Buku Panduan Hospital Fisioterapi
Short Description
Garis Panduan Perkhidmatan Fisioterapi...
Description
2012
GARIS PANDUAN PERKHIDMA TAN FISIOTERAP I DI HOSPITAL KKM 1
Prakata
Buku Garis Panduan Perkhidmatan Fisioterapi di Hospital KKM ini disediakan sebagai garis panduan dan rujukan kepada Ahli Fisioterapi yang memberikan perkhidmatan di hospital Kementerian Kesihatan Malaysia. Buku panduan ini telah dihasilkan melalui usaha gigih serta kerjasama yang erat daripada Ahli Fisioterapi yang berpengalaman dan mempunyai kepakaran di dalam bidang penjagaan pesakit yang mengalami berbagai kondisi (penyakit). Buku ini mengandungi tajuk-tajuk seperti Garis Panduan Audit Personel dan Dokumentasi Fisioterapi. Norma Kerja, Pengurusan Masa, Sistem Maklumat Pengurusan Kesihatan, Outcome Measures dan Program Mentoring Fisioterapi yang dapat dijalankan untuk meningkatkan kualiti perkhidmatan fisioterapi. Dengan adanya buku panduan ini, semoga mereka yang terlibat dalam perkhidmatan di Hospital dapat menggunakan segala informasi untuk melicinkan proses memberi perkhidmatan yang terbaik kepada pesakit dan juga dapat menyeragamkan perkhidmatan Fisioterapi di semua hospital seluruh Malaysia.
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Kata-kata Aluan
Salam Sejahtera dan Salam 1 Malaysia
Terima kasih diucapkan kepada Jawatankuasa Panduan ini kerana memberi peluang kepada saya untuk menulis sepatah dua kata. Terlebih dahulu saya ucapkan tahniah kepada kumpulan kerja Profesyen Fisioterapi di atas dedikasi, komitmen dan usaha tungkus lumus untuk menghasilkan buku panduan ini. Perkhidmatan fisioterapi adalah perkhidmatan yang dikendalikan oleh Pegawai Pemulihan Perubatan (Anggota) / Jurupulih Perubatan (Anggota) yang merupakan salah satu daripada kumpulan profesional sains kesihatan bersekutu dan memainkan peranan yang penting dalam rawatan dan penjagaan kesihatan pesakit atau klien. Penghasilan buku panduan ini adalah sangat diperlukan untuk rujukan dan amalan praktik di antara Pegawai / Ahli Fisioterapi di hospital hospital seluruh Malaysia. Usaha sentiasa menambahkan dan mengukuhkan ‘evidence based knowledge, skills and competency’ perlu diutamakan dalam praktik untuk memberi perkhidmatan yang terbaik kepada pesakit. Pengkhususan dalam beberapa bidang fisioterapi akan dapat memberi perkhidmatan yang khusus bagi pesakit yang memerlukan. Selain daripada ini, kerja berpasukan dan semangat prihatin perlu menjadi budaya kerja. Saya percaya buku ini akan bermanfaat kepada semua Pegawai / Ahli Fisioterapi yang berkhidmat di peringkat primer, sekunder atau pun di peringkat tertiari.
Saya berharap, adanya buku ini, ia akan dapat
menyelaraskan perkhidmatan fisioterapi dalam Kementerian Kesihatan Malaysia. Sekali lagi syabas kepada semua yang terlibat secara langsung atau tidak langsung untuk menghasilkan buku ini. Sekian, Terima Kasih.
Puan Tan Yoke Hwa Pengarah Bahagian Sains Kesihatan Bersekutu Kementerian Kesihatan Malaysia
3
Kata-kata Aluan
Assalamualaikum dan Salam Sejahtera,
Saya berasa bersyukur dan bangga Ahli Jawatankuasa Profesyen Fisioterapi, Bahagian Sains Kesihatan Bersekutu, Kementerian Kesihatan Malaysia dapat menghasilkan Buku Panduan Perkhidmatan Fisioterapi di Hospital, Kementerian Kesihatan Malaysia. Buku ini mendapat sokongan daripada Bahagian Sains Kesihatan Bersekutu, Kementerian Kesihatan Malaysia Buku Panduan ini bertujuan untuk menjadi panduan kepada Pegawai/Ahli Fisioterapi yang berkhidmat di Hospital. Buku ini dapat memberi kefahaman mengenai pengendalian perkhidmatan fisioterapi dari perspektif pengurusan perkhidmatan dan perawatan fisioterapi. Kandungan buku ini adalah komprehensif yang mana ianya merangkumi aspek pentadbiran, pengurusan serta prosedur kerja perawatan dan pemulihan Fisioterapi Buku panduan ini telah dihasilkan melalui percambahan fikiran dikalangan Ahli Fisioterapi berpengalaman dan yang bertugas di Hospital. Penghasilan buku panduan ini tidak akan wujud tanpa usaha gigih Jawatankuasa Teknikal Profesyen Profesion Fisioterapi, Kementerian Kesihatan Malaysia. Peranan Ahli Fisioterapi dalam penjagaan kesihatan masyarakat semakin hari terus meningkat dan mencabar. Ini memerlukan Ahli Fisioterapi meningkatkan keupayaan di dalam melaksanakan pelbagai program kesihatan (Fisioterapi) dengan cemerlang. Buku panduan ini dapat menyelaraskan perkhidmatan di peringkat hospital yang mengutamakan best outcome dan pencapaian kualiti hidup masyrakat. Diharapkan buku panduan ini akan menafaatkan semua Ahli Fisioterapi yang berkhidmat di hospital. Tahniah dan syabas. Wassallam.
Y. BHG. DATIN HJH. ASIAH MOHD. HASHIM AMN, AMP, PPT Ketua Profesyen Fisioterapi, Bahagian Sains Kesihatan Bersekutu, Kementerian Kesihatan Malaysia
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KANDUNGAN 1. GARIS PANDUAN AUDIT PERSONEL FISIOTERAPI 1.1.
PENGENALAN ............................................................................................................... . .........
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1.2.
OBJEKTIF UMUM ......................................................................................................................
9
1.3.
OBJEKTIF KHUSUS ..................................................................................................................
9
1.4.
TATACARA / PROSES PENGAUDITAN ...................................................................................
10
1.5.
CARTA ALIRAN PENGAUDITAN PERSONEL FISIOTERAPI .................................... ............
11
1.6.
BORANG PENGAUDITAN PERSONEL FISIOTERAPI ............................................................
12
2. GARIS PANDUAN AUDIT DOKUMENTASI FISIOTERAPI 2.1.
OBJEKTIF UMUM ....................................................................................................................... 17
2.2.
OBJEKTIF KHUSUS ................................................................................................................... 17
2.3.
TATACARA MENJALANKAN AUDIT DOKUMENTASI ..............................................................
18
2.4.
CARTA ALIRAN PENYELIAAN AUDIT DOKUMENTASI ............................................. .............
20
2.5.
PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM CONDITION .......................
21
2.6.
LAPORAN AUDIT DOKUMENTASI ............................................................................................. 37
3. NORMA KERJA 3.1.
NORMA KERJA MENGIKUT PENGKHUSUSAN DAN TUGAS- TUGAS AM ............................. 39
3.2.
JUSTIFIKASI NORMA KERJA ....................................................................................................
40
4. PENGURUSAN MASA 4.1. PERBANDINGAN PENGURUSAN MASA YANG EFEKTIF DAN TIDAK EFEKTIF .................. 49 4.2. CIRI-CIRI PENGURUSAN MASA YANG EFEKTIF ...................................................... 50 4.3. FAEDAH-FAEDAH PENGURUSAN MASA .................................................................. 50 4.4. KAEDAH PELAKSAAN PENGURUSAN MASA ............................................................ 51 4.4.1.CARTA PENGURUSAN MASA .......................................................................... 52 5. TUGAS PANGGILAN BERJADUAL 5.1. PENGENALAN ............................................................................................................ 55 5.2. OBJEKTIF .......................................................................................................................55 5.3. OPERASI PERKHIDMATAN TUGAS PANGGILAN BERJADUAL ............................... 55 5.4. KRITERIA PESAKIT UNTUK TUGAS PANGGILAN BERJADUAL .............................. 55 5.5. CARTA ALIRAN PROSES RUJUKAN DAN PERAWATAN PESAKIT BARU BAGI TUGAS PANGGILAN BERJADUAL ......................................... 56 5.6. CARTA ALIRAN PROSES RUJUKAN DAN PERAWATAN PESAKIT ULANGAN BAGI TUGAS PANGGILAN BERJADUAL ............................................... 57 5.7. KAEDAH PELAKSANAAN TUGAS PANGGILAN BERJADUAL FISIOTERAPI ........ 58 SUMBER RUJUKAN ................................................................................................. 59
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6. OUTCOME MEASURE 6.1. OBJEKTIF .................................................................................................................... 61 6.2. PENILAIAN ASAS (MEASUREMENT TOOLS) ........................................................... 62 6.3. OUTCOME MEASURE 6.4. PART 1 – MUSCLE TESTING ..................................................................................... 64 6.4.1.OXFORD SCALE 6.5. PART 2 – MUSCLE TONE .......................................................................................... 68 6.5.1.MODIFIED ASTHWORTH SCALE 6.6. PART 3 – BALANCE 6.6.1.FUNCTIONAL REACH TEST ............................................................................ 71 6.6.2.TIME UP & GO TEST ........................................................................................ 73 6.6.3.BERG’S BALANCE SCALE .............................................................................. 75 6.6.4.DYNAMIC GAIT INDEX ..................................................................................... 80 6.7. PART 4 – ENDURANCE & TOLERANCE 6.7.1.SIX MINUTE WALK TEST ................................................................................. 86 6.7.2.BORG SCALE .................................................................................................... 89 6.8. PART 5 – BODY FUNCTION 6.8.1.GROSS MOTOR FUNCTIONAL MEASUREMENT (GMFM) ............................. 91 6.8.2.GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM (GMFCS) .............. 92 6.8.3.MOTOR ASSESSMENT SCALE (MAS) ............................................................. 93 6.8.4.ASIA SCALE ....................................................................................................... 96 6.8.5.ALGOFUNCTION SCALE .................................................................................. 98 6.8.6.DISABILITY ARM, SHOULDER & HAND SCORE (DASH) .............................. 99 6.8.7.NECK DISABILITY INDEX (NDI) ...................................................................... 102 6.8.8.REVISED OSWESTRY DISABILITY INDEX (RODI) ....................................... 105 6.9. GARIS PANDUAN PENGUMPULAN STATISTIK 6.10.
