Page 201 - HA Convention 2015

Corporate Scholarship Presentations

CS1.4 Rehabilitation Services 09:00 Room 228

Enhancing the Compliance Rate of Care Pathway in Stroke Care and Rehabilitation in Acute Stroke Unit (ASU) of
Prince of Wales Hospital
Chan KK
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong

Introduction

In 2013, stroke is the forth-leading cause of death in Hong Kong with about 25,000 new stroke cases. The mortality and
morbidity of stroke patients in Acute Stroke Unit (ASU) were reduced markedly according to international studies.

Objectives

(1) To promote organised and efficient patient care pathway from the best evidence and guidelines; (2) to encourage
multidisciplinary communication and care planning; and (3) to reinforce new staff to learn the key interventions for acute
stroke patient shortly.

Methodology Tuesday, 19 May

Case notes of stroke patients in ASU of the Princes of Wales Hospital from September 2013 to March 2014 were reviewed.
Compliance rate of the stroke care pathway in ASU before and after December 2013 was compared.

Result and Outcome

From September to November 2013, 116 case notes were reviewed and compliance rate of the stroke care pathway was
45.4%. Since the education talk and road show for nursing staff in December 2013, the compliance rate was increased to
59.2% from January to March 2014 with total 139 cases included.

Conclusion

After enhancing the utilisation of stroke care pathway by education talk and road show for nursing staff in ASU, the
compliance rate was significantly increased. Therefore, the workflow of the ASU was improved in order to maximise the
efficiency of the rehabilitation process of stroke patients.

CS1.5 Rehabilitation Services 09:00 Room 228

Cognitive-behavioural Approach in Chronic Pain Management - Observation and Application in Allied Health in HOSPITAL AUTHORITY CONVENTION 2015
Hospital Authority
Yu ACH 199
Physiotherapy Department, Caritas Medical Centre, Hong Kong

A team of six allied health professionals had attended an Overseas Corporate Scholarship Programme in pain management.
The programme aimed to build up new competency service to reduce the risk of long-term/chronic problems related to pain
means of psychosocial approach and ultimately achieving a better quality of life.

Chronic pain often affects the physical, psychological, social and vocational functioning of individuals, societal cost is also
substantial. Repeated failures in the use of strong analgesics along the analgesic ladder in treating chronic pain brings about
the need for treatment alternatives. Efficacy of cognitive behavioural therapy (CBT) in management of chronic pain has been
positively assured by various researches. There are studies supporting the evidence of morphological changes of the brain
after cognitive behavioural therapy.

CBT programmes involve a combination of cognitive and behavioural techniques. A multidisciplinary team that includes
medical doctors, nurses, physiotherapists, clinical psychologist plays a key role in facilitating these groups of patients to
breakthrough their sufferings. They collaborate with their clients rather than as experts to give solutions to their clients.
Elements of the programme include reconceptualisation of the pain problem and self-management strategies. These
strategies include activity pacing, goal setting, thought management, desensitisation and stretching exercises.

Successfulness of CBT-based programmes rely not only on careful screening assessment for appropriate clients but active
participation and motivation of subjects. Participants have to go through processes such as first assessment screening and
preview before enrolled to the programme. During the course programme, the team’s interview and reinforcement are of
utmost importance to gain client’s confidence and reliance. Clients’ cognitive progress were monitored and recorded in these
interviews. Other activities such as family activities, interviews and rehabilitation meetings can also act as catalysts to get
changes. Finally, home-based management skills reinforcement can further consolidate the skills learnt from the programme.
In addition to the strategies, cultural variations, existence of complementary medicine, government rehabilitation policies,
and education level of clients also affect the outcomes of the CBT-based programme.

In Hong, Kong, the highly government-funded medical system is facing the challenge of an aging population. Chronic pain
problem inevitably exacerbates the burden. The introduction of CBT-based programme could be the subject of discussion
among healthcare stakeholders.