROLOGICAL JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

CP 1 1 1 1 3

MENINGITIS 2 3 1 1 1 3 2 2 2 8

ENCEPHALITIS* 1 1 1 2

POTT'S DSE 3 4 3 2 3 1 1 4 1 3 12

CVA 1 4 3 2 1 2 3 10

TBI 1 1 1 1 1 1 1

SCI 1 1 3 5 1 7

PNI 1 1 1 1 3

GBS 2 2

OTHERS - Neuro 3 3 1 2 1 1 6 1 14

Table 4. Neurological Cases in 2006 (January to October)

Figure 26. Percentages of Neurological Conditions from January to October 2006

CP 5%

MENINGITIS 13%

ENCEPHALITIS* 3%

POTT'S DSE 19% CVA

16% TBI 2%

SCI 11%

PNI 5%

GBS 3%

OTHERS - Neuro 23%

Neurological Conditions in 2006 (Jan-Oct)

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2005

GENERAL SURGERY JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

PRE/POST - OP 1 3 3 3 3 1 1 2 1 18

AMPUTATION 1 2 5 4 2 1 1 12

BURNS 1 1

OTHERS 1 1 3 2 1 1 1 9

Table 5. Cases from General Surgery in 2005

Figure 27. Percentage of Conditions from General Surgery in 2005 Pre- and post-operation management is commonly treated. A treatment protocol has been

created to address this. This was shown to the surgeons for comment before being passed onto the Physio Unit members and Surgical Nurses.

2006

GENERAL SURGERY JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

AMPUTATION 5 2 2 1 1 2 1 12

HAND INJURIES 1 1 2 4

OTHERS 1 1 2

Table 6. Cases from General Surgery from January to October 2006

Figure 28. Percentage of Conditions from General Surgery from January to October 2006

PRE/POST - OP 45%

AMPUTATION 30%

BURNS 2%

OTHERS 23%

General Surgical Conditions

AMPUTATION 67%

HAND INJURIES

22%

OTHERS 11%

General Surgical Conditions in 2006 (Jan-Oct)

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2005

RESPIRATORY CASES: JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

ASTHMA 1 1

RESTRICTIVE LUNG DISEASE 1 1 1 2

INFECTION 1 2 3

PTB 1 1 4 3 3 8

OTHERS 2 2 1 1 1 3 8

Table 7. Respiratory Cases in 2005

Figure 29. Percentages of Respiratory Conditions seen in 2005

Pulmonary tuberculosis and other respiratory conditions, followed by chest infections are

commonly treated at the Physio Unit.

2006

RESPIRATORY CASES JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

ASTHMA 1 1

RESTRICTIVE LUNG DISEASE 1 1

INFECTION 1 1

PTB 1 1 2

PNEUMONIA* 1 1 2

OTHERS 1 1 2 1 2 2 3 10

Table 8. Respiratory Cases in 2006

Figure 30. Percentages of Respiratory Conditions from January to October 2006

ASTHMA 5%

RESTRICTIVE LUNG

DISEASE 9%

INFECTION 14%

PTB 36%

OTHERS 36%

Respiratory Conditions

ASTHMA 6%

RESTRICTIVE LUNG

DISEASE 6%

INFECTION 6%

PTB 11%

PNEUMONIA* 12%

OTHERS 59%

Respiratory Conditions in 2006 (Jan-Oct)

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UNREGISTERED (2005)

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

UNREGISTERED 1 2 2 2 4 2 1 4 1 16

UNREGISTERED (2006)

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen

UNREGISTERED 2 4 3 2 2 3 5 4 3 25

Table 9. Unregistered (Diagnosis) cases in 2005 and 2006

Unregistered diagnoses are cancers, obstetric and gynaecological conditions (e.g. obstetric neuropraxia, ovarian cysts), leprosy, gun shot wounds, and diabetes.

