Standard Operating Procedure - JSS - Physiotherapy

Jagadguru Shri Shivarathreeshwara Hospital

JSSH/SOP/ PMR Issue date: 1-JULY-2017 Issue No.:01

PMR Centre Next Rev. date: 30-JUNE-2019

Rev No.:00

Page 1 of 19 Effective Date: 1-JULY-2017

Standard Operating Procedure

DEPARTMENT OF PHYSICAL MEDICINE &

REHABILITATION CENTRE

Prepared By: Reviewed By: Approved By:

Department Coordinator Head of the Department Medical Superintendent

Signature Signature Signature




Rev No.:00


JSS PHYSICAL MEDICINE & REHABILITATION CENTRE

Brief of the department

The PMRC has been established with the objective of providing comprehensive rehabilitation to

physically disabled individuals, a hitherto unavailable service in this area. The centre has the

capacity to cater to 24 in patients and also has an outpatient wing.

Since its inception in Dec 2016, the Centre has catered to over 120 individual’s children, adults

and the elderly. We have the capacity to rehabilitate people with stroke, spinal cord injury ,

cerebral palsy, Parkinson’s disease, head injury, amputation to name a few conditions. In addition

to doctors, and nurses, we have on staff physiotherapists, Occupational Therapists, Medico

Social Worker, speech language pathologists, clinical psychologists, orthotics and prosthetics and

recreation therapy thus providing comprehensive and holistic care.

Department structure:

Admitting Doctor

The Deputy Director of PMRC

2-Physiotherapist

2-Occupational therapist

1-Clinical Psychologist

4-Rehab staff nurse

1-Medico socio worker




Rev No.:00


4- Therapuetic attenders

Scope of services: We the JSS PMR giving the service for the In- patients Rehab Services from

Monday to Sunday 9AM to 5.30 PM. for OPD patients Monday to Friday 9AM to 5.30 PM.

Applicable laws, regulations and licenses as per JSS Hospital

Policy & SOP of registration and admission as per JSSH.

Definition for vulnerable group:

Vulnerable groups in JSS PMRC those in cognitive impairment those who are in fall risk and

those who are in dysphagia risk and who are potentially to become medically unstable eg.

Uncontrolled diabetes and cardiac problems. Rehab nurses will do hourly supervision; relevant

posters will be put up in the room as well as the bracelets those will be put on the patient list

during admission.

Responsibility during working hours are of all staffs and post working hours is of the duty rehab

nurse. All patients who are medically unstable are placed near the nurse’s station as extent to the

possible.

We have call bell system in the bathroom and room in case of emergency.

SOP for initial assessment , reassessment and providing round the clock service

Nutritional needs: patients are referred to dietician for nutritional assessment

Pain management and safety policy:

Use of gait belts




Rev No.:00


Use of wheelchair seat belts

Use of bed rails

Use of non-slippery mats in washrooms

Walking aids and orthosis prescribed to be used at all time

Identify early warning signs: rehab nurses will do a daily examination for skin breakage,

pulmonary embolism, DVT, hypoglycemia, hypotension and if any medical emergency patient

will be referred to EMD red zone or emergency department as required.

Documented care plan:

Policy

To ensure that all patients POC completed within 3 days of admission

Purpose

POC is the framework within which all disciplines will treat the patients, this POC will updated

on patient situation changes (Improves or Deteriorate)

Definition

POC is a Document that outlines all the procedure undertaken by all disciplines in a inter-

disciplinary manner to ensure that best care for the patients. This will form the guidelines from

which weekly individual department goals are.

Responsibility

Ensuring compilation of POC is MSW

Compilation of POC is all disciplines




Rev No.:00


Distribution

IP/OP on regular therapy

Process details

Patient admitted in JSS PMRC OP/IP will be evaluated by all all disciplines within 48 hours of

admission, all involved in the patient care will sit together and completed the POC and will be

submitted to MSW with 72 hours

Follow up

POC revised at every weekly case conference and updated

Reassessment:

post discharge patient will be advised for a follow up of reassessment to see any deterioration or

maintenance of the condition.

