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P-475
Early supported discharge following mild stroke: a qualitative
study of patients
’
and their partners
’
experiences of rehabilitation
at home
S. Lou
1
, K. Carstensen
1
, M. Møldrup
2
, S. Shahla
3
, E. Zakharia
4
,
C. Nielsen
1,5
.
1
CFK- Public Health & Quality Improvement, Central
Denmark Region, AarhusN,
2
Department of Rehabilitation, Horsens
Regional Hospital, Horsens,
3
Department of Internal Medicine/Geriatrics,
Randers Regional Hospital, Randers,
4
Department of Neurology, Viborg
Regional Hospital, Viborg,
5
Department of Public Health, Aarhus
University, AarhusC, Denmark
Objectives:
Early supported discharge (ESD) allows mild-to-moderate
stroke patients to return home as soon as possible and continue
rehabilitation in familiar surroundings and at their own pace. Thus, the
main responsibility for further rehabilitation is put in the hands of
patients and their partner, who must collaborate to adjust to post-
stroke everyday life. However, couples
’
joint experiences of stroke,
early discharge and rehabilitation at home remains poorly inves-
tigated. Aim: To investigate how mild-to-moderate stroke patients
’
and their partners
’
experience and manage everyday life in a context
of ESD.
Methods:
Qualitative interviews were performed with a purposive
sample of 22 ESD patients and 18 partners. Interviews were per-
formed 3
–
6 weeks after stroke and data was analysed using thematic
analysis.
Results:
The analysis identified three themes:
“
Home as a healing
place
”
involved the couples
’
experiences of a well-informed discharge
from hospital. They trusted the health professionals
’
assessment that
the patient was ready to come home. Home was described as a
comforting and calm place, where recovery could meaningfully take
place.
“
Flow of everyday life
”
comprised the experiences of adapting
to and continuing everyday life. Most interviewees had relatively
little physical and cognitive impairment and at this point patients
and partners were hopeful of full recovery in a foreseeable future.
“
Professional safety net
”
involved the much appreciated stroke
team. Though most participants had only had one visit from the
team, knowing that they were an accessible resource was of great
importance for the couples.
Conclusion:
ESD was experienced as a meaningful and adequate
rehabilitation service that allowed patients and partners to collabora-
tively re-invent and re-build their flow of everyday life by jointly
adjusting routines, activities and their relationship.
P-476
Patient-centred goal setting in geriatric rehabilitation: a feasibility
study
E.B. Smit, H. Bouwstra, H. van der Wouden, L. Wattel, C.M.P.M. Hertogh.
Department of General Practice & Elderly Care Medicine, VU University
Medical Center, Amsterdam, the Netherlands
Background:
Goal setting is considered essential in geriatric rehabili-
tation. It can result in higher levels of motivation, self-efficacy and
health related quality of life. Currently, no standardmethod is available
for geriatric rehabilitation which combines patient-centred goal
setting with the use of valid measurement instruments. Objective:
To determine the feasibility of a new goal setting intervention with
active patient participation and evaluation of rehabilitation goals by
means of standardized functional measurement instruments.
Design:
This qualitative study assessed the feasibility of the interven-
tion on two geriatric inpatient rehabilitation wards. Both patients and
professionals participated in open interviews. Patients were inter-
viewed once their rehabilitation period was finished and the
professionals at the end of the study period. Interview transcripts
were analysed qualitatively using a framework analysis according to
six pre-established feasibility criteria: acceptability, demand, imple-
mentation, practicality, adaptation and integration.
Results:
A total of eight stroke patients and three professionals
participated in the study. Both patients and professionals expressed a
need for patient-centred goal setting. The content and the design of
our intervention was considered appropriate by both groups. No
adverse effects were reported. The professionals reported that they did
not consistently carry out the intervention. The main reasons for this
were lack of time and falling back in old patrons. Finally, professionals
found it difficult to apply this method to patients with communication
problems.
Conclusion:
Adaptions are needed before the intervention can be
successfully implemented in current practice. Recommendations for
implementing this new goal setting intervention will be presented at
the conference.
P-477
Preventing falls in the rehabilitation setting
M. Smith, T. George, J. Papa, E. Chytilova, M. Mc Mahon, C. Tiernan,
L. Cogan.
The Royal Hospital Donnybrook
Background:
Systematic reviews suggest that multifactorial assess-
ment and intervention can reduce falls by 20
–
30%. A quality
improvement initiative was implemented on four hospital rehabi-
litation units. The initiative involved an implementation of the key
components of multifactorial interventions. The aim of the initiative
was to reduce falls by 20% over 12 months and further 20% by 10
months.
Methods:
Quality initiative was implemented in 4 rehabilitation units.
The project included application of falls care bundle to all patients.
The falls leads nurses used PDSA cycle to implement and to sustain the
falls care bundle. Data on falls were collected from incident reports.
Data on falls care bundle compliance were collected each month by
falls lead nurses.
Results:
In June 2014, the falls rate was 7.1 falls per 1,000 bed days.
In April 2015, the falls rate decreased to 4.2 falls per 1,000 bed days
and in April 2016 the falls rate decreased to 2.5 falls per 1,000 bed
days. Concurrently, the compliance with the fall care bundle in June
2014 was 11%, in April 2015 was 56% and in April 2016 was 73%. Overall,
the initiative lead to increased awareness of falls among staff and
patients, improved falls risk assessment and falls care planning.
Additionally, a falls huddle was introduced as a part of the post-fall
assessment.
Conclusion:
Introducing evidence-based fall care bundles of multi-
factorial assessment and intervention using a quality improvement
approach resulted in improved delivery of multifactorial assessment
and intervention and a significant reduction in the fall rates.
P-478
Reducing pressure ulcer development and increasing patient
engagement in an elderly rehabilitation population
M. Smith, T. George, M. Betamor, M. Mc Mahon.
The Royal Hospital
Donnybrook
Background:
The development of a pressure ulcer is a serious
complication not only in terms of patient safety but also in terms of
patients
’
overall experience. Collaborative quality improvement
initiative was introduced to one of the hospital
’
s rehabilitation units
(n = 27 beds). The goal was set to reduce the incidence of avoidable
pressure ulcers to 0% within 6 months.
Methods:
The quality improvement initiative collaborative is centred
on the introduction of the SSKIN (surface, skin inspection, keep
moving, incontinence, nutrition) care bundle, which is an evidence-
based tool to prevent pressure ulcers. PDSA cycles were used by the
nurse lead to implement the SSKIN care bundle with patients who
were at risk of developing a pressure ulcer and were also used to
increase patient engagement in preventing pressure ulcers. Data on
the incidence of pressure ulcers and patient engagement was collected
each month from incident reports and from the safety cross calendar.
Results:
The results from this collaborative showed a 75% reduction in
pressure ulcers development. The compliance with the SSKIN care
bundle increased to 80% in 6 months. Furthermore, screening of
patients for the risk of pressure ulcer development increased in 6
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S155