Page 122 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP3.5 Clinical Safety and Quality Service I 14:30 Room 221

Monday, 18 May Clinical Audit on “Guideline on Protective Measures for Hemiplegic Shoulder — from Occupational Therapy

Perspective”
Leung T 1, Chan H 2, Cheung P 3, Kwan I 4, Wong C 5, Fung ML 6, Wong SS 7, Chan C 3, Soo A 2
1Occupational Therapy Department, Prince of Wales Hospital, 2Occupational Therapy Department, Tai Po Hospital,
3Occupational Therapy Department, Tuen Mun Hospital, 4Occupational Therapy Department, Tung Wah Hospital,
5Occupational Therapy Department, Tung Wah East Hospital, 6Occupational Therapy Department, Kowloon Hospital,
7Occupational Therapy Department, Princess Margaret Hospital, Hong Kong

Introduction

Occupational therapists working in Hospital Authority are increasingly concerned about hemiplegic shoulder protection.
As a result, a hemiplegic shoulder protection working group was formed in January 2008 under the stroke working group
of Coordinating Committee in Occupational Therapy (OTCOC). With the launch of Guideline on Protective Measures for
Hemiplegic Shoulder in March 2011, auditing of the awareness and use of this newly developed Guideline is of utmost
importance to our clinicians. Thus a task group under the Medical Specialty Group of OTCOC was formed in August 2012 to
plan and implement the audit.

Objectives

To examine the extent of application of the Guideline on Protective Measures for Hemiplegic Shoulder against the standard
stated in the Guideline through; (1) increasing the awareness of the staff on use of the guideline; (2) assessing the difficulties
and the application of the Guideline; (3) recommending improvement and future action after the audit; and (4) improving the
standard of practice and enhancing global service consistency.

Methodology

The audit was divided into two phases: Phase one - a prospective, cross-sectional e-survey with questionnaire consisting
13 questions. The e-survey was distributed to hospitals providing stroke services. Occupational therapists who have been
providing or have provided services to stroke patients since the launch of the Guideline in 2011 were expected to complete
the survey. Phase two – onsite clinical audit on resources for hemiplegic shoulder protection and documentation review on
selected settings that provided services to stroke clients. An audit group was formed in each cluster, members of the group
had at least five years of experience working with stroke patients. Cross-cluster onsite audit was carried out, each cluster
would audit one acute setting, one rehabilitation setting and one ambulatory setting.

Results

The survey reflected that almost all respondents (96.6%) were aware of the Guideline and almost all of them (92.6%)
knew how to access the guideline. Most of the respondents (84.6%) received related training from different sources, most
respondents (88%) indicated that they assessed shoulder pain and subluxation regularly. The most common intervention was
“positioning” which was 97.1%. Most respondents (85.1%) reflected that they would have regular review on the prescribed
hemiplegic shoulder protective measures. Almost all respondents (95.4%) would provide shoulder protection education to
patients and carers. A total of 352 documentation were audited in seven different clusters and 19 different settings across
different phases of stroke rehabilitation: acute, rehabilitation and ambulatory care. The resources available in each setting is
also reviewed. The data of phase two audit was in the process of analysis with more result to be released.

HOSPITAL AUTHORITY CONVENTION 2015

120