Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Cheung WL(1), Tsang KY(1), Fan MK(1), Chau CM(1), Wong MY(1), Lau KC(1), Chen PW(1), Wong LC(1)
Affiliation :
(1)Stroke Sub-specialty Group, Medical & Geriatric Specialty Group, Service Development Subcommittee, COC-grade in Occupational Therapy
Introduction :
Hemiplegic shoulder pain is common after stroke. The Guideline on Protective Measures for Hemiplegic Shoulder – From Occupational Therapy Perspective was launched in March, 2011 and was revised in May, 2022. To continuously improve service quality, the first audit was conducted in 2015. This second audit evaluates the implementation of the guideline among seven clusters, assessing local clinical practices on shoulder protection and making recommendations.
Objectives :
1. Evaluate the awareness of occupational therapists (OT) in using the guideline.
2. Evaluate the compliance with the clinical documentation guideline and resources available across clusters.
3. Recommend on areas for future actions.
4. Improve standard of practice and service uniformity.
Methodology :
In phase one, an e-survey was designed to assess the awareness of OT on the use of the guideline and its application. It was distributed to OT providing stroke services in seven clusters through convenience sampling.
In phase two, a cross cluster onsite audit was conducted to review clinical documentation and resources for hemiplegic shoulder protection. 20 hospitals from 7 clusters were involved. The data collection period was from September 2022 to January 2023. The selection criteria included the principle diagnosis of stroke for the current admission and Hong Kong Version of the Functional Test of the Hemiplegic Upper Extremity (FTHUE-HK) at level 5 or below. Medical records were retrieved through random sampling.
Result & Outcome :
In phase one audit, 213 questionnaires were received. 98% of respondents were aware that the guideline was published, and 95.8% of them received training on the use of it.
In phase two, the on-site audit was conducted from February to March 2023, involving 365 patient records. Most of the compliance rate with the seven standards were above 90%. Only the rate of providing educational material of positioning advice and mobilization were 82.7% and 84.3% respectively. When comparing with the audit in 2014, all of the compliance rate improved.
The audit group recommended development of electronic format of standardized assessment form. Aligning the electronic educational material among hospitals would enhance communication during patient journey and patients’ accessibility.