D. Causes of Disability

From the database of 2006, the causes of disability were tabulated with the following results:

Figure . Causes of Disability of Cases in 2006

Note that sicknesses may be prevented, so awareness raising and prevention programs should address this. One condition, rheumatoid arthritis, in particular, was listed also as genetic, caused by trauma, and other. Further information should be done for the use of the statistical tool. The conditions caused by “other” varied. A more detailed history may be taken for these. Conditions caused by trauma were further segregated into those caused by motor vehicular accidents (4 cases) that resulted in traumatic brain injuries and orthopedic cases such as fractures; falls caused spinal cord injuries and fractures; 3 cases of rascalism resulted in orthopedic conditions; 1 case of domestic violence resulted in a fracture/dislocation. Fifty six “other traumatic causes” may be further reviewed, especially with history taking techniques to identify the specific causes. Genetic abnormalities that were seen at the unit were arthrogryposis and clubfeet. These had no geographical significance, though. Sports injuries resulted in only 4 being treated further at the unit. Sports medical support provided by MGH Physio Unit on site of sporting events used a different statistical gathering tool and reported as such. Conditions resulting from aging were arthritis and low back pain.

110

74

69

7

4

2

0 20 40 60 80 100 120

Sickness

Other

Trauma

Genetic

Sports Injury

Aging

22

E. Financial Management The individual Out-patient records has a column for the Receipt Number, to make sure that the patients pay for the services that they are able to access at the unit and so that the Unit has a means of income for the hospital. From the records, the following are documented:

Table 10. Frequency of treatment of out-patients & resulting income to Physio Unit The above figures should tally with the accounting records at the Department of Finance Administration.

Month 2005 2006

January 20 22

February 35 18

March 49 19

April 41 15

May 39 28

June 29 20

July 35 27

August 30 42

September 26 28

October 39 47

November 5 December 19 Frequency of treatments 367 266

Total Income (calculated at 6 kina/treatment) K2202 K1596

TOTAL K3798

23

IV Operational Concerns

A. Activities done per Physio Unit Worker (*including Volunteer’s Activities)

Treatments done were documented using the individual Patient Records started on October

2005. The following table shows the Physio Unit worker working on the patients (counted by surname)

Physio Worker

Number of Patients (Surnames)

total % AI JP Q Z

BALANGUE 131 107 91 329 19.7

EMINI 130 234 156 520 31.2

HURIM 132 70 23 225 13.5

GIREY 56 81 22 159 9.5

SAWENI 45 69 43 157 9.4

IYAPE 11 14 8 33 2

LUNDU 104 4 0 108 6.5

NAUA 50 29 18 97 5.8

AUPAE 11 13 10 34 2

LUKE MOTA 5 0 0 5 0.3

TOTAL OF PATIENTS DOCUMENTED 1667 99.8*

Table 11. Physio Worker’s Patient Load

Note: *Rounded off figure

From the above, it is recommended that Eunice Emini, who occupies a Casual position, be

made permanent. She is very hardworking, shouldering 31.2% of the patient treatments. Marie Balangue acts as the training supervisor, so Girey’s, Iyape’s, Lundu’s, Naua’s, and Aupae’s caseloads are supervised by her. The total of their treatments (33.4%) then counts towards her training duties. Also, as clinical supervision of Lutheran School of Nursing students are done by Marie Balangue, it is suggested that Eli Hurim take responsibility for these, and that she needs some training for such. If the Physio Unit is to function more efficiently, therefore, additional staff members are necessary. Otherwise, a job re-design should take place. For the latter, a review of the tasks was done (November 2006) and the physio workers came up with the following:

Unit Tasks:

Cleaning the unit

Prepare hot & cold packs (current situation: no separate switches for refrigerator and for heater)

Lay away the clean laundry (towels, bed sheets, pillowcases, etc)

Prepare the plinths at the beginning of the day

Final clean-up of the plinths and unit at the end of the day Clinical Physios/Patient care:

Oversees that the unit is clean

Making a plinth.

Attends Ward Rounds

Assist guardians in transporting patients to and from the wards as necessary, once transfers had been taught to the guardians.

Follows the Code of Professional Conduct for physiotherapists

Provide physiotherapy care

Educates patient and caregiver on aspects of rehabilitation, nutrition, and hygiene

Ensure that proper documentation is done, accurate information, timely

Maintains equipment

Manufacture occupational therapy aids & splinting

Weekly (Thursdays), patient audit and check

Consult with other health professionals regarding treatment

Public relations

24

Awareness & Teaching Duties

Attends Ward Rounds

Prepares for Grand Rounds – theoretical aspects (Clinical aspects should be the responsibility of the physio-in-charge of patient care) – ensures that the materials are available

In some cases, conducts Grand Rounds

Conducts In-Service training Clerking:

Checks patient’s referral

Books out-patients into the Appointment book, when necessary

Informs patient of how much to pay. If patient pays at the Unit, Unit receipt must be given, and taken up to the Accounting for the MGH Receipt number for the Patient file.

