Issuu on Google+

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

0


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

Number of Patients

Monthly Total Number of Patients 90 80 70 60 50 40 30 20 10 0

78

51

62

56 46

43

50

47

35

31 14

JAN

FEB MAR APR MAY JUN

JUL

21

AUG SEP OCT NOV DEC

Month in 2005

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.

2006 Monthly Total Number of Patients 57

Number of Patients

60

51

50

41 35

40 30

28

31

29

29

25 19

20 10

0 JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

Month in 2006

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.

1


90 78

80 70

62 57

56

60 51

40 30

50

46

50 35

35

28

43

31

29

51 47 2005

41

25

2006

31

29

21

19

20

14

10 0 Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

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

Number of Patients

Patient Categories 90 80 70 60 50 40 30 20 10 0

17 10 17 35

12

17

29

30

15

63

16

13

35

32

10

40

29

52

21

7 8

5 15

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Month in 2005 New Patient

Continuing Patient

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.

2


Patient Categories in 2006

Number of Patients

60

7

50

10

40 30

14

11

8

17

3

20

12

6

10

16

21

20

21

19

JAN

FEB

MAR

APR

MAY

50

41

6

26

24

13

0 JUN

JUL

AUG

SEP

OCT

Month in 2006 New Patient

Continuing Patient

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  Tuberculosis (2 cases) cases)  Meningitis  Tuberculosis of the Spine  Cerebral Malaria or Pott’s Diseas (4 cases)  Achilles tendinitis  Knee injuries  Hip dislocation  Stroke (3 cases)  Lateral epicondylitis  Rheumatoid Arthritis  Tumor  Spinal Cord Injury  Fractures 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) 120 100

100 84

80

71

71 64

66

66

69

71

75 68

60

50 53

2006

41 40 20

16

21

20

21

26 19

24

13

0 Jan Feb Mar Apr May Jun

Jul Aug Sep Oct Nov Dec

Figure 6. New Patients in 2005 and 2006

3

2005


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. 50 45

47 43

41

40

40

36

35 29

30

35

34

34 31

30 24

25

25

32

28

20

20

16 12

15

0

2005 2006

10

10 5

32 29

0 Jan Feb Mar Apr May Jun

Jul Aug Sep Oct Nov Dec

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

Number of Patients

Patient Age Groups 70 60 60 51 50 39 39 35 40 31 31 29 30 23 22 19 18 20 17 15 14 20 12 11 14 9 12 12 10 3 1 0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Month in 2005 Pediatric

Adult

Figure 8. Pediatric and Adult Patients in 2005 The most common diagnosis for children treated were the following:  Fractures  Meningitis  Delayed Development  Clubfoot

4


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

Number of Patients

Patient Age Groups 40 35 30 25 20 15 10 5 0

34

34 29

21

23 12

7

22 9

FEB

MAR

10

APR

17 11

5

JAN

22

20

19

MAY

8

JUN

12

13

SEP

OCT

7

JUL

AUG

Month in 2006 Child

Adult

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

5


Comparison of 2005 and 2006 figures: Children or Pediatric: 25 22 20

20

18

17

15

15 12

14

12 12 9

10

11 9

10

13 12 12 11

2005 2006

7

7 5

5

3 1

0 Jan Feb Mar Apr May Jun

Jul Aug Sep Oct Nov Dec

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: 70 60

60

51 50 39

40

39 35 31

30 20

23 21

23

31 34

29 22

19

34

2006

22

20

12 10

2005

29

14

17

8

0 Jan Feb Mar Apr May Jun

Jul Aug Sep Oct Nov Dec

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.

6


2. Sex/Gender

Number of Patients

Segregation of Patients according to Sex 50

44 36

40 30 20

29 28 23 17

22 13

30 27

36 28 27 23 18 17

27

26

21 10

6

10

9

13 7

0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Month in 2005 Male

Female

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.

Number of Patients

Segregation of Patients in 2006 according to Sex 35 30 25 20 15 10 5 0

27 23

16

18 12

15

15 1517

16

10

JAN

9

FEB

24

MAR

APR

MAY

13

14

JUN

JUL

28

29

23 18

6

AUG

SEP

OCT

Month in 2006 Male

Female

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.