PENGENALAN.................................................................................................. 110
6.11.KAEDAH PENGUMPULAN STATISTIK .......................................................... 111 6.12.
GARIS PANDUAN AM – BORANG LAPORAN PER – 06-0203B ................... 114
6.13.
SISTEM MAKLUMAT PENGURUSAN KESIHATAN KKM ............................. 116
7. PROGRAM MENTORING FISIOTERAPI 7.1. PENGENALAN ......................................................................................................... 119 7.2. OBJEKTIF PROGRAM MENTORING FISIOTERAPI ................................................ 119 7.3. DEFINISI .................................................................................................................... 119 7.4. TEMPOH MASA PROGRAM ...................................................................................... 120 7.5. KRITERIA PEMILIHAN MENTOR ............................................................................... 120 7.6. TERMA RUJUKAN MENTOR ..................................................................................... 120 7.7. PERANAN MENTEE ................................................................................................... 121 7.8. KRITERIA PEMILIHAN PENEMPATAN PROGRAM MENTORING ........................... 121 7.9. MEKANISME SISTEM MENTORING ......................................................................... 122 7.10. LATIHAN UNTUK MENTOR .................................................................................... 122 7.11. PROSES KERJA DAN CARTA ALIRAN – PENGENDALIAN
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LATIHAN FISIOTERAPI KKM ................................................................................... 122 7.12. LOG BOOK .............................................................................................................. 122 7.13. CARTA ALIRAN PENGENDALIAN LATIHAN FISIOTERAPI ................................... 123 7.14. PROSES KERJA – PENGENDALIAN LATIHAN FISIOTERAPI KKM ...................... 124 7.15. CONTENT OF LOG BOOK ....................................................................................... 125 7.16. FEEDBACK FORM AND CERTIFICATION OF COMPLETION OF MENTORING .. 147 7.17. SENARAI SEMAK ORIENTASI ................................................................................ 148 7.18. CERTIFICATION OF COMPLETION OF MENTORING ........................................... 150 7.19. CLINICAL PRACTICE COMPETENCY EVALUATION FORM ................................. 151 7.20. ASSESSMENT OF PATIENT ................................................................................... 152 7.21. CLINICAL PRACTICE COMPETENCY EVALUATION FORM ............................... 154 8. RONDAAN WAD 8.1. SENARAI SEMAK FISIOTERAPI RONDAAN WAD .................................................. 157 8.2. RINGKASAN LAPORAN GRAND WARD ROUND .................................................... 167 8.3. REFERENCES ........................................................................................................... 167
PERKARA 1.
Prakata
2.
1. Kata-kata aluan
3.
Skop Perkhidmatan
4.
Piawaian Prosedur Operasi (Standard Operating Procedure) Perkhidmatan
MUKA SURAT
Fisioterapi di Klinik Kesihatan 5.
Piawaian Prosedur Operasi (Standard Operational Policy) Perkhidmatan Home Visit
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6.
Piawaian Prosedur Operasi (Standard Operational Policy ) Antenatal dan Postnatal
7.
2012
Piawaian Prosedur Operasi (Standard Operational Policy) Kanak-kanak Berkeperluan Khas
8.
Piawaian Prosedur Operasi (Standard Operational Policy) Program Promosi Kesihatan
9
Garis Panduan Senaman 1. Senaman Warga Emas 2. Senaman Ante Natal dan Post Natal
10.
Pengumpulan Data Sistem Maklumat Pesakit
11.
Aktiviti Kualiti
12.
Peralatan dan Pengurusan Aset Alih Kerajaan
13.
Lampiran
GARIS PANDUAN AUDIT PERSONEL FISIOTERAPI
GARIS PANDUAN AUDIT PERSONEL FISIOTERAPI PENGENALAN
Audit personel adalah satu aspek pemantauan yang dibuat ke atas setiap anggota (Ahli Fisioterapi) yang meliputi kriteria/ ciri-ciri kualiti peribadi, pengurusan dan kepimpinan, kepatuhan dalam menjalankan amalan klinikal dan dokumentasi. Ianya bertujuan untuk mengukur tahap profesionalisma dan prestasi kerja seseorang anggota dimana ianya perlu dilakukan secara berkala dan berterusan.
OBJEKTIF UMUM
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Sebagai garis panduan dalam pengauditan anggota bagi memastikan setiap anggota memenuhi kriteria profesyen Fisioterapi berdasarkan Amalan Piawaian Fisioterapi semasa melaksanakan tugas-tugas klinikal dan bukan klinikal. OBJEKTIF KHUSUS i.
Menyediakan satu garis panduan dan penggunaan borang pengauditan personel yang seragam.
ii.
Memberi kemudahan kepada Pegawai Audit untuk menilai tahap prestasi anggota di bawah seliaan.
iii.
Sebagai satu asas bagi merancang dan membuat tindakan susulan untuk meningkatkan prestasi anggota.
iv.
Memastikan setiap anggota menghayati dan mengekalkan kualiti
sebagai seorang
Penjawat Awam yang profesional.
TATACARA / PROSES PENGAUDITAN 1. Pegawai yang melakukan audit adalah terdiri dari Ahli Fisioterapi Kanan (Gred U32 dan keatas) yang bertanggungjawab ke atas Ahli Fisioterapi di bawah seliaannya. 2. Seorang Ketua Pegawai Audit akan dilantik oleh Ketua Jabatan Fisioterapi / Unit Fisioterapi bagi menyelaras tugas-tugas Pegawai Audit. 3. Pengauditan dijalankan sekurang-kurangnya 2 kali di setiap satu penempatan klinikal mengikut tempoh masa penempatan hospital masing- masing. (contoh: 3 bulan / 6 bulan /1 tahun). 4. Sekurang-kurangnya 2 kes klinikal akan diaudit bagi setiap anggota yang diselia. Pengauditan akan dibuat dengan menggunakan borang-borang yang telah ditetapkan.
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5. Pegawai Audit akan memberi maklum balas kepada anggota yang diselia untuk tujuan nasihat, tunjuk ajar, kaunseling atau penghargaan. 6. Setiap Pegawai Audit akan membuat laporan anggota di bawah seliaannya kepada Ketua Pegawai Audit sebelum 5hb. bulan berikutnya. 7. Ketua Pegawai Audit bertanggungjawab untuk menyiapkan laporan keseluruhan audit yang telah dijalankan untuk dihantar kepada Ketua Jabatan Fisioterapi / Unit Fisioterapi. 8. Sekiranya prestasi anggota tersebut masih tidak memuaskan pada audit susulan, beliau akan dirujuk kepada Ketua Pegawai Audit / Ketua Jabatan Fisioterapi / Unit Fisioterapi untuk tindakan susulan. 9. Hasil laporan audit ini akan digunakan sebagai asas/panduan dalam penyediaan Laporan Nilaian Prestasi Tahunan anggota tersebut. *PENETAPAN STANDARD PENCAPAIAN ANGGOTA ADALAH 85%
CARTA ALIRAN PENGAUDITAN PERSONEL FISIOTERAPI
Mula
Lantikan Ketua Pegawai Audit
Penyediaan Jadual audit
Maklum anggota diselia
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Selia anggota
Maklumbalas seliaan
ya Bermasalah
Tindakan susulan
tidak Laporan Penyeliaan
Tamat
( Standard perlu dikaji semula setiap 3 tahun)
BORANG PENGAUDITAN PERSONEL FISIOTERAPI HOSPITAL : Nama Pegawai :................................................................. Jawatan :............................................................................ Tempat / Bahagian Bertugas : ......................................... Nama Pegawai Audit : ....................................................... Tarikh : ............................................................................... Masa : .................................................................................