Policy

Ensure weekly update of POC

Purpose

Ensure that the new goal set at each week or reflected in the POC

Definition

POC is formed after initial evaluation will be updated in every week depending upon patient

condition




Rev No.:00


Scope

Inter disciplinary

Responsibility

Ensuring compilation of weekly updated of POC is MSW

Compilation of weekly POC is all disciplines

Process details

Any changes in the POC will discuss in the case conference and updated in the POC after setting

of goal ( see SOP for weekly goals)

Patient and family members: for documentation of educating patients and attender, family

conferences are done

Purpose

To discuss any concerned and patients /Therapist may have about the patient status , discuss

achievable goals and subsequent of discharge

Definition

Process of involving family / patient with the Treating therapist in a discussion as above

Responsibility

All Disciplines

Distribution

PMRC In-patients Admission procedure

All Disciplines




Rev No.:00


Process details

within 1 weeks after patient admission ( after all initial evaluation completed) and initial POC is

finalized, the Patient and patient attender will be invited for Family conference , prior to take

informed consent to be taken and while family conference audio recording will be done.

Patient and patient attender involve to express their views , goals that they have about PMR,

therapist will communicate their POC, Expectation and what support there require from patient

family, and all documented and taken signature by all present in the family conference and one

copy given to the family and one copy documented in the file.

Before Discharge every patient has to take part of Therapeutic Outing, it is an Integral part of

Rehabilitation prior to discharge. So as to enable us and the patients to better understand their

needs in the community.




Rev No.:00


Informed consent

Consent Form

I am Care taker of Admitting in JSS Physical Medicine and Rehabilitation

Centre General Ward / Semi Special / Special Ward by agreeing Terms and Conditions explain

by the Nursing / Reception / any other Rehabilitation team member like,

Waking up by 6 am in the morning.

General ward room should be open after 6 am and any staff from JSS PMRC can visit at any

point of time.

Personal Hygiene / Nursing procedure etc should finish by 8 am.

Breakfast before 8 30 am and should report to therapy area by 8 55 am.

Any clarification regarding the treatment can enquire treating therapist / Clinical in charge /

Deputy Director.

Lunch Break at 1 pm.

Breakfast / Lunch / Dinner should have in Dining hall both Patient and care taker.

Management is not responsible for any loss during the stay in JSS PMRC.

Patient and Care taker responsibility to maintain cleanliness in JSS PMRC.

General ward patient at tenders may use the Stove in dining room (Next to nurse station) for

heating water, tea, coffee only.




Rev No.:00


Special ward patient at tenders may use the stoves in their room to cook small items in the

patient at tenders room (near exit), the Maintenance of the stove is their responsibility use only

stove allotted to your room.

Patient at tenders must accompany patients to all therapies and Learn and assist in exercise,

Therapists will Teach and Guide only.

Tariff has been explained as mention below:

General ward: 330 INR – 2 sharing

General ward: 660 INR- single

Private ward: 1000 INR- 2 sharing

Private ward: 2000 INR-single

Note: Initial tariff cannot be change




Rev No.:00


Role and Responsibility of Each Discipline area

Medical officer

To ensure suitability of the patient for rehabilitation.

To supervise the medical needs of the patient.

To lead the rehabilitation team.

Physical therapists

Provide services that develop, maintain and restore people’s maximum movement and

functional ability. They treat patients at any stage of life, when movement and function are

affected by ageing, injury, diseases, disorders, environmental factors. Physical therapists help

people maximize their quality of life, by increasing mobility.

Role &Responsibilities of physiotherapist

Undertake examination/assessment of the patient.

Evaluate the findings from the examination/assessment to make clinical judgments re-

garding patients/clients.

Formulate a diagnosis and plan.

Determine when patients/clients need to be referred to another health care professional.

Implement a physical therapist intervention/treatment.

Determine the outcomes of the interventions/treatments.

Make recommendations for self-management and educate patient & care giver in safe

management of mobility.




Rev No.:00


Role & Responsibilities of Occupational Therapy:

What Is Occupational Therapy:-

'Occupational Therapy is a holistic evidence-based client- centered first contact and/or referral profession

of modern health care system, based on science of occupation, with primary focus on purposeful goal-

oriented activity/occupations, enhanced with the use of latest technological systems for evaluation, diag-

nosis, education and treatment of the patients (clients) of any age group, whose function(s) is (are) im-

paired by physical, psychosocial and cognitive impairments, development disorders, or the ageing process

affecting their quality of life, with the aim to prevent disability, promote health & well-being and return to

optimum occupational roles.