7


3. In/Out/Hospital Staff

Number of Patients

Patient Classification 90 80 70 60 50 40 30 20 10 0

1

3

6

2

15

14

30

5 14

9 23

33

1 12

46

44

30

25

4 16 31

2 2

24

21

2 11

22

36

18

0 2 13

0 7 13

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Month in 2005 In Patients

Out-Patients

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).

Number of Patients

Patient Classification 60 50 40

2 0

30 20 10

6

5

11

0

4

12 11

18

21

JAN

FEB

3 8

16

18

MAR

APR

0

1

19

1 1

13

28 19

16 9

27

11

9

12

MAY

JUN

JUL

AUG

20

22

SEP

OCT

Month in 2006 In-Patient

Out-Patient

Hospital Staff

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).

8


II Physiotherapy Treatment A. Frequency of Treatments

Frequency of Treatment

Total Frequency of Treatments Done 450 400 350 300 250 200 150 100 50 0

389 338

324

261

248

221

255 193

172 132 93

88

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Month in 2005

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.

Frequency of Treatments

Total Frequency of Treatments 250 205 200

175

150

113 87

100

94

108

100 60

55

JUN

JUL

68

50 0 JAN

FEB

MAR

APR

MAY

AUG

SEP

OCT

Month in 2006

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

9


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. 8

7

77

7

6

6

6

6 5

5 4

4

2

5

4 3

3

5

4 3

2

4

4

3 2

3 2

2005 2006

2

1 0 Jan Feb Mar Apr May Jun

Jul

Aug Sep Oct Nov Dec

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.

10


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: A. Evaluations Initial Evaluations Re-evaluations Home-Evaluations B. Education Patient education Family/Caregiver education Community Education C. Chest Physiotherapy D. E. F. G.

H. I.

J.

K. L.

Cryotherapy Aquatherapy Jobst compression & Elevation Electrotherapy TENS ES NMES Interferential Currents Heating Agents Ultrasound HMP Soft Tissue Mobilizations Peripheral Joint Mobilization Manipulation Massage Stretching Therapeutic Exercises Prescription Demonstration Supervision Diet Advice Plan Others Posture Education Ergonomics Orthotics Prosthetic Assessment Gait re-education Traction Work Hardening Taping POP Neurological techniques Others

IMPLICATIONS - 189 - 77 -1

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

- 172 - 73 -0 - 36

Needed: Patient space for education : Time for community education Training: Caregiver training Needed: Re-check client base with Ward 2 Nurses doing a good job! Training: Student nurses trained for CPT Needed: Ice packs (currently only 5 at unit) Needed: Pool area (?) Needed: Equipment

- 48 - 11 -5 - 38 -7 -0 -1 - 59 - 61

Needed: More equipment (Only 1 TENS machine – owned by HSaweni) Needed: More equipment (Currently only 1 Ultrasound machine & Hot packs used are IV bags.)

-9 - 32 - 86 - 27

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

- 185 - 153 - 167

Needed: Equipment Training: More training focused on exercises

- 24 - 22 - 12 -2 - 35 -2 -5 -5 -0 - 0* -4 - 10 - 47**

Needed: Nutritionist Training: Nutritionist/Dietician 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: Home evaluation Community Education Neuromuscular Electrical Stimulation (no machine) Paraffin Wax Bath (no equipment – a makeshift was done with pan & candle wax: oil mixture) 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) 1. 2. 3. 4. 5.

11


III Management Concerns A. Caseload (per Physio Unit worker) Data gathered from 2005, analysed revealed the following.

Average Number of Patients Per Working Day 249 400 350 300 250 200 150 100 50 0

373

285

337

363

16

20

23

21

15.6

18.7

12.4

16.0

256

255

22

22 16.5

11.6

151

201

21 12.1

23 8.7

180

21 7.2

178

71

21

22

20

8.6

8.1

3.6

Month in 2005 Total Number of Daily Patients Seen Number of Working Days in the Month Average Number of Patients Per Working Day

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.