Skala Rumusan
1 Tidak
2 Kurang
memuaskan
Memuaskan
3 Memuaskan
4 Baik
5 Cemerlang
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PERKARA KUALITI PERIBADI (40 markah) Disiplin a) Ketepatan masa b) Keterampilan diri c) Mematuhi peraturan Sikap
SKALA
CATATAN
a) Bertanggungjawab, jujur dan amanah b) Kesungguhan menjalankan tugas (Komitmen) c) Komunikasi berkesan d) Proaktif
Inovatif dan kreatif
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PERKARA AMALAN KLINIKAL (35 markah) Standard of practice (safety, privacy, confidentiality &
SKALA
CATATAN
customer’s right ) Pengurusan klinikal i.
Penilaian Subjektif dan Objektif
ii.
Outcome Measure
iii.
Clinical Reasoning
iv.
Implementation (Treatment Skill)
v.
Evaluation
vi. Patient Education DOKUMENTASI (10 markah) Penggunaan borang penilaian yang tepat Kesempurnaan Borang caj rawatan pesakit dalam Statistik Harian Statistik Bulanan PENGURUSAN / KEPIMPINAN (10 markah) Pengurusan Masa Sumbangan dalam aktiviti kualiti Contoh; KIK, ISO, AKREDITASI, QAP, NIA, KPI (Senaraikan) LAIN – LAIN KATEGORI (5 markah) Tugas bukan klinikal yang diarahkan / kegiatan dan sumbangan di luar tugas rasmi Contoh; Penyeliaan Linen, FEMS, BEMS , CLS, PERSATUAN, SUKAN, KOMUNITI (senaraikan)
JUMLAH KESELURUHAN ( % )
13
Rumusan Komen pegawai audit Fisioterapi
Tindakan Susulan
Nama anggota yang di audit : Tandatangan & Cop :
Tandatangan & Cop pegawai audit Fisioterapi :
NOTA: SKALA
RUMUSAN
PERATUSAN
5
CEMERLANG
90 – 100
4
BAIK
80 – 89
3
MEMUASKAN
70 – 79
2
KURANG MEMUASKAN
50 – 69
1
TIDAK MEMUASKAN
KURANG 49
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CLINICAL ASPECT Indicator Scale Communication 1
Description Has no eye contact. Abrupt with patient and did not greet patient.
skill 2 3 4
Did not check status of patient by questioning adequately. Just followed the previous treatment. Greeted patient but did not check status by questioning. Smiled, checked status of patient by questioning. Explained treatment but the
5
effects of treatment.Obtained written/verbal consent where relevant. Smiled, has eye contact. Checked status of patient by questioning. Explained to
1 2
patient about problem, treatment and reasoning of the treatment. Did not use any assessment tools and techniques. Poor recording. Used basic assessment tools and techniques. Poor skills with uncertainty.
3
Recording is vague/not clear. Used basic assessment tools and techniques well. Demonstrated understanding
4
of basic assessment tools effectively and recorded result. Used basic assessment tools and techniques well. In addition , used appropriate
Measurement Tools Selection of Appropriate Measurement
special technique. Carried out the assessment effectively and modified when
tools
necessary. Recording is good. Demonstrated skilled use of basic and special techniques as assessment based on
5
clinical reasoning. Attempted use of assessment tools based on evidence. Analysis of problem and clinical reasoning
1 2
Attempted variety of assessment tools. Good recording of all relevant parameters. Unable to identify the patient’s problems. Problem written vaguely. Able to identify but poor ability to analyze assessment findings.
3 4
Has poor understanding of the patient’s problem. Able to identify patient problem based on analysis of assessment findings. Able to identify and prioritize problem based on analysis of assessment findings.
5
Reassessment done and able to identify the effectiveness of treatment. Able to identify and prioritize patient’s problem and related problem with good clinical reasoning. Ongoing assessment of patient based on re-examination of outcome of treatment. Demonstrated critical thinking. Able to interact with doctors with regard to patient’s treatment and progress.
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2012 1
Choice of Treatment With clinical reasoning
2 3 4 5
1 ill of treatment technique
2 3 4 5
1 Home exercise program and patient education
2 3 4 5
1 Patient contact time and time management.
2 3 4 5
Treatment with no clinical reasoning towards effective outcome. No regards of patient’s comfor safety and respect. Used basic treatment techniques which were not outcome orientated. Has regard for patient’s comfort, safety and respect. Used basic treatment techniques, with some clinical reasoning towards outcome, Ensured patient’s comfort, safety and respect. Treatment based on good clinical reasoning with knowledge of patho-physiological effects towards good outcome. Changed treatment according to expected outcome. Treatment based on good clinical reasoning with knowledge of pathophysiological effects and evidence with expected outcome and goals. Focuses on optimal functional ability. Used new treatment techniques based on evidence for best outcome. Demonstrated ability to change treatment technique according to the finding toward effective outcome. Interacts with other relevant care providers towards optimal function. Unable to carry out treatment technique correctly with poor knowledge of treatment technique and its effects. Has knowledge of treatment technique but poor/ ineffective application. Able to carry out basic treatment technique safely with patient’s satisfaction and demonstrated an on going improvement. Demonstrated correct technique and effective treatment with an outcome. Able to handle patients confidently. Able to teach others. Handled patient with confidence. Paid attention to patient’s comfort. Skills are finely coordinated and executed effectively. Has good knowledge of treatment technique and knows the pathophysiologycal effects of treatment and expected outcome. There is effective outcome. Able to instill confidence in patient. Able to teach skill to others. No Home exercise program and patient education given. Does not talk with patient regarding home program. Talk to patient about his/her condition and treatment. No exercise program given. Patient education not done. Talks and explain to patient about his problem. Verbal explanation of home exercises program. Handout given but program not written or clearly explained. Explained to patient about his problems and instructed correctly. Written handout of exercise program. Pamphlet given. Explained to patient about his problems and instructed correctly. Written handout of exercise program. Pamphlet given. Made sure patient and carer understood and carry out the program. Checked at subsequent visit whether patient can execute exercises correctly and documented Unable to handle the number of patient allocated within the time given. Able to handle all patient but unable to complete documentation. Able to handle own number of patient within the time allocated. Documentation is complete. Effective use of contact time with patient. Able to handle extra patient when required. Effective use of contact time with patient with holistic approach that includes manual skills and patient education. Arranges duties and task without neglecting the patient.
GARIS PANDUAN AUDIT DOKUMENTASI FISIOTERAPI
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Objektif Umum Menilai kepatuhan terhadap proses kerja yang telah ditetapkan bagi menghasilkan mutu kerja yang berkualiti tinggi.
Objektif Khusus 1.
Mewujudkan satu garis panduan dan keseragaman penggunaan borang audit dokumentasi.
2.
Memastikan setiap anggota menjalankan penilaian terhadap pesakit dengan menggunakan borang ‘Problem Orientated Medical Record’ (POMR) yang diisi lengkap.
3.
Memantau penggunaan borang Penilaian Fisioterapi, ‘Outcome Measure’ dan ‘Physiotherapy Care Protocol’ dalam setiap penilaian dan perawatan pesakit.
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TATACARA MENJALANKAN AUDIT DOKUMENTASI 1. Ketua Penyelia yang dilantik oleh Ketua Jabatan Fisioterapi/ Unit Fisioterapi adalah mengikut kekananan di hospital masing-masing. 2. Audit akan dijalankan oleh Pegawai Pemulihan Anggota atau Jurupulih Perubatan Anggota Kanan. 3. Jadual penyeliaan akan disediakan oleh Ketua Penyelia di Unit Fisioterapi masing -masing. 4. Penilaian Audit Dokumentasi akan dijalankan 2 kali pada setiap penempatan fisioterapi mengikut jadual penyeliaan di Unit Fisioterapi masing-masing iaitu pada awal dan pertengahan penempatan . 5. Penyelia akan mengaudit minimum 2 kes klinikal untuk setiap anggota yang diselia yang berlainan kondisi. 6. Kes yang dipilih secara rawak mestilah sekurang-kurangnya telah mendapat 3 kali rawatan fisioterapi. 7. Kes yang telah diaudit tidak boleh diaudit semula pada kali kedua kecuali berlainan kondisi. 8. Penyelia perlu menyediakan laporan dan menyerahkannya sebelum atau pada 5hb bulan seterusnya kepada Ketua Penyelia. 9. Penyelia akan memberi maklum balas kepada setiap anggota yang diaudit. Sekiranya prestasi anggota yang diselia tidak memuaskan, tunjuk ajar dan nasihat akan diberikan. 10. Ketua Penyelia bertanggungjawab mengumpul dan menganalisa laporan untuk dihantar kepada Ketua Jabatan Fisioterapi sebelum atau pada 15hb bulan seterusnya 11. Sekiranya prestasi anggota tersebut masih tidak memuaskan, beliau akan dirujuk kepada Ketua Penyelia / Ketua Jabatan Fisioterapi.