Specific occupational Therapy services include but are not limited to:

Preventive health literacy assessment & interventions in activities of daily living (ADL), work &

productive activities, play, leisure

Functional capacity analysis, prescription, designing and training in the use of assistive technol-

ogy, adaptive equipment & splints, and environmental modifications to enhance functional per-

formance.

Develop & improvise ADLs (Activities of Daily Living).This includes taking self-care activities

like dressing activities buttoning/unbuttoning, writing skill development, Skills training viz. cal-

culations & handling money.

Demonstrate on use of adaptive devices at home, school or work place (viz. pen holder/swivel

spoon, etc.)

Demonstration to parents/care-givers regarding execution of strategies at home along with home

programme.

Group therapy sessions to improve social interaction and inter-personal skills




Rev No.:00


Role and Responsibility of MSW

Medical social work is a sub-discipline of social work, also known as hospital social work. Medical

social workers typically work in a hospital, outpatient clinic, community health agency, long-term care

facility or they work with patients and their families in need of psychosocial help

Initial Evaluation

Socio Economic assessment of patient and family

Case work counseling, short term and long term, with special reference to disability, both individ-

ual and family depending on the type/ severity and the treatment advised

Assistance (Community Re-integrate)

Educational assistance, School and institutional placement, family services

Coordination with community Resources for the integration of PWD in the community

Assistance (PWD Card)

Coordination in respective Govt Hospitals to avail PWD card

Facilitating Govt benefits from respective local authorities

Family Conference

Participation in interdisciplinary Case Conferences and conduct family conference for each pa-

tients and conference will be conduct based on patient and family members need.

Home Evaluation




Rev No.:00


Assisting home evaluation and work station evaluation and modification recommendations with

physiotherapist ,occupational therapist

Role and Responsibility of Rehabilitation Nursing

Rehabilitation nursing is a special branch of nursing which deals with assisting and educating a person

with disability to take care of health care needs to prevent secondary complications.

Responsibilities of rehabilitation nurse

Undertake examination/assessment of the health needs of patient

Evaluate the findings from the examination/assessment to make clinical judgments regarding hy

giene, nutrition, skin, excretory functions

Determine when patients/clients need to be referred to another health care professional.

Implement a training program in self-care, bladder training, bowel training

Coordinate with other member of the team to assess needs and potential complications before

they arise

Make recommendations for self-management and educate patient & care giver in safe manage-

ment of health

WHAT IS CLINICAL PSYCHOLOGY

After an injury or serious illness, the emotional recovery is as important as physical recovery. Our

qualified psychologist will work with you and your family to improve emotional wellness and overall

well-being. We provide psychological assessments & therapeutic interventions for patients who are

recuperating from medical and neurological disabilities. In the latter patients our treatment is aimed




Rev No.:00


specifically at identifying & addressing any behavioral & emotional impairments and changes in their

thinking (cognitive) abilities. Our psychologists carry out a thorough psychological evaluation and assess

the mood & coping skills of individual patients. A psychological treatment plan will then be developed

and will include a combination of:

· Counseling & behavioral therapy and Individual & group counseling sessions

· Relaxation/stress management sessions and ongoing Therapy.

The scope & nature of the specific psychological services vary, based on the patient’s disability/ illness

and will also be progressively altered depending on his/her response to the therapy sessions.

ROLE AND RESPONSIBILITY OF PSYCHOLOGIST

To optimize cognitive functions like

To improving patient alertness

To improve patient orientation level daily.

Problem solving

Memory

Calculation

Judgment

Behavior

Sequencing, planning, Organization

To provide appropriate cognitive aids.




Rev No.:00


Role & Responsibilities of Recreational Therapist

Therapeutic Recreation: Recreational therapy or Therapeutic recreation (TR) is a systematic

process that utilizes recreation and other activity-based interventions to address the assessed needs

of individuals with illnesses and/or disabling conditions, as a means to psychological and physical

health, recovery and well-being. Recreational therapy may also be simply referred to as recreation

therapy.