12


B. Patient Load

Number of Patients

Weekly Analysis of Patient Load

Days of the Week

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 InService 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.

13


C. Conditions treated & Trends of Conditions Total Percentage of Conditions Seen:

Conditions treated in 2005 Respiratory Conditions 6%

General Surgery Conditions 11%

Orthopaedic Conditions 63%

Neurological Conditions 20%

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:

Conditions seen in 2006 (Jan-Oct) OTHERS 10%

PEDIATRIC 3% RESPIRATORY

6%

GENERAL SURGICAL 4%

ORTHOPEDIC S 52%

NEUROLOGICAL

25%

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.

14


Trends of Conditions: 2005 ORTHOPEDICS:

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

Patients seen

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

1

1

3

1

3

2

1

4

1

13

1

1

1

1

1

SOFT TISSUE INJURY

OA RA

1

3

4

JRA

1

OSTEOMYELITIS CLUBFOOT OTHER - ORTHO

2

1

1

2

1

2

1

5

2

1

1

2

2

1 4

2

9 1

3

9

Table 1. Orthopedic Cases in 2005

Orthopedic Cases OSTEOMYELITIS

JRA 0%

2%

CLUBFOOT 4% OTHER ORTHO 4%

RA 2%

STI 26%

OA 5% FX/ DISLOCATION

BACK PAIN 19%

38%

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.

15


2006 ORTHOPEDICS

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

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

RA

1

1

1

3

5

1

1

2

1

DEC

1

1

1

OSTEOMYELITIS

3

CLUBFOOT

1 3

3

2

3

2

2

3

1 4

11

2 6

14

45

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

Orthopedic Cases in 2006 (Jan-Oct) SOFT TISSUE INJURY 16%

OTHER ORTHO 32%

BACK PAIN 29%

CLUBFOOT 1%

OSTEOMYELI TIS 2% JRA 1%

OA 3%

RA 4%

FX/ DISLOCATION 12%

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

16

Patients seen

5

JRA

OTHER - ORTHO

NOV


2005 NEUROLOGY:

JAN

CP MENINGITIS POTT'S DSE CVA TBI SCI PNI GBS OTHERS - Neuro

1

FEB

MAR

APR

MAY

JUN

1

3

3

3

6

6

1

2

3

2

2

1

2

1

1

2

1

2

1

1

1

4

2

2

1

1

3

2 2

4

JUL

AUG

SEP

1

1

1

5

2

2

OCT

1 4

4

2

NOV

DEC

Patients seen

2

7 19

2

2

2

1

1

1

7

3

2

1

14

2

1

5 7

2 1

1

4 2

3

2

3

2

1

1

1

14

Table 3. Neurological Cases seen in 2005

Neurological Conditions OTHERS Neuro 18%

CP 9%

GBS 1%

MENINGITIS 24%

PNI 5% SCI 9%

TBI 7%

CVA 18%

POTT'S DSE 9%

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.

17


2006 NEUROLOGICAL CP MENINGITIS ENCEPHALITIS* POTT'S DSE CVA TBI SCI PNI GBS OTHERS - Neuro

JAN FEB MAR 2

3

1

3 1

4 4

3 3

1 1

1

3

3

APR MAY JUN 1 1 1 1 1 1 2 3 1 2 1 1 1 1

1

2

JUL AUG SEP OCT NOV DEC 1 3 2 2 2 1 1 1 4 1 3 1 2 3 1 1 1 3 5 1 1 1 2 1 1 6 1

Patients seen 3 8 2 12 10 1 7 3 2 14

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

Neurological Conditions in 2006 (Jan-Oct) OTHERS Neuro 23%

CP 5%

MENINGITIS 13% ENCEPHALITIS*

3% GBS 3%

PNI 5% SCI 11%

CVA 16%

TBI 2%

POTT'S DSE 19%

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

18


2005 GENERAL SURGERY

JAN

PRE/POST - OP

1

AMPUTATION

1

FEB

MAR

APR

MAY

3

3

3

2

5

4

2

1

1

3

BURNS

JUN

JUL

AUG

SEP

OCT

3

1

1

2

1

NOV

DEC

Patients seen

1

18

1

12

1

OTHERS

2

1 1

1

1

9

Table 5. Cases from General Surgery in 2005

General Surgical Conditions PRE/POST OP 45%

OTHERS 23%

BURNS 2%

AMPUTATION 30%

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 AMPUTATION HAND INJURIES OTHERS