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12. Borang audit yang digunakan adalah :
i)
Borang AC/PHYSIO – 01/2011 (General )
ii)
Borang AC/PHYSIO – 02/2011 (Back Pain)
iii)
Borang AC/PHYSIO – 03/2011 (OA Knee)
iv)
Borang AC/PHYSIO – 04/2011 (Critically ill Adult )
v)
Borang AC/PHYSIO – 05/2011 (Shoulder Pain)
vi)
Borang AC/PHYSIO – 06/2011 (Neck Pain)
vii)
Borang AC/PHYSIO – 07/2011 (Well Elderly)
viii)
Borang AC/PHYSIO – 08/2011 (Elderly with illness)
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CARTA ALIRAN PENYELIAAN AUDIT DOKUMENTASI
Mula
Lantikan Ketua Penyelia oleh Ketua Jabatan / Unit Fisioterapi
Penyediaan Jadual
Maklum anggota diselia
Audit Dokumentasi
TIDAK
Maklumbalas audit
Tindakan susulan
YA
Laporan Penyeliaan
Tamat
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AC/PHYSIO - 01/2011 PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM CONDITION: GENERAL R/N @ I/C.......................................................... In / Out Patient: ............................................ Diagnosis: ................................................... One form to be completed for each patient’s record. Please tick in the relevant space. Items
Yes
No
NA
Remarks
Appropriate Assessment Form is used Presenting condition / problem is well documented Pain is well documented – VAS (Visual Analogue Scale) Area Nature Aggravating factors Easing factors 24 hr pain behaviour Irritability Relevant symptoms are marked on the body chart Special questions are addressed – Contraindications / Precautions / Allergies Social / Family history / lifestyle Relevant Investigation Medication Current history is well documented Past history is well documented (if relevant) Observation made is relevant and well documented Palpation carried out is relevant and well documented Specific assessment tools and techniques are used Result of outcome measures are well recorded Items
Yes
No
NA
Remarks
21
Physiotherapist’s Impression is adequately recorded Goals are well identified – Short term Long term Treatment plan is well recorded There is evidence of informed consent obtained from patient Interventions are implemented according to the treatment plan There is evidence of all dispensed advise / information Subjective markers are reviewed at each session Objective markers are reviewed at each session Analysis of problem is recorded Changes in treatment plan are well documented Discharge plan is adequately recorded There is document at the time of initial contact with patient There is adequate documentation of patient’s every visit Documented records are – concise Legible Logical sequence Dated Signed & stamped after each entry Other comments
Date: ……………………………… Auditee: ………………………………….
Signature stamp: ………………………………………..
Auditor: ………………………………….
Signature /stamp: …………………………………….
22
AC/PHYSIO - 02/2011 PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM CONDITION: BACK PAIN R/N @ I/C :............................................................. In / Out Patient: ............................................ Diagnosis :.............................................................. One form to be completed for each patient’s record. Please tick in the relevant space. Items
Yes
No
NA
Remarks
Appropriate Assessment Form is used Presenting condition / problem is well documented Pain is well documented – VAS (Visual Analogue Scale) Area Nature Aggravating factors Easing factors 24 hr pain behaviour Irritability Relevant symptoms are marked on the body chart Special questions are addressed – Contraindications / Precautions / Allergies Social / Family history / lifestyle Relevant Investigation Medication Current history is well documented Past history is well documented (if relevant) Observation made is relevant and well documented Palpation carried out is relevant and well documented Specific assessment tools and techniques are used Result of outcome measures are well recorded Physiotherapist’s Impression is adequately recorded Goals are well identified – Short term
23
Items
Yes
No
NA
Remarks
Long term Treatment plan is well recorded There is evidence of informed consent obtained from patient Interventions are implemented according to the treatment plan There is evidence of all dispensed advise / information Subjective markers are reviewed at each session Objective markers are reviewed at each session Analysis of problem is recorded Changes in treatment plan are well documented Discharge plan is adequately recorded There is document at the time of initial contact with patient There is adequate documentation of patient’s every visit Documented records are – concise Legible Logical sequence Dated Signed & stamped after each entry KNOWLEGDE AND USE OF PHYSIOTHERAPY CARE PROTOCOL The condition is classified The Oswestry LBP questionnaire is used Specific tests carried out are relevant Pressure biofeedback is used Treatment provided is relevant to the classified condition Scoring of the Oswestry scale is well understood Items
Yes
No
NA
Remarks
Red flags and their management is well understood The Algorithm is well understood There is adequate knowledge of patient education Other comments
Date:……………………………… Auditee : ………………………………….
Signature & stamp………………………………
Auditor : ………………………………….
Signature & stamp: ……………………………
AC/PHYSIO -03/2011
24
PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM CONDITION: OA KNEE R/N @ I/C: ...........................................................In / Out Patient: ............................................................ Diagnosis: ............................................................ One form to be completed for each patient’s record. Please tick in the relevant space. Items
Yes
No
NA
Remarks
Appropriate Assessment Form is used Presenting condition / problem is well documented Pain is well documented – VAS (Visual Analogue Scale) Area Nature Aggravating factors Easing factors 24 hr pain behaviour Irritability Relevant symptoms are marked on the body chart Special questions are addressed – Contraindications / Precautions / Allergies Social / Family history / lifestyle Relevant Investigation Medication Current history is well documented Past history is well documented (if relevant) Observation made is relevant and well documented Palpation carried out is relevant and well documented Specific assessment tools and techniques are used Result of outcome measures are well recorded Physiotherapist’s Impression is adequately recorded Goals are well identified – Short term Long term Treatment plan is well recorded There is evidence of informed consent obtained from patient Interventions are implemented according to the treatment plan There is evidence of all dispensed advise / information Subjective markers are reviewed at each session Objective markers are reviewed at each session Analysis of problem is recorded Changes in treatment plan are well documented Discharge plan is adequately recorded There is document at the time of initial contact with patient There is adequate documentation of patient’s every visit Documented records are – concise Legible Logical sequence Dated Signed & stamped after each entry
25
Items
Yes
No
NA
Remarks
KNOWLEGDE AND USE OF PHYSIOTHERAPY CARE PROTOCOL Patient’s profile is identified Treatment provided is relevant to the profile The algofunction is well understood The algorithm is well understood There is adequate knowledge of the Do’s and Don’ts Other comments
Date: ……………………………… Auditee: ………………………………….
Signature & stamp: ………………………………………..
Auditor: ………………………………….
Signature & stamp: ……………………………………….
26
AC/PHYSIO - 04/2011 PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM CONDITION: CRITICALLY ILL ADULT R/N @ I/C: ................................................... In / Out Patient: ...................................................................... Diagnosis: .................................................. One form to be completed for each patient’s record. Please tick in the relevant space. Items Appropriate Assessment Form is used
Yes
No
NA
Remarks
Presenting condition / problem is well documented Pain is well documented – VAS (Visual Analogue Scale) Area Nature Aggravating factors Easing factors 24 hr pain behaviour Irritability Relevant symptoms are marked on the body chart Special questions are addressed – Contraindications / Precautions / Allergies Social / Family history / lifestyle Relevant Investigation Medication Current history is well documented Past history is well documented (if relevant) Observation made is relevant and well documented Palpation carried out is relevant and well documented Specific assessment tools and techniques are used Result of outcome measures are well recorded Physiotherapist’s Impression is adequately recorded Goals are well identified – Short term
27
Items
Yes
No
NA
Remarks
Long term Treatment plan is well recorded There is evidence of informed consent obtained from patient Interventions are implemented according to the treatment plan There is evidence of all dispensed advise / information Subjective markers are reviewed at each session Objective markers are reviewed at each session Analysis of problem is recorded Changes in treatment plan are well documented Discharge plan is adequately recorded There is document at the time of initial contact with patient There is adequate documentation of patient’s every visit Documented records are – concise Legible Logical sequence Dated Signed & stamped after each entry KNOWLEGDE AND USE OF PHYSIOTHERAPY CARE PROTOCOL Treatment provided is relevant to the profile. Red Flags and their management is well understood. There is adequate knowledge of postural drainage position. There is adequate knowledge of patient education. Other comments
Date: ……………………………… Auditee: ………………………………….
Signature & stamp: …………………………………..
Auditor: ………………………………….
Signature & stamp: ………………………………….
AC/PHYSIO - 05/2011
28
PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM CONDITION: SHOULDER PAIN R/N @ I/C: ..................................................... In /Out Patient: .................................................................. Diagnosis: ..................................................... One form to be completed for each patient’s record. Please tick in the relevant space.