Ensures that the Physio forms (In-patient forms, out-patient forms) are available in the unit

Ensures that all the Physio forms used have complete information (May begin initial interview)

Keeps the patient records in alphabetical order

Records patient’s treatment schedule

Receives and files notices – from the DMS, CEO, Intra-office memo

Ensures that the memo board and posters are up=to=date and relevant to the unit

Prepares orders for dispensary, stationery, and rations

Collect and store ration orders

Collects laundry

At the end of the month, collects the Daily Time Records – signed

Records the statistics – daily, fortnightly, monthly

OIC – Physiotherapist (in future, OIC-Rehabilitation)

o Prepares the monthly, quarterly, and annual reports o Plans the unit activities

Yearly planning occurs in October-November Consider Medical Symposium, relevant trainings available

o Ensures that adequate resources are available for the unit – inventory, solicits from other parties for support for the unit, responsible for registering of equipment solicited

o Organizes the Unit files o Delegates other responsibilities o Assists the Human Resources Division regarding staffing of the unit (plan, advice on

recruitment, orients the selected staff, trains the staff in their roles, evaluates the staff member’s performance annually)

o Responsible for conflict resolution of unit matters o Public relations

Volunteer’s Activities in 2005 & 2006

Physiotherapy Clinical Services (from 1 March 2005 to 18 December 2006)

Home Visits

24 March, 9 July, 8 August, 12 December, and 16 December 2005

12 May, 13 May, 23 June, 20 September, 21 September, 3 November, and 9 November 2006

In-Service Training: Grand Rounds 2005 – LOW BACK PAIN (Marie Balangue with Hugh Saweni) 2005 – STROKE (Marie Balangue) 5 May 2006 – SPORTS MEDICINE (Marie Balangue) August 2006 – MGH Client Database (Marie Balangue & Hugh Saweni) November 2006 – POTT’S DISEASE (Mercia Girey)

In-Service Training – at the Physio Unit Letter cuts – 2005 Bracelet making – 29 March 2006 Appropriate Paper Technology (Paper making) – 11 May 2006 & 15 May 2006 Bedside teaching

25

In-Service Training – for Livelihood – with Creative Self Help Centre

Appropriate Paper Technology (Paper making) & Bracelet making – 11 May 2006 & 15 May 2006

In-Service Training

Women with Disabilities (echoing of a seminar) – 3 August 2006 at MGH (with CSHC staff)

Participation in Community/Rural Outreach Programmes Community Outreach at Jomba Parish with DWU Business Studies (18 June, 25 June, 9

July, 23 July, 6 August, 10 September 2005) – Marie Balangue helped facilitate with the Leadership training, co-facilitated on Personal Hygiene with Dr. Almira de Mira, helped with the Medical Mission, and co-facilitated on Food & Nutrition)

Community Visit of Bogia Relief Care Centers (12 November 2005) with World Vision Community Outreach at Holy Spirit Parish with DWU Business Studies (12 March, 1 April,

24 June, 5 August, 2 September 2006) – Marie Balangue facilitated 2 sessions – Leadership and Nutrition & Disability Prevention; helped in the Medical Mission; Eli Hurim attended the Personality Development with Marie Balangue; Judy Aupae and Paul Yakimp helped facilitate with Nutrition & Disability Prevention

Village visits and Wheelchair provisions – with CSHC – North Coast (5 April 2006), Karkar (24 to 25 April 2006), Yabob (1 August 2006)

Teaching With DWU – Physio

Thermal Agents (18 April 2005) The Knee Joint (16 June 2005) Gait Retraining (17 and 24 August 2005) Clinical Visits – 24 February 2006 (CVA & Neurological Conditions), 3 March 2006

(Neurological and Orthopedic Conditions), 7 April 2006 (Pediatrics & Orthopedic Conditions), 24 April 2006 (Available cases), 7 July 2006 (SOAP Notes: Low Back Pain)

Observing the NOPS Team – 10 April 2006 Testing Questionnaire Form for Pilot Research – 19 May 2006

With Lutheran School of Nursing Chest Physiotherapy – 2005 Gait re-training: Preparing patient for crutches – measuring, education on exercise – 10