JAN FEB MAR 5 2 2 1

APR MAY JUN 1 1 2 1 1

JUL AUG SEP OCT NOV DEC 1 2 1

Patients seen 12 4 2

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

General Surgical Conditions in 2006 (Jan-Oct) OTHERS 11%

HAND INJURIES 22%

AMPUTATION 67%

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

19


2005 RESPIRATORY CASES:

JAN FEB

MAR

APR MAY JUN JUL AUG

SEP OCT NOV

ASTHMA

DEC

Patients seen

1

RESTRICTIVE LUNG DISEASE

1

1

INFECTION

1

PTB

1

OTHERS

2

1

2

1

1

2

2 4

1

1 1

3 3

3

3

8 8

Table 7. Respiratory Cases in 2005

Respiratory Conditions RESTRICTIVE LUNG DISEASE 9%

ASTHMA 5% OTHERS 36%

INFECTION 14%

PTB 36%

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 ASTHMA RESTRICTIVE LUNG DISEASE INFECTION PTB PNEUMONIA* OTHERS

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Patients seen 1 1 1 1 1 1 1 1 2 1 1 2 1 1 2 1 2 2 3 10

Table 8. Respiratory Cases in 2006

Respiratory Conditions in 2006 (Jan-Oct) RESTRICTIVE LUNG DISEASE 6%

ASTHMA 6%

INFECTION 6%

PTB 11% OTHERS 59%

PNEUMONIA* 12%

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

20


UNREGISTERED (2005) UNREGISTERED

JAN 1

FEB 2

MAR 2

APR 2

MAY 4

JUN

JUL 2

AUG 1

SEP

OCT 4

NOV 1

DEC Patients seen 16

UNREGISTERED (2006) UNREGISTERED

JAN FEB MAR APR MAY JUN 2 4 3 2 2

JUL AUG SEP OCT NOV DEC 3 5 4 3

Patients seen 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:

Aging

2

Sports Injury

4

Genetic

7

Trauma

69

Other

74

Sickness

110 0

20

40

60

80

100

120

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.

21


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:

Month

2005 20 35 49 41 39 29 35 30 26 39 5 19 367

January February March April May June July August September October November December Frequency of treatments Total Income (calculated at 6 kina/treatment) TOTAL

2006 22 18 19 15 28 20 27 42 28 47

266

K2202 K1596 K3798

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.

22


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) Number of Patients (Surnames) Physio Worker AI JP Q Z BALANGUE 131 107 91 EMINI 130 234 156 HURIM 132 70 23 GIREY 56 81 22 SAWENI 45 69 43 IYAPE 11 14 8 LUNDU 104 4 0 NAUA 50 29 18 AUPAE 11 13 10 LUKE MOTA 5 0 0 TOTAL OF PATIENTS DOCUMENTED

total

%

329 520 225 159 157 33 108 97 34 5 1667

19.7 31.2 13.5 9.5 9.4 2 6.5 5.8 2 0.3 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

23


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

24


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 Mathew F Yiyiri Milliana Zugu Beverly Dei Glenda Paul Dorothy

27 – 31 March 2006 3 – 7 April 2006 22 May – 2 June 2006 22 May – 2 June 2006 26 June 2006 – 14 July 2006 26 June 2006 – 14 July 2006

25

1 Week 1 Week 2 Weeks 2 Weeks 3 Weeks 3 Weeks


Iowa Erasi Kino Martha Telam Maria Terada Miwa Gena C Powes F

28 August 2006 – 8 September 2006 28 August 2006 – 8 September 2006 16 October 2006 – 3 November 2006 16 October 2006 – 3 November 2006 6 – 28 November 2006 22 – 28 November 2006