Items
Yes
No
NA
Remarks
Appropriate Assessment Form is used Presenting condition / problem is well documented Pain is well documented – VAS (Visual Analogue Scale) Area Nature Aggravating factors Easing factors 24 hr pain behaviour Irritability Relevant symptoms are marked on the body chart Special questions are addressed – Contraindications / Precautions / Allergies Social / Family history / lifestyle Relevant Investigation Medication Current history is well documented Past history is well documented (if relevant) Observation made is relevant and well documented Palpation carried out is relevant and well documented Specific assessment tools and techniques are used Result of outcome measures are well recorded Physiotherapist’s Impression is adequately recorded Goals are well identified – Short term
29
Items
Yes
No
NA
Remarks
Yes
No
NA
Remarks
Long term Treatment plan is well recorded There is evidence of informed consent obtained from patient Interventions are implemented according to the treatment plan There is evidence of all dispensed advise / information Subjective markers are reviewed at each session Objective markers are reviewed at each session Analysis of problem is recorded Changes in treatment plan are well documented Discharge plan is adequately recorded There is document at the time of initial contact with patient There is adequate documentation of patient’s every visit Documented records are – concise Legible Logical sequence Dated Signed & stamped after each entry KNOWLEGDE AND USE OF PHYSIOTHERAPY CARE PROTOCOL The special test used is relevant There is adequate knowledge of specific tests DASH score is used There is adequate knowledge of the DASH score Items The Algorithm is well understood There is adequate knowledge of patient education Others Comments
Date: ……………………………. Auditee: ……………………….
Signature & stamp: ………………………………………..
Auditor: ……………………….
Signature & stamp: ……………………………………….
AC/PHYSIO - 06/2011
30
PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM CONDITION : NECK PAIN R/N @ I/C: ..................................................In / Out Patient: ............................................................... Diagnosis: ................................................. One form to be completed for each patient’s record. Please tick in the relevant space. Items
Yes
No
NA
Remarks
Appropriate Assessment Form is used Presenting condition / problem is well documented Pain is well documented – VAS (Visual Analogue Scale) Area Nature Aggravating factors Easing factors 24 hr pain behaviour Irritability Relevant symptoms are marked on the body chart Special questions are addressed – Contraindications / Precautions / Allergies Social / Family history / lifestyle Relevant Investigation Medication Current history is well documented Past history is well documented (if relevant) Observation made is relevant and well documented Palpation carried out is relevant and well documented Specific assessment tools and techniques are used Result of outcome measures are well recorded Physiotherapist’s Impression is adequately recorded Goals are well identified – Short term Long term Treatment plan is well recorded There is evidence of informed consent obtained from patient
31
Items
Yes
No
NA
Remarks
Interventions are implemented according to the treatment plan There is evidence of all dispensed advise / information Subjective markers are reviewed at each session Objective markers are reviewed at each session Analysis of problem is recorded Changes in treatment plan are well documented Discharge plan is adequately recorded There is document at the time of initial contact with patient There is adequate documentation of patient’s every visit Documented records are – concise Legible Logical sequence Dated Signed & stamped after each entry KNOWLEGDE AND USE OF PHYSIOTHERAPY CARE PROTOCOL The NDI is used Specific tests carried out are relevant Pressure biofeedback is used Scoring of the NDI scale is well understood VBI test is well understood Treatment provided is relevant The Algorithm is well understood Other comments
Date: ……………………………… Auditee: ………………………………….
Signature & stamp: ………………………………………..
Auditor: ………………………………….
Signature & stamp: ……………………………………….
32
AC/PHYSIO - 07/2011 PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM CONDITION: WELL ELDERLY R/N @ I/C: .........................................................In / Out Patient: ............................................................ Diagnosis: ......................................................... One form to be completed for each patient’s record. Please tick in the relevant space. Items
Yes
No
NA
Remarks
Appropriate Assessment Form is used Presenting condition / problem is well documented Pain is well documented – VAS (Visual Analogue Scale) Area Nature Aggravating factors Easing factors 24 hr pain behaviour Irritability Relevant symptoms are marked on the body chart Special questions are addressed – Contraindications / Precautions / Allergies Social / Family history / lifestyle Relevant Investigation Medication Current history is well documented Past history is well documented (if relevant) Observation made is relevant and well documented Palpation carried out is relevant and well documented Specific assessment tools and techniques are used Result of outcome measures are well recorded Physiotherapist’s Impression is adequately recorded Goals are well identified – Short term Long term Treatment plan is well recorded There is evidence of informed consent obtained from patient Interventions are implemented according to the treatment plan There is evidence of all dispensed advise / information
33
Items
Yes
No
NA
Remarks
Subjective markers are reviewed at each session Objective markers are reviewed at each session Analysis of problem is recorded Changes in treatment plan are well documented Discharge plan is adequately recorded There is document at the time of initial contact with patient There is adequate documentation of patient’s every visit Documented records are – concise Legible Logical sequence Dated Signed & stamped after each entry KNOWLEGDE AND USE OF PHYSIOTHERAPY CARE PROTOCOL The Fall Risk Screening form is used. Specific test carried out are relevant. Red Flag is well understood. Treatment provided is relevant to the classified condition. There is adequate knowledge of patient education. Other comments
Date: ……………………………… Auditee: ………………………………….
Signature & stamp: …………………………………..
Auditor: ………………………………….
Signature & stamp: ………………………………….
AC/PHYSIO - 08/2011
34
PHYSIOTHERAPY CLINICAL DOCUMENTATION AUDIT FORM (2006) CONDITION : ELDERLY WITH ILLNESS R/N @ I/C: ................................................. In / Out Patient: ..................................................................... Diagnosis: ............................................... One form to be completed for each patient’s record. Please tick in the relevant space. Items
Yes
No
NA
Remarks
Appropriate Assessment Form is used Presenting condition / problem is well documented Pain is well documented – VAS (Visual Analogue Scale) Area Nature Aggravating factors Easing factors 24 hr pain behaviour Irritability Relevant symptoms are marked on the body chart Special questions are addressed – Contraindications / Precautions / Allergies Social / Family history / lifestyle Relevant Investigation Medication Current history is well documented Past history is well documented (if relevant) Observation made is relevant and well documented Palpation carried out is relevant and well documented Specific assessment tools and techniques are used Result of outcome measures are well recorded Physiotherapist’s Impression is adequately recorded Goals are well identified – Short term Long term Treatment plan is well recorded There is evidence of informed consent obtained from patient Interventions are implemented according to the treatment plan There is evidence of all dispensed advise / information
35
Items
Yes
No
NA
Remarks
Subjective markers are reviewed at each session Objective markers are reviewed at each session Analysis of problem is recorded Changes in treatment plan are well documented Discharge plan is adequately recorded There is document at the time of initial contact with patient There is adequate documentation of patient’s every visit Documented records are – concise Legible Logical sequence Dated Signed & stamped after each entry KNOWLEGDE AND USE OF PHYSIOTHERAPY CARE PROTOCOL Able to identify patients problem according to the objective assessment. The discharge care plan is well understood Treatment provided is relevant to the classified condition. There is adequate knowledge of patient education. Other comments
Date: ……………………………… Auditee: ………………………………….
Signature & stamp: …………………………………..
Auditor: ………………………………….
Signature & stamp: ……………………………………
LAPORAN AUDIT DOKUMENTASI 36
TARIKH: ........................................................................... AUDITEE: ......................................................................... AUDITOR: ........................................................................ WAD: ................................................................................ PESAKIT LUAR: .............................................................. DIAGNOSIS: ................................................................... KOMEN ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... .....................................................................................................................................................
CADANGAN PENAMBAHBAIKAN ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... .....................................................................................................................................................