& 12 August 2005(LSN classroom at 11-11:50 am, attended by LSN2 students) Introduction of Massage, Chest Physiotherapy, Percussion,& Postural Drainage – 17

August 2006 (In-Service Classroom, MGH at 10 am attended by LSN2 students); 28 November 2006

Care of patient in Plaster of Paris, splints, sandbags, & Artificial Limbs – 18 August 2006 (LSN classroom at 11 am, attended by LSN2 students)

Preparing Patients for Crutches and Measuring Crutches – 23 August 2006 Supervision of Students (Divine Word University – Physiotherapy) at MGH

Clinical Orientation – 30 May to 3 June 2005; 6 June to 9 June 2005

Clinical Supervision – 4 April to 3 June 2005 (Bill Iyape and Simon Lundu); 5 October to 2 December 2005 (Simon Lundu and Paul Na’au); 14 August – 1 December 2006 (Judy Aupae, Paul Yakimp, Margaret Guants)

Resident Physiotherapist (1 March 2006 to 18 December 2006 – Mercia Girey) Supervision of Students – Lutheran School of Nursing

LSN 1, 2, & 3 Week Rotations – For 2006, 35 students (total) rotated in the Physio Unit (see names below) and forms were carried out: Daily Time Record, Pre-Evaluation form with schedule, Caseload with Nursing and Physiotherapy management, Procedural Activities of a Physiotherapist, Physiotherapy Evaluation Forms, and Post-Evaluation forms done for this student group

Year 1 – 12 Student Nurses

Marcus F 27 – 31 March 2006 1 Week

Mathew F 3 – 7 April 2006 1 Week

Yiyiri Milliana 22 May – 2 June 2006 2 Weeks

Zugu Beverly 22 May – 2 June 2006 2 Weeks

Dei Glenda 26 June 2006 – 14 July 2006 3 Weeks

Paul Dorothy 26 June 2006 – 14 July 2006 3 Weeks

26

Iowa Erasi 28 August 2006 – 8 September 2006 2 Weeks

Kino Martha 28 August 2006 – 8 September 2006 2 Weeks

Telam Maria 16 October 2006 – 3 November 2006 3 Weeks

Terada Miwa 16 October 2006 – 3 November 2006 3 Weeks

Gena C 6 – 28 November 2006 2.5 Weeks

Powes F 22 – 28 November 2006 2.5 Weeks

Year 2 – 13 Student Nurses

Kailou M 27 February – 3 March 2006 1 week

Manga Franklyn 13 – 24 March 2006 2 weeks

Neirahi Maureen 1 – 12 March 2006 1.5 weeks

Noglai Mary 1 – 12 March 2006 1.5 weeks

Poli 12 – 16 June 2006 1 week

Gibson Francisca 19 June – 14 July 2006 4 weeks

Ikema Angela 19 June – 14 July 2006 4 weeks

Kawage J 10 – 28 July 2006 3 weeks

Lare I 17 – 28 July 2006 2 weeks

Sumiog Jayson 17 – 28 July 2006 2 weeks

Maika Jepi 28 August - 8 September 2006 2 weeks

Angawi M 16 – 27 October 2006 2 weeks

Kasa Lilly 6 – 17 November 2006 2 weeks

Year 3 – 10 student nurses

Hiasihri 30 January – 10 February 2006 2 weeks

Kainge Christina 13 – 24 February 2006 2 weeks

Sine I 27 March – 7 April 2006 2 weeks

Darius Joan 3 – 7 April 2006 2 weeks

Zinong Zillah 10 – 28 April 2006 1 week

Wanamaga Joyce 10 – 21 April 2006 2 weeks

Ume Natasha 22 May – 2 June 2006 2 weeks

Telenge William 19 – 30 June 2006 2 weeks

George Josephine 19 – 30 June 2006 2 weeks

Ireew 30 October – 3 November 2006 1 week

It was observed that all 35 students did not sign their own DTRs. Further questioning

should be carried out with regards this.

Resourcing

17 May 2005 – USNS Mercy fixed our airflow at the unit

20 & 23 May 2005 – USNS Mercy donated 26 bedsheets, 18 towels, 2 disarticulated knees, 2 disarticulated shoulders, 16 canes, 7 cold packs (small), 2 cold packs (lumbar), 5 heating chemical refills, 2 cusio straps, 1 Velcro s/b hook, 4 NCM Clinic Smooth, 2 boxes Iogel (ph iontophoresis electrodes with gel sponge), 4 uiversal knee braces, 2 therabands (special heavy resistance), 12 pairs Axillary crutches, and 10 ankle braces to the Unit

29 May 2005 – Greg Clarke donated a digital camera for MGH

15 July 2005 – A satisfied patient donated a computer to the unit

29 July 2005 – An anonymous donor gave 2 plastic containers for the sheets to the unit

10 August 2005 – Andrew Brooks donated curtains and a pot to the unit

12 August 2005 – Peter and Maureen Hill fixed the Unit’s drainage and roof leaks

19 August 2005 – Susan Kopioto donated pillowcases to the unit

10 October 2005 – An anonymous donor gave 3 reams of paper for the unit

18 October 2005 – Lori Witham donated a cervical traction to the unit

4 November 2005 – An anonymous donor gave plastic containers to the unit

12 December 2005 – Anthony Crasner donated K200 to the unit

14 February 2006 – Rooke’s Marine provided transport for wheelchairs to the Unit

22 February & 13 March 2006– Protect Security provided transport for wheelchairs to the Unit

25 April 2006 – RD Tuna donated a stand fan to the Unit

25 May 2006 – James Barnes (c/o Ikie Kalie) donated a white board to the Unit

7 June 2006 – Ian Priestley and Rotary Club of Huon Gulf donated hospital materials to the Unit

27

8 August 2006 – Gary Litz donated meat and other food to the Unit

18 August 2006 – Chris Tsang donated 2 tubes of Aspercreme to the Unit

Unspecified date – Ron McKenna donated a radio-casette recorder to the Unit

Unspecified dates – George Kuzma donated hand-held pumps, knee supports, and ankle supports to the unit

B. Patient Recording

From the individual Patient Records that were used, the following compares the documented patients (from the Patient Schedule and the Individual Records):

2005 2006

total # of pts 628 406 222

in file: 336

% 53.5

Having only 53.5% of the patients’ individual records kept at the Unit may mean the following –

lack of authority for documentation (Prior to October 2005, only the Physiotherapist could write in the records). To address this, a checklist was done wherein the Physio technician or aide may be able to check the treatment given and signed by the watchman or watch-meri of the patient.

lack of time for documentation - most probably due to many patients/day. Although ideally, one should stay and finish work, security and family issues should be addressed; and

lack of records – either because no forms are available

other reasons?

C. Attendance at the Physio Unit

This was not checked because 2 logbooks are kept – one at the DMS Office, which went missing

at least twice for more than a week each, and another one at the Unit for the staff members. However, no photocopies were done for the Daily Time Record forms by the staff members.

It is recommended that each staff member is responsible for their own DTR. It has been observed that personal accountability is high. It is also each staff member’s responsibility to calculate their own overtime done. Recommendation – Daily Log

Date & Time

Major Activities Specific Description Other Activities Related

Finances Involved

Travel to & from work

Clinical Duties

Teaching Duties

Training duties

Administrative duties

The above table may be further discussed and changed to suit the physio worker. This way,

time management may be studied to improve service provision in terms of increased hands-on for patient care.

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Physiotherapy Unit – Modilon Hospital Responsibilities of A Physiotherapist

Teacher

Training Supervisor Clinical Physiotherapist

Administrative Officer

Stakeholder = Accountability

Directly: Students (LSN & DWU) DWU Indirectly: Patients Hospital

Directly: Students DWU Hospital Indirectly: Patients

Directly: Patient Hospital Indirectly: PNG for workforce

Directly: Staff Hospital Indirectly: Patient

Aim To share knowledge, behaviour, and skills

To allow students to gain skills in patient management

To rehabilitate, promote, and prevent disabilities

To plan, organize, staff, decide, coordinate, record, and budget for the services available at the unit and with other stakeholders.

Sustainability More students into the profession

Knowledgeable and skilled students in the profession

Effective and appropriate services to the patient optimized function for patient

Structures in place for medico-legal purposes; Motivated staff better work performance; Efficiently run hospital

Duties Know students (2 mins/student)

Prepare teaching material (depending on method, subject matter, evaluation tool minimum 1 hour)

Teach, with constant evaluation of method to keep interest in subject (1 hour/subject matter)

Evaluate students’ learning (prepare evaluation tool – 1 hour, implement evaluation – 1 hour, check results – 2 hours minimum)

Know student’s knowledge (1 hour)

Assess student’s skills (1 hour)

Plan for student’s learning areas (minimum 3 hours)

Supervise student’s performance with patients (minimum 5 hours)

Check student’s documentation (minimum: 10 minutes/SOAP note)

Evaluate patient’s and student’s progress (minimum: 10 minutes/patient)

Fill in any gaps (minimum: 5 minutes/gap identified)

Provide suitable environment for patient care (30 minutes/day)

Ward Rounds (minimum 1 hour/round/ward)

Read chart of referred patient (5 minutes/chart minimum)

Assess Patients

Educate Patient & Family

Treat Patient (1 hour/patient ideal)

Evaluate Patient’s progress (5 minutes/patient)

Document patient care (30 minutes/patient)

Statistics (2 minutes/patient)

In-Service lectures every W & F (3 hours preparation, 1 hour presentation)

On-call 24 hours (1 hour/preliminary round)

Provide some time for patient care (minimum 15 minutes/patient – 1.5 hours)

Audit daily & monthly statistics (20 minutes/day)

Motivate staff (1 minute/member)

Liaise with line manager (DMS, CEO) (minimum 10 minutes)

Plan for the unit – strategic plan, action plan, budget, staff ceiling (minimum 4 hours)

Organize for patient transport and other needs (referral to NOPS, CSHC, etc) (minimum 2 hours)

Coordinate patient management with other hospital units, other stakeholders (minimum 1 hour)

Record staff appraisals, reports – on activities, etc (minimum 1 hour)

Decide on patient issues, staff issues, hospital issues (minimum

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5 minutes/issue)

Budget resources (include search for means of budget) for the department (minimum 5 hours)

Community Outreach/Networking (1 hour minimum)

TOTAL TIME (minimum/day)

6 hours minimum 10.25 hours minimum

2.32 hours/patient ave # patients/day = 5 11.60 hours minimum (without IST & On-Call)

15 hours minimum

Considerations 2 years (8-4.06) for Resident Physiotherapist 2 weeks (8-4.06) for LSN II student 1 week (August) (8-4.06) for Clinical Orientation, DWU Physio 10 & 16 weeks 8-4.06 for Clinical Placement, DWU Physio

8 – 4.06; On-call 24 hours

For meetings: Intra-office Inter-office Intra-hospital Networking – MDG, donors, etc Resourcing

Individual Responsibilities and Accountabilities:

1. Daily Time Records 2. Leave Forms 3. Maintain equipment 4. Maintain department in clean and tidy condition 5. Patient care – Fills up Physio Patient form, Assessment form, Treats patient, Progress

notes, Discharge notes, referral notes (when necessary) 6. To perform other-related duties consistent with the above

D. Physio Workers’ Attendance

Further studies could be made of this as the study started in October 2005 using

individual DTRs in the Physio Unit showed high compliance in the following months but the DMS instituted a logbook at the Administrative Office in 2006 and this was lost 3 times.

30

V Planning

Planning for Timetables: Daily Schedule:

TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

7.45 Time in/ Cleaning/

Preparing Plinths

Cleaning Time in/ Cleaning/

Preparing Plinths

Cleaning Time in/ Cleaning/ Preparing

Plinths

7.50 Ward Exercises 1 Ward Exercises 1

7.55 2 2

8.00 WARD ROUNDS 3 WARD ROUNDS 3 GRAND ROUNDS

In-Service Classrm

8.05 4 4

8.10 CASE PRESENTATION

OUT-PATIENT TREATMENTS

9.00 In-Service Lectures

WARD ROUNDS

10.00 TREATMENT (Tx) DWU calls for

Cases Or DISABILITY

NETWORK

WARD Tx/ Out-patient Tx

Impress Schedule with

Minai/PrintShop

WARD TREATMENT

Photocopying Ward Rounds/Tx 11.00 Meeting with DMS

11.30 TREATMENT TQM Meeting Staff Meeting

12.00-1.00

L u n c h B r e a k

1.00 STROKE CLINIC/ IN-PATIENT TX

STROKE CLINIC/ IN-PATIENT TX

In-Service Training

With CSHC

STROKE CLINIC/

CASE STUDY With DWU

2.00

3.00 Wellness Program (suggested)

Wellness Program

3.30 Documentations/ Cleaning

Weekly Schedule:

MONDAY – TUESDAY - WEDNESDAY – 10 am - Photocopying schedule with DMS Secretary THURSDAY – OIC meeting with DMS, when necessary FRIDAY – 8 am – Grand Rounds at the In-Service Classroom 12 noon – List for patient caseload for the weekend, if necessary

Monthly Schedule: Every 7th day – Submission of Patient Statistics Every 23rd day – Submission of On-Call Roster Every Quarter, 1st week – Quarter Reports

Yearly Schedule:

January – workers back from Recreational Leaves; annual report due February April – 1st Quarter Report due; Taxes due May – June – Mid Year Report due July – August – 2nd Quarter Report due September – Medical Symposium October – 3rd Quarter Report due; Planning for next year’s activities November - December – Christmas; preparation of Annual Report

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Sample Yearly Schedule for 2007: NATIONAL MGH

ACTIVITIES

PHYSIO

UNIT

DWU

- PHYSIO

LSN LEPROSY

MISSION

CSHC OTHERS

JAN 1 New Year

Inventory

Call NOPS

for

Foundation

Wheelcha

irs (shipment

arrived

15

December 2006)

22 Lecturers Return/ Staff

23 Induction

25 Academic

Board Meeting

29

Registration of Students

31 Semester

1 Begins

Curriculum Vitae

meeting

postponed

to this month

28 Internationa

l Day for

Leprosy

25 Meetin

g for

MDG

Meet with Jackie Kauli

for Annual

Activity

planning for Saidor visits

FEB 20 International

Mother’s Language Day

Annual

Reports Financial

Reports

Call

Cathy Ketepa

(NOPS)

for

Motivation

Wheelcha

ir program

me check

PNG-wide

18

Graduation Day

19 University

Council

Meeting

MAR 8 International Women’s Day

International World

Peace Day 9 Commonwealth Day

29 NATIONAL

DISABILITY DAY

15 Mercia Girey’s

Birthday

1 Academic Board

Meeting

19-25 Mid semester

Study Period

26 Lectures

Resume

TAXES due April!

APR 1 Palm Sunday

5 Holy Thursday 6 Good Friday

8 Easter Sunday

9 Easter Monday

7 World Health Day 23 Book & Copyright

Day

25 ANZac Day

Environmen

t Summit at DWU

MAY 3 World Press

Freedom Day

15 International Day

of Family 17 World

Telecommunications’

Day 31 World No Tobacco

Day

5 Eunice

Emini’s

Birthday

6 Open

Day/EU Cup

Grand Final

9 Europe Day 18 Lectures

begin

21 Exams begin

28 Exams

JUN 5 & 6 World

Environment Day 10 National Labour

Day

11 Queen’s Birthday 16 International Day

against Drug Abuse &

Illicit Trafficking 17 World Day to

Combat

Desertification &

Drought

1 Semester I

ends 4-17

Semester I

Break 18 Semester

II Begins

26 University Council

Meeting

JUL 1 International Day of

Cooperating

11 World Population Day & St Benedict’s

Day

19 Madang Provincial

Government Day 23 Remembrance Day

28

Hospitality &

Tourism Night

VSO

Disability

Programme Conference

23? National

Board of Disabled

Conference

? Women with

Disabilities

Conference

AUG

9 International Day of World’s Indigenous

People

13 Hugh Saweni’s

Birthday

6-12 Mid-Semester

Study Period

13 Lectures

32

begin

18 Cultural Day

21 DWU DAY

SEP Medical Symposium in

Port Moresby 6 National Prayer Day

8 International

Literacy Day

16 PNG Independence Day

16 International Day

for Preservation of the Ozone Layer

29 World Maritime

Day

5 Academic

Board Meeting

7 Business

Studies

Ethics Symposium

24

Information Systems

Symposium

National

Games

OCT 1 International Day of Orders

4 World Habitat Day

5 International/Nationa

l Teacher’s Day

9 World Post Day 11 International Day

for Natural Disaster

Reduction

16 World Food Day 24 Eradication of

Poverty

World Development Information Day

United Nations’ Day

25-30 Disarmament Week

5 Lectures End

8 Exams

Begin 19 Semester

II ends

22 Staff Infrastructur

e

29 Staff

Research Begins

NO

V

20 Universal

Children’s Day

8 Academic

Board

Meeting 27 University

Council

Meeting

National

Soccer

Games

DEC 1 World AIDS Day 3 International Day

for Disabled Persons

5 International Volunteer Day for

Economic & Social

Development

7 International Civil Aviation Day for

Economic & Social

Development 10 Human Rights Day

11 Anniversary of

UNICEF 25 Christmas Day

26 Boxing Day

1 Eli Hurim’s

Birthday

7 Staff Research

Ends

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Appendix A

Patient Record

This is designed for use of the Physio Unit workers, whether from the Casual to the Physio level. This requires that the patient participates in documenting their treatment, so as to avoid talks of non-performance of the Physio Staff, and monitoring of the treatments by Physio Unit workers who do not have the authority to document, according the National Department of Health.

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PATIENT NAME (Given Name, Surname) SEX/age (Day, Month, Year) DATE OF BIRTH

CONTACT DETAILS Guardian: _________________________ PHD Number: __________________ Phone Numbers: ____________________ MGH Number: ___________________ Village, District: ____________________ Health Centre: _________________ Community Centre: __________________ Religion: ________________________

Place of Origin:

Medical Diagnosis: ____________________________________________________________ Doctor: ________________________ ____________________________________ Physio: ________________________ Precautions:________________________________ Nurse: ________________________ _____________________________ ________________________ _____________________________

Date of Referral: _____________________ Source of Referral: ________________________ Date of Initial Physiotherapy Evaluation: ______________________ by _________________

DATE

TIME

PHYSIO WARD/BED NUMBER

PHYSIO SERVICES PROVIDED CONFIRM TX DONE A B C D E F G H I J K

1

2

3

4

5

6

7

8

9

10

CODES

1 – Obstetric & Gynecology or Women’s Health Physiotherapy 2 – Neurologic Physiotherapy 3 – Musculoskeletal Physiotherapy (soft tissue injuries, fractures, dislocations, strains, strains, etc)

4 – Cardiorespiratory Physiotherapy, including Surgical Pre-op & Post-op 5 – Emergency & Sports Physiotherapy 6 – Orthotics & Prosthetic Assessment & Prescription 7 – Dermatological Conditions (includes burns, leprosy, etc)

8 – Wellness Program (health assessment, exercise prescription, diet advice, etc) 9 – Others(includes Occupational Therapy, Special Education, Special Nursery, etc) * Genetic disorder

PHYSIO SERVICES

A – Initial (IE); Re-evaluation (RE); Home Evaluation (HE); Work Evaluation (WE) B – Patient Education (P); Family Education (F); Community Education (C) C – Chest Physiotherapy (CPT) D – Cryotherapy (Ice & others)

E – Jobst Compression & Elevation (J), POP application (POP) F – Electrical: TENS, ES, NMES, Interferential Circuit G –Heating Modalities (HMP, PWB, UTZ) H – Soft Tissue Mobilization Techniques- Peripheral Joint Mobilization (PJM);

Manipulation (M); Massage (Ms) I – Exercises – prescription (P); Demonstration (D); Supervision (S) J – Diet – Assessment (A); Plan (P) K – Others : Posture education (PE); Ergonomics (E); Orthotics (O);

Prosthetic Assessment (PA); Traction (T); Work Hardening(WH); Neurological Techniques (NT), etc

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APPENDIX B

SOAP Note

This is a one-page document intended for use of Physio Aides, Assistants, and Students. It is designed for easy referral to the case.

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PATIENT SEX AGE

MEDICAL DIAGNOSIS

OCCUPATION Smoke/Chew Buai Alcohol? HPI:

PMHx: __ previous hospitalization: __ malaria Last episode: __________________ ___ Anemia __ TB commenced Tx A on __________ /finished/absconded __ commenced Tx B on _____________finished/absconded

__ Lepra __ DM

FMHx:

Medications Taken:

Dosage Indication S/E

Dates Re-checked:

S: Primary Complaint Expectations

O: Vital Signs RR: PR: BP: During Treatment After Treatment

Ocular Inspection

Palpation Neurological Tests Special Tests

ROM MMT ADL

A:PT Impression:

P:

Expected period of physiotherapy tx: Problem List: Interventions:

The Use of the Statistics at Modilon General Hospital

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