2 Weeks 2 Weeks 3 Weeks 3 Weeks 2.5 Weeks 2.5 Weeks

Year 2 – 13 Student Nurses Kailou M Manga Franklyn Neirahi Maureen Noglai Mary Poli Gibson Francisca Ikema Angela Kawage J Lare I Sumiog Jayson Maika Jepi Angawi M Kasa Lilly

27 February – 3 March 2006 13 – 24 March 2006 1 – 12 March 2006 1 – 12 March 2006 12 – 16 June 2006 19 June – 14 July 2006 19 June – 14 July 2006 10 – 28 July 2006 17 – 28 July 2006 17 – 28 July 2006 28 August - 8 September 2006 16 – 27 October 2006 6 – 17 November 2006

1 week 2 weeks 1.5 weeks 1.5 weeks 1 week 4 weeks 4 weeks 3 weeks 2 weeks 2 weeks 2 weeks 2 weeks 2 weeks

Year 3 – 10 student nurses Hiasihri Kainge Christina Sine I Darius Joan Zinong Zillah Wanamaga Joyce Ume Natasha Telenge William George Josephine Ireew

30 January – 10 February 2006 13 – 24 February 2006 27 March – 7 April 2006 3 – 7 April 2006 10 – 28 April 2006 10 – 21 April 2006 22 May – 2 June 2006 19 – 30 June 2006 19 – 30 June 2006 30 October – 3 November 2006

2 weeks 2 weeks 2 weeks 2 weeks 1 week 2 weeks 2 weeks 2 weeks 2 weeks 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

26


   

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):

total # of pts in file: %

2005 406

628 336 53.5

2006 222

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.

27


Physiotherapy Unit – Modilon Hospital Responsibilities of A Physiotherapist Teacher Stakeholder = Accountability

Aim

Directly: Students (LSN & DWU) DWU Indirectly: Patients Hospital To share knowledge, behaviour, and skills

Training Supervisor

Clinical Physiotherapist Directly: Patient Hospital

Directly: Staff Hospital

Indirectly: PNG for workforce

Indirectly: Patient

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

Directly: Students DWU Hospital Indirectly: Patients

Sustainability

More students into the profession

Knowledgeable and skilled students in the profession

Effective and appropriate services to the patient  optimized function for patient

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)

   

 

28

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)

Administrative Officer


5 minutes/issue) Budget resources (include search for means of budget) for the department (minimum 5 hours)  Community Outreach/Networ king (1 hour minimum) 15 hours minimum 

TOTAL TIME (minimum/day)

6 hours minimum

Considerations

10.25 hours minimum

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

2.32 hours/patient ave # patients/day = 5 11.60 hours minimum (without IST & OnCall) 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.

29


V Planning Planning for Timetables: Daily Schedule: TIME 7.45 7.50 7.55 8.00 8.05 8.10

MONDAY Time in/ Cleaning/ Preparing Plinths

TUESDAY Cleaning Ward Exercises 1 2

WARD ROUNDS

3 4 CASE PRESENTATION

9.00 10.00 11.00

11.30 12.001.00 1.00 2.00 3.00 3.30

TREATMENT (Tx) DWU calls for Cases Or DISABILITY NETWORK TREATMENT

WARD Tx/ Out-patient Tx

WEDNESDAY Time in/ Cleaning/ Preparing Plinths WARD ROUNDS

In-Service Lectures Impress Schedule with Minai/PrintShop

THURSDAY Cleaning Ward Exercises 1 2 3 4 OUT-PATIENT TREATMENTS

FRIDAY Time in/ Cleaning/ Preparing Plinths GRAND ROUNDS In-Service Classrm WARD ROUNDS

Photocopying Meeting with DMS

Ward Rounds/Tx

TQM Meeting

Staff Meeting

In-Service Training With CSHC Wellness Program

STROKE CLINIC/ CASE STUDY With DWU

WARD TREATMENT Lunch

STROKE CLINIC/ IN-PATIENT TX

Break

STROKE CLINIC/ IN-PATIENT TX Wellness Program (suggested) 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