DISEDIAKAN OLEH: PENYELIA
....................................................... (Tandatangan & cop)
lias
37
2012 Nisbah Bil 1
Pengkhususan Lymphoedema
(rawatan dan dokumentasi) ( 1 pesakit = tidak melebihi 70 minit )
2
Kardiak
( 1 pesakit = tidak melebihi 30 minit )
3
Geriatrik
( 1 pesakit = tidak melebihi 30 minit )
4
Spinal Injury
( 1 pesakit = tidak melebihi 45 minit )
5
Neurologi
( 1 pesakit = tidak melebihi 45 minit )
6
Intensive Care Unit
( 1 pesakit = tidak melebihi 25 minit )
7
Women’s Health
( 1 pesakit = tidak melebihi 35 minit )
8
Hand
( 1 pesakit = tidak melebihi 30 minit )
9
Spine
( 1 pesakit = tidak melebihi 45 minit )
10
Infectious Disease Ward
( 1 pesakit = tidak melebihi 30 minit )
11
Burn
( 1 pesakit = tidak melebihi 30 minit )
Ulasan
NORMA KERJA
NORMA KERJA MENGIKUT PENGKHUSUSAN DAN TUGAS-TUGAS AM TUGAS – TUGAS AM Bil
Generik
Nisbah (rawatan dan dokumentasi)
1
Pesakit Dalam
1 : 18 ( 1 pesakit = 25 minit )
2
Pesakit Luar
1 : 22 ( kes rujukan baru : 6, 1 pesakit = 30 minit, kes lama : 16, 1 pesakit = 20 minit )
Kes-kes rumit atau kes baru mungkin memerlukan masa yang lebih daripada diperuntukan di atas, namun ianya harus dijustifikasikan mengikut kes individu
38
JUSTIFIKASI NORMA KERJA Kawasan Kardiak
Norma 30 - 60 minit
Justifikasi Ulasan : a) Melengkapkan borang penilaian POMR yang disediakan oleh
setiap orang
KKM b) Penilaian pesakit semasa akut, sub akut dan rehabilitasi
pesakit
memerlukan penggunaan masa yang berbeza. Bagi fasa akut,
bergan-
masa untuk seorang pesakit ialah 30 minit. Bagi fasa sub akut dan
tung
rehabilitasi, masa untuk seorang pesakit ialah 60 minit.
kepada
c) Bagi merancang pelan tindakan yang berkesan untuk pesakit,
fasa.
maklumat terperinci mengenai keadan fizikal serta aktiviti harian pesakit sebelum dan selepas insiden kardiak adalah sangat
Nisbah 1:12
mustahak. d) Untuk kes akut, frekuensi perawatan fisioterapi adalah 2 kait sehari untuk setiap pesakit. e) Setiap pesakit akut memerlukan rawatan fisioterapi individu (oneto-one attention). f)
Untuk pesakit non-ventilated, penilaian dan perawatan pesakit adalah secara holistik.
g) Setiap pesakit kardiak memerlukan rujukan daripada pengamal perubatan / pakar. h) Program
pendidikan
pesakit
memerlukan
60
minit
bagi
merangkumi Pump Talk, Fasa II Program Rehabilitasi Kardiak, Fasa III Program Rehabilitasi Kardiak dan Circuit Training. i)
Jika ada masalah komunikasi,
ceramah perlu diberi dalam 2
bahasa. j)
Pegawai / ahli Fisioterapi yang terlatih perlu mengawasi dan mengendalikan Circuit Training dengan penuh perhatian demi keselamatan pesakit.
k) Setiap pegawai / ahli Fisioterapi perlu menerima latihan Basic Life Support untuk kegunaan kecemasan.
39
JUSTIFIKASI NORMA KERJA Kawasan
Norma
Justifikasi Ulasan :
ICU ( Unit
30 min
Rawatan
seorang
Rapi )
pesakit
a) Melengkapkan borang penilaian POMR yang disediakan oleh KKM b) Perawatan pesakit semasa akut memerlukan penggunaan masa selama 30 minit.
Nisbah -
c) Pegawai / ahli Fisioterapi perlu mengikut standard of practice
1:12
dalam Care Protocol for Critically Ill Patient. d) Untuk kes unit rawatan rapi, frekuensi perawatan fisioterapi adalah 2 kait sehari untuk setiap pesakit kecuali atas permintaan pakar perubatan. e) Setiap pesakit akut memerlukan rawatan fisioterapi individu (oneto-one attention). f)
Untuk pesakit non-ventilated, penilaian dan perawatan pesakit adalah secara holistik.
g) Penyediaan diri untuk infeksi control mengikut Standard Infection Control.
Infectious
30 minit
Disease
seorang
Ward
pesakit
Ulasan : a) Penyediaan diri untuk infeksi control mengikut Standard Infection Control. b) Pengunaan masa untuk perawatan Fisioterapi mengikut kondisi
Nisbah -
pesakit, sama ada pesakit dalam keadaan tenat, lemah, dan lain-
1:16
lain c) Pegawai / Ahli Fisioterapi memerluka skil komunikasi yang berkesan terutama semasa mengendalikan pesakit yang tidak memahami atau mengikut arahan yang diberi d) Perawatan Fisioterapi secara holistik merangkumi chest physiotherapy, limb physiotherapy dan pendidikan pesakit e) Selepas perawatan Fisioterapi bagi pesakit berjangkit seperti pesakit H1N1, pegawai / ahli Fisioterapi perlu mandi sebelum meninggalkan wad.
40
JUSTIFIKASI NORMA KERJA Kawasan Wad Burn
Norma 30 min seorang
Justifikasi Ulasan : a) Penilaian pesakit memerlukan penggunaan borang Penilaian
pesakit
Burn yang terperinci yang disediakan. a) Pegawai / ahli Fisioterapi boleh melibatkan diri semasa pesakit
Nisbah -
menjalani Rawatan hidroterapi (bathing dan soaking),
1:12
penggunaan air suam memudahkan pergerakan sendi pesakit. b) Pegawai / ahli Fisioterapi perlu mengamalkan Personal Protection Equipments (PPE) seperti apron, sarung tangan dan mask, untuk kepentingan kawalan infeksi c) Kes ventilator perlu mengikut prosedur seperti di ICU d) Pendidikan pesakit untuk pesakit yang stabil memerlukan penerangan yang teliti kepada pesakit dan mendapatkan kerjasama serta keyakinan daripada pesakit e) Frekuensi rawatan 1- 2 kali sehari bergantung kepada keadaan pesakit dan rujukan pengamal perubatan / pakar. f)
Perawatan holistik perlu diamalkan sepanjang masa untuk setiap pesakit burn.
Hand
40 min seorang pesakit Nisbah 1: 15
Ulasan : a) Penilaian pesakit – kes baru memerlukan masa selama 60 minit. b) Penggunaan borang – Borang Penilaian Hand sangat terperinci seperti pengukuran ROM untuk sendi-sendi yang kecil c) Komunikasi – pesakit tidak memahami arahan yang diberi d) Evaluasi menggunakan sistem berkomputer memakan masa yang lama – penggunaan mesin E-link e) Penggunaan Outcome Measure – special test, pinch test, hand dynamometer f) Pendidikan pesakit – proses penerangan kepada pesakit dan mendapatkan kerjasama daripada pesakit g) Perancangan program rawatan mengikut Standard Protokol – tendon repair protocol h) Perancangan frekuensi rawatan - untuk kes akut perlu lebih kerap i) Teknik rawatan – joint mobilisation, soft tissue manipulation, wax, ultrasound dan lain-lain j) Mengendalikan ”Hand Class”
41
JUSTIFIKASI NORMA KERJA Kawasan
Norma
Neurologi
60 minit
Rehabilitation
setiap
(Pesakit Luar
pesakit.
dan Pesakit Dalam)
Justifikasi Ulasan : a) Melengkapkan borang penilaian POMR yang disediakan oleh KKM b) Jika perlu, borang tambahan yang perlu diisi adalah Modified
Nisbah
Ashworth Scale (MAS), Motor Assessment Scale (MAS), Time Up
-
& Go (TUG) dan Berg Balance Test. Setiap borang tambahan
1:8
yang perlu diisi memerlukan lebih masa untuk melengkapkannya c) Bagi merancang pelan tindakan yang berkesan untuk pesakit, maklumat terperinci mengenai keadan fizikal serta aktiviti harian pesakit sebelum dan selepas insiden strok
adalah sangat
mustahak. Untuk mendapat maklumat yang bermanfaat, soalan perlu tepat untuk mendapat jawapan yang betul. Sesi persoalan ini juga mengambil masa. Jika terdapat masalah komunikasi terutama pada kes-kes akut dalam insiden tersebut, masa akan dipanjangkan d) Perawatan Rehabilitasi Neurologi merangkumi hampir seluruh badan dan setiap aduan pesakit tentang ketidakupayaannya perlu dilayani dan pelan tindakan akan berubah pada setiap aduan yang berbeza e) Walaupun penilaian serta perawatan memerlukan masa yang panjang dan mungkin melebihi satu jam, pengurusan yang efisien dimana faktor kecerdasan minda serta kecergasan fizikal pesakit tidak dijejaskan, purata satu jam tetap digunakan sebagai tanda aras untuk tindakan selanjutnya
42
JUSTIFIKASI NORMA KERJA Kawasan
Norma
Women’s
35 min
and men’s
seorang
health
pesakit
Justifikasi Ulasan : a) Penggunaan borang ( Pelvic Floor Assessment ) untuk setiap pesakit baru. b) Penggunaan
borang
keizinan
rawatan
(Consent
Form)
Nisbah -
memerlukan penjelasan teliti untuk memberi keyakinan kepada
1:12
pesakit. c) Prosedur seperti Pelvic Floor Pervagina or Peranal Assessment untuk setiap pesakit untuk mengetahui tahap kekuatan otot sebagai rujukan untuk menentukan senaman d) Pendidikan pesakit – proses penerangan kepada pesakit untuk mendapatkan kerjasama dan pemahaman daripada pesakit Perancangan program rawatan e) Teknik rawatan seperti penggunaan Vaginal Cone, Electrical Stimulation,Vaginal prop exercise yang memerlukan prosedur . f)
Perancangan frekuensi rawatan - untuk kes akut perlu lebih kerap
Lymphe-
70
min Masa untuk seorang pesakit 70 minit
dema
seorang pesakit
Ulasan : a) Penggunaan borang
( Lymphoedema
Assessment ) untuk
setiap pesakit baru. Nisbah 1:6
b) Melakukan Circumference Measurement
untuk bahagian
bengkak sebelum dan selepas rawatan bagi mendapatkan outcome measure. c) Prosedur MLD ( Manual Lymphatic Drainage ) yang mengambil masa yang lama bagi memastikan lymph fluids dialirkan dari bahagian yang bengkak. d) Melakukan bandaging ke atas anggota yang bengkak. e) Rawatan senaman selepas prosedur MLD dan bandaging kepada setiap pesakit lymphoedema. g) Pendidikan pesakit – proses penerangan kepada pesakit untuk mendapatkan kerjasama dan pemahaman daripada pesakit.