Recreational therapists work with clients to restore motor, social and cognitive functioning, build

confidence, develop coping skills, and integrate skills learned in treatment settings into community

settings. Intervention areas vary widely and are based upon client interests. Examples of

intervention moralities include creative arts (e.g., crafts music, dance, drama, among others),

sports, Badminton, Basketball adventure programming, and leisure education..

Occupational Therapy will check motor Execution Deficit, Hand Function Dexterity, visuo- motor

Deficit

Physio Therapy-will check-balance, strength, Endurance, Walking/W/C,

SLP-Communication,Comprehension, intelligibility,

CL psychology-problem Solving, Memory, recall, judgment.

SPEECH LANGUAGE PATHOLOGIST

Health care professionals, trained to evaluate and treat individuals of all ages with communication,

cognitive or swallowing problems.

Provide therapeutic program based on an individualized assessment.

WHAT WE WORK ON

Receptive Language – understanding spoken or written language.




Rev No.:00


Expressive Language – ability to communicate wants, needs, thoughts through words, sentences,

gestures and writing.

Voice and resonance – quality, loudness and pitch of voice.

Social Language – understanding and appropriate use of language in social situations.

Feeding or swallowing – the process of food entering the mouth, chewing and swallowing.

Augmentative – Alternative Communication – verbal communication is supplemented or replaced

by other methods.

Revisit and discharge protocol: we don’t have re visits, only follow up visit.

There are 3 category of discharge procedure,

1) When we meet goal,

2) On patients request

3) When patient is not suitable for therapy.

Policy

Process after patient discharge, patient will be followed up for period of time in which may last

from 3 months to 1 year in order to ensure that maintenance of what would have been achieved.

Purpose

To ensure that patient after discharge from JSS PMRC are able to cope with the society and any

secondary compliances can be identified.

Distribution

All IP/OP




Rev No.:00


Responsibility

MSW (Medico Social Worker)

Process

15 days to 1 month after discharge patient will be contacted to find out if they have any issues

with reentry, that might require intervention from PMRC staff, if there is a need patient invited to

return to PMR center then we will do family conference and discussion will be taken to re admit

or educate and counsel & discharge.

Process will continue until such time discharge patient does not report anymore, in case

secondary problems (Deteriorate function identified) they will be counselled to return to PMR

for short duration in order to increase their status

Clinical audits in department: we are doing case discussion on every Saturday.

Quality initiatives: in the department is documentation,

In-service training: - In service within PMRC Centre done by PT, OT, Clinical psychology,

MSW, nursing and therapeutic attenders.

Functional Independence Measure (FIM) training BY PT staff.

Dysphagia management by Speech Therapist

Therapeutic attender training By PT,OT staff Nuese.

Self-care training by -OT staff.

Quality indicators captured is going on, patient feedback; incident report is a quality indicator

and action taken

Safe measures and practice including ICP, safe medication, injection practice: as

per hospital SOP.




Rev No.:00


Use of gait belts

Use of wheelchair seat belts

Use of bed rails

Use of non-slippery mats in washrooms

Walking aids and orthosis prescribed to be used at all time

Description for the operations and services, volume of work, turnaround time of important

services:

Description for the operations: - physiotherapist, occupational therapist, Medico social worker,

nursing, speech therapist and clinical psychology

Turn around time: - as soon as the patient comes based on OPD the evaluation needs to be

started within the next 15 mins where as in case of In patients the evaluation is done once the

patient is medically and functionally stable.

Interface with administration and institutional leadership: as per hospital SOP

Inter departmental and with other hospital referral/ transfer policy: as per hospital SOP

EQUIPMENT MAINTENANCE:

1. Each equipment in the dept. will have a usage log sheet attached beside it.

2. Every user is expected to fill in the details.

3. The receptionist will do a weekly assessment of the usage logs and send requests to bio medical engineer for service and maintenance as appropriate




Rev No.:00


4. All electrical equipment will be checked daily by the therapy attender and Therapist also

for safety precautions

5. Infection control precautions will be maintained at all times.

6. Whirlpools will be cleaned after every use. The attender will clean and disinfect the whirl-pool prior to and after usage for open wounds. Otherwise it will be disinfected every day

7. All cleanable equipment will be spray cleaned after every use.

8. All mechanical equipment will undergo a safety check every month.

Documents

Standard Operating Procedure - JSS - Physiotherapy