30


Sample Yearly Schedule for 2007: NATIONAL JAN

1 New Year

FEB

20 International Mother’s Language Day

MAR

8 International Women’s Day International World Peace Day 9 Commonwealth Day 29 NATIONAL DISABILITY DAY

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 3 World Press Freedom Day 15 International Day of Family 17 World Telecommunications’ Day 31 World No Tobacco Day 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 International Day of Cooperating 11 World Population Day & St Benedict’s Day 19 Madang Provincial Government Day 23 Remembrance Day

MAY

JUN

JUL

AU G

MGH ACTIVITIES

9 International Day of World’s Indigenous People

Annual Reports Financial Reports

PHYSIO UNIT Inventory Call NOPS for Foundatio n Wheelcha irs (shipment arrived 15 Decembe r 2006) Call Cathy Ketepa (NOPS) for Motivatio n Wheelcha ir program me check PNG-wide 15 Mercia Girey’s Birthday

DWU - PHYSIO 22 Lecturers Return/ Staff 23 Induction 25 Academic Board Meeting 29 Registration of Students 31 Semester 1 Begins

LSN Curriculu m Vitae meeting postponed to this month

LEPROSY MISSION 28 Internationa l Day for Leprosy

CSHC

OTHERS

25 Meetin g for MDG

Meet with Jackie Kauli for Annual Activity planning for Saidor visits

18 Graduation Day 19 University Council Meeting

1 Academic Board Meeting 19-25 Mid semester Study Period 26 Lectures Resume

TAXES due April!

Environmen t Summit at DWU

5 Eunice Emini’s Birthday

6 Open Day/EU Cup Grand Final 9 Europe Day 18 Lectures begin 21 Exams begin 28 Exams 1 Semester I ends 4-17 Semester I Break 18 Semester II Begins 26 University Council Meeting 28 Hospitality & Tourism Night

VSO Disability Programme Conference 23? National Board of Disabled Conference ? Women with Disabilities Conference

13 Hugh Saweni’s Birthday

6-12 MidSemester Study Period 13 Lectures

31


SEP

OCT

NO V

DEC

begin 18 Cultural Day 21 DWU DAY 5 Academic Board Meeting 7 Business Studies Ethics Symposium 24 Information Systems Symposium

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 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 20 Universal Children’s Day

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

National Games

5 Lectures End 8 Exams Begin 19 Semester II ends 22 Staff Infrastructur e 29 Staff Research Begins

1 Eli Hurim’s Birthday

8 Academic Board Meeting 27 University Council Meeting 7 Staff Research Ends

32

National Soccer Games


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.

33


PATIENT NAME

(Given Name, Surname)

SEX/age

CONTACT DETAILS Guardian: _________________________ Phone Numbers: ____________________ Village, District: ____________________ Community Centre: __________________ Place of Origin:

(Day, Month, Year)

DATE OF BIRTH

PHD Number: __________________ MGH Number: ___________________ Health Centre: _________________ Religion: ________________________

Medical Diagnosis: ____________________________________________________________ Doctor: ________________________ ____________________________________ Physio: ________________________ Precautions:________________________________ Nurse: ________________________ _____________________________ ________________________ _____________________________ Date of Referral: _____________________ Source of Referral: ________________________ Date of Initial Physiotherapy Evaluation: ______________________ by _________________ DATE

TIME

PHYSIO

WARD/BED NUMBER

A

PHYSIO SERVICES PROVIDED B C D E F G H I J

K

CONFIRM TX DONE

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

34

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


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.

35


PATIENT MEDICAL DIAGNOSIS OCCUPATION

SEX

AGE

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: Dosage

Indication

S/E

Medications Taken:

Dates Re-checked:

Primary Complaint

S: O: Vital Signs

Expectations

RR:

Ocular Inspection

PR: BP: Palpation

During Treatment

After Treatment

ROM

MMT

Neurological Tests Special Tests

A:PT Impression:

P:

Expected period of physiotherapy tx: Problem List:

Interventions:

36

ADL


The Use of the Statistics at Modilon General Hospital