JUSTIFIKASI NORMA KERJA 43
Kawasan
Geriatrik
Norma
Justifikasi
35 min
Sesi penilaian dan terapi rawatan terhadap pesakit geriatrik memerlukan masa selama 35 minit untuk seorang pesakit.
‘Special test’ yang selalu diaplikasikan semasa proses penilaian pada setiap pesakit ialah seperti:
seorang pesakit Nisbah 1 : 12
i.
Time Up & Go Test, 3 kali ulangan – (5 minit)
ii.
Berg’s Balance Test 14 prosedur - (14 minit)
iii.
Incentive spirometer (3 minit)
iv.
2 minutes walking test ( 5 minit)
‘SGH Training Centre’ penglibatan multidisiplin dalam memberi input perawatan. Fisioterapi merupakan salah satu disiplin yang terlibat secara langsung dalam memberi input kepada pesakit, penjaga dan juga staf-staf di wad.
Faktor intrinsik seperti proses penuaan, perubahan fisiologi seperti kurang
deria
pendengaran,
kurang
penglihatan,
dementia
(nyanyuk),kesukaran berkomunikasi adalah penyumbang kepada masa yang diperlukan untuk ahli fisioterapi menjalankan proses penilaian serta perawatan untuk pesakit geriatrik ENERGY CONSUMER
Pesakit geriatrik memerlukan tenaga daripada ahli fisioterapi dan staf terutama semasa proses rawatan yang melibatkan “lifting and transfer” and “ambulation with aids”.
Kekurangan tenaga - Memerlukan bantuan dari segi tenaga daripada staf semasa menjalankan prosedur rawatan
JUSTIFIKASI NORMA KERJA 44
Kawasan
Norma
Justifikasi
Traumatic
60 minit
Sesi terapi rawatan terhadap pesakit Traumatic Brain Injury(TBI)
Brain Injury
setiap
memerlukan masa selama 1 jam untuk seorang pesakit.
pesakit Ulasan: Nisbah 1:6
Penilaian dan ‘special test’ dijalankan merangkumi MAS, Berg Balance, Incentive spirometer dan 2 min walking test. Faktor-faktor yang menyebabkan sesi rawatan memerlukan masa yang lama:1. Kekurangan kemudahan yang diperlukan untuk pesakit
merawat
2. Kekurangan wad yang mempunyai (highly specialist unit) 3. Kekurangan penglibatan penjaga dan ahli keluarga semasa sesi rawatan dijalankan 4. Kekurangan pembantu perawatan kesihatan untuk membantu ahli terapi menjalankan proses rawatan 5. Tiada ruang/tiada tempat yang sesuai untuk menjalankan penilaian dan perawatan pesakit 6. Terlalu ramai pelatih-pelatih doktor dan paramedik menyebabkan kesesakan dan ketidakselesaan pesakit dan ahli fisioterapi menjalankan proses rawatan 7. Komunikasi : masalah berinteraksi dengan pesakit penjaga semasa proses perawatan dijalankan
dan
8. Masalah penglihatan dan pendengaran menyukarkan proses perawatan pesakit bersama ahli fisioterapi 9. Kognitif : ketidakupayaan pesakit untuk memahami serta berinteraksi secara berkesan sepanjang tempoh perawatan
45
JUSTIFIKASI NORMA KERJA Kawasan Spinal Cord Injury (SCI)
Norma 60 minit setiap
Justifikasi
1.
pesakit Nisbah 1:6
‘TIME CONSUMER’ Sesi penilaian dan perawatan terhadap pesakit Spinal Cord Injury (SCI) memerlukan masa selama 45 minit ke 60 minit untuk seorang pesakit. Penilaian (Outcome Measurement Tools) umum yang selalu digunakan adalah ASIA, MMT dan FIM. Contoh Functional Independece Measurement (FIM) proses penilaian dalam 15- 20 minit untuk 18 prosedur.
‘SGH Training Center” dimana multidisiplin terlibat memberi input perawatan dan Fisioterapi adalah salah satu daripada disiplin yang memberi input dalam latihan kepada pesakit atau penjaga serta staf wad.
Had daripada pengurusan operasi pembedahan itu sendiri kadangkala menghadkan proses penilaian dan perawatan bagi pesakit Contoh: pemakaian orthosis seperti SOMI Brace sebelum memulakan rawatan Fisioterapi.
2. ‘MIX UP SETTING REHAB UNIT ‘ Highly specialised wad – setiap pesakit SCI adalah berlainan isu (Precaution dan contraindication) perawatannya maka ini boleh melambatkan rawatan Fisioterapi
Tiada wad khas untuk pesakit SCI maka pelbagai kes ortho lain
Pesakit SCI yang ‘lodging’ di wad lain –perlu bergerak di luar kawasan asal pesakit SCI yang sepatutnya.
3. ‘Energy consumer’ Pesakit SCI banyak memerlukan tenaga terutamanya semasa prosedur atau aktiviti ‘transfer dan lifting ‘
Kekurangan tenaga - perlu mencari dan menunggu tenaga staf lain untuk membantu semasa prosedur ini.
46
2012
PENGURUSAN MASA Disediakan oleh : PENGENALAN
Pengurusan masa bermaksud kemampuan menguruskan masa secara berkesan bagi melakukan aktiviti harian dan merasa puas hati dengan apa yang telah dilakukan. Pengurusan masa yang berkesan merupakan ciri penting di dalam gaya hidup yang sihat. Menguruskan masa melibatkan penggunaan peralatan dan kaedah atau teknik untuk merancang dan menjadualkan masa dengan sesuai dan tepat. Peralatan dan teknik tersebut bertujuan untuk meningkatkan keberkesanan penggunaan masa anda. Pengurusan masa amat penting bagi membantu dalam mengurus dan mengendalikan masa dengan bijak.
47
PERBANDINGAN PENGURUSAN MASA YANG EFEKTIF DAN TIDAK EFEKTIF PENGURUSAN MASA EFEKTIF Dapat memenuhi tarikh atau masa yang
PENGURUSAN MASA TIDAK EFEKTIF Kerapkali merasa tertekan
ditetapkan Dapat mncapai matlamat yang
Kerapkali melangkaui masa yang
ditetapkan
ditetapkan
Sentiasa menghabiskan masa yang
Kerapkali mengambil masa yang lama
berkualiti untuk melaksanakan tugas
untuk melaksanakan tugasan
yang penting. Sentiasa mempunyai tujuan jangka
Kurang matlamat dan hala tuju dalam
pendek dan jangka panjang untuk
melaksanakan sesuatu tugasan/aktiviti.
sesuatu tugasan/aktiviti. Kurang tekanan kerja dan merasa lebih
Sentiasa merasa kekurangan masa dan
terkawal
merasa terlalu banyak aktiviti perlu dilaksanakan.
CIRI-CIRI PENGURUSAN MASA YANG EFEKTIF 48
1. Sentiasa mengikut jadual yang boleh disesuaikan dengan sebarang perubahan. 2. Mengutamakan pelaksanaan tugas–tugas yang penting. 3. Sentiasa mempunyai tujuan jangka pendek dan jangka panjang untuk sesuatu tugasan/aktiviti. 4. Menjadualkan aktiviti harian,mingguan dan bulanan
FAEDAH-FAEDAH PENGURUSAN MASA 1. Meningkatkan produktiviti dan memungkinkan penghasilan kerja yang efektif dengan usaha yang minima. 2. Membimbing individu mencapai tujuan dengan menggunakan masa dan tenaga yang bersesuaian. 3. Meningkatkan daya kawalan terhadap penggunaan masa. 4. Membantu dalam memenuhi masa dengan mengenal pasti aktiviti yang penting serta berkualiti dalam kehidupan seharian
KAEDAH PELAKSANAAN PENGURUSAN MASA 49
Carta Penggunaan Masa Definisi:
Satu jadual pergerakan pegawai dalam melaksanakan tugasan harian.
Objektif: 1. Mendokumentasikan segala aktiviti pegawai dalam tugas harian. 2. Memudahkan penyelia untuk memantau pergerakan kakitangan. 3. Meningkatkan akauntabiliti pegawai ke atas tugasan mereka. 4. Memudahkan penyelia merancang pengagihan tugas yang lebih saksama. 5. Meningkatkan disiplin di kalangan pegawai dalam pengurusan masa. Cara Pelaksanaan:
Semua pegawai diwajibkan untuk menyediakan carta pengurusan masa masingmasing sebelum memulakan tugas penempatan yang baru.
Satu salinan carta pengurusan masa yang telah siap didokumenkan perlu diserahkan kepada penyelia masing-masing.
Satu salinan akan disimpan oleh pegawai yang berkenaan.
Pegawai perlu melaksanakan tugas berlandaskan jadual carta pengurusan masa yang telah disediakan kecuali jika terdapat sebarang perubahan yang diarahkan oleh Ketua Jabatan atau penyelia berkenaan.
50
JABATAN FISIOTERAPI, HOSPITAL ………………………………. CARTA PENGURUSAN MASA KAKITANGAN
Jam 4.00
7.30 8.00 5.00
9.00
10.00
11.00
12.00
1.00
ISNIN
R
SELASA
E
RABU
H
KHAMIS
A
2.00
3.00
51
JUMAAT
T
PETUNJUK:
52
Catatan: Petunjuk mestilah menggunakan kod warna. Penerangan Tentang Cara Pengisian Carta: 1. Lengkapkan butiran maklumat terdapat di dalam carta. 2. Dokumenkan sebarang aktiviti / tugasan formal mengikut ruangan julat masa yang telah disediakan, contoh pada jam 8.30 – 9am – catitkan Mesyuarat Pagi/ CME hospital/ wad Paediatrik dan lain-lain. 3. Warnakan kotak ruangan tersebut untuk membezakan satu aktiviti dengan aktiviti lain.
Sumber Rujukan: 1. Covey, S. (1990) The seven habits of highly effective people, Simon and Shuster, New York. 2. Dryden, W. (2002) Life coaching: A cognitive behavioral approach, BrunnerRoutledge, England. 3. Susan, W. (2003) Time management strategies in nursing practice. Journal of Advanced Nursing, 43(5), 432-440. 4. Julie, M. (2004) Time management from the inside out, 2nd. Ed., Henry Holt and Company, New York. 5. Julie, M. (2004) Organising from the inside out, 2nd. Ed., Henry Holt and Company, New York. 6. Flauaus, J. (2008) The art of time management. The Journal of the European Medical Writers Association, 17(3), 152.
53
2012
TUGAS PANGGILAN BERJADUAL
TUGAS PANGGILAN BERJADUAL FISIOTERAPI 54
Pengenalan:
Perkhidmatan yang disediakan untuk pesakit yang mempunyai masalah kardiorespiratori, yang memerlukan perawatan segera yang mana jika tidak dirawat, kondisi pesakit menjadi semakin teruk.
Semua Pegawai / Ahli Fisioterapi perlu menjalankan perkhidmatan ini kecuali terdapat keadaan yang memerlukan pengecualian atau tertakluk kepada keperluan sesebuah hospital tersebut.
Tahap pengetahuan Pegawai / Ahli Fisioterapi perlu mencukupi untuk membolehkan mereka: mengenalpasti ketidakfungsian pesakit melalui proses penilaian yang bersesuaian. memilih, merancang dan melaksanakan intervensi fisioterapi.
Objektif:
Untuk memastikan pesakit mendapat perawatan Fisioterapi yang berterusan walaupun pada hari cuti supaya kondisi pesakit terkawal.
Operasi Perkhidmatan Tugas panggilan Berjadual: Hari:
Cuti Hujung Minggu dan Hari Kelepasan Am
Masa: 8.00 pagi – 1.00 petang ( bergantung kepada keperluan setempat) Kriteria Pesakit Untuk Tugas Panggilan Berjadual:
Pesakit yang dirawat di semua Unit Rawatan Rapi, yang kondisinya memerlukan rawatan berterusan.
Pesakit wad yang menggunakan mesin ventilator dan dirujuk untuk tugas atas panggilan berjadual.
Pesakit kardiorespiratori yang memerlukan rawatan Fisioterapi yang segera, sekiranya tidak dirawat kondisinya akan bertambah teruk.
Perawatan Fisioterapi yang dilakukan adalah berlandaskan “Physiotherapy Care Protocol Critically Ill Adult, 2003”.
55
Carta Aliran Proses Rujukan dan Perawatan Pesakit Baru Bagi Tugas Panggilan Berjadual: Pesakit dirujuk oleh Peg. Perubatan yang bertugas di Wad berkenaan Rujukan secara terus didalam wad
Rujukan melalui telefon
Maklumat pesakit perlu diperolehi termasuk nama pesakit, diagnosis, nama disiplin yang merujuk.
Peg. Perubatan perlu menulis nota rujukan di dalam Bed Head Ticket (BHT) / mengisi borang rujukan pesakit dalam
Penilaian dilakukan ke atas pesakit
Perawatan Fisioterapi dilakukan ke atas pesakit
Rawatan berterusan akan diambilalih oleh Ahli Fisioterapi yang bertugas di Wad berkenaan.
56
Carta Aliran Proses Rujukan dan Perawatan Pesakit Ulangan Bagi Tugas Panggilan Berjadual:
Ahli Fisioterapi yang bertugas di Wad berkenaan perlu memaklumkan maklumat pesakit kepada Ahli Fisioterapi untuk tugas panggilan berjadual
Penilaian semula dilakukan ke atas pesakit
Perawatan Fisioterapi dilakukan ke atas pesakit
Rawatan berterusan akan di ambilalih oleh Ahli Fisioterapi yang bertugas di Wad berkenaan.
57
Kaedah Pelaksanaan Tugas Panggilan Berjadual Fisioterapi 1. Penyelia Fisioterapi menyediakan jadual untuk Tugas Panggilan Berjadual yang mengandungi nama pegawai bertugas, tarikh bertugas, nombor telefon pegawai dan pengesahan Ketua Unit. 2. Jadual Tugas Panggilan Berjadual ini perlu dihantar kepada Bilik Operator Hospital. 3. Sebarang pertukaran pegawai bertugas, hendaklah dimaklumkan kepada Telefonis sebelum tarikh bertugas. 4. Pegawai yang bertugas di wad hendaklah memaklumkan senarai nama pesakit yang memerlukan rawatan panggilan berjadual kepada pegawai yang berkenaan, pada petang sebelum hujung minggu atau hari Kelepasan Am. 5. Ahli Fisioterapi yang bertugas untuk Tugas Panggilan Berjadual perlu mengetik kad perakam waktu pada waktu datang bertugas dan apabila selesai bertugas. 6. Senarai nama pesakit, R/N pesakit, diagnosis pesakit, nama wad dan nama, cop serta tandatangan pegawai yang bertugas perlu didokumenkan di dalam Buku Tugas Panggilan Berjadual. 7. Buku Tugas Panggilan Berjadual ini disimpan di Unit Fisioterapi. 8. Catitkan maklumat
pesakit yang dirawat menggunakan buku statistik harian yang
sedia ada. 9. Bagi Ahli Fisioterapi Kumpulan Sokongan layak untuk membuat tuntutan elaun lebih masa manakala bagi Kumpulan Profesional layak untuk mendapat “time off”. 10. Contoh borang-borang tuntutan untuk elaun lebih masa seperti di Lampiran A.
58
Sumber Rujukan Physiotherapy Care Protocol, Critically Ill adult, No. 3/2003. Beverly Harden, Emergency Physiotherapy – An Oncall Survival Guide, 2004 Emergency Respiratory Oncall Working : Guidance for Physiotherapist, March 2002, The Chartered Society of Physiotherapy. Julie C.Reeve, A Survey of Physiotherapy Oncall and Emergency Duty Services in New Zealand, 2003, New Zealand Journal Of Physiotherapy Standard of Physiotherapy Practice , November 2008, 4th Ed., New Zealand Society of Physiotherapy. ( Review date: November 2010) Alexandra Hough (2001), Physiotherapy In Respiratory Care – An evidence based approach to respiratory and cardiac management, 3rd Ed., Nelson Thornes Ltd, UK.
59
2012
OUTCOME MEASURE
60
OUTCOME MEASURE 1.1
OBJEKTIF: 1)
Menyediakan satu pengkhususan dalam praktis fisioterapi terhadap masalah dan keupayaan pesakit.
2)
Meningkatkan kualiti perkhidmatan fisioterapi dengan mencapai piawaian antarabangsa.
3)
Menentukan pengukuran asas (baseline) bagi merancang intervensi yang lebih efektif dan holistik.
4)
Menilai keberkesanan rawatan yang telah diberikan.
5)
Memberi gambaran progresif pesakit terhadap rawatan.
6)
Meningkatkan kompetensi fisioterapi dengan praktis yang berlandaskan evidence based.
7)
Menyeragamkan penggunaan format outcome measure yang digunapakai.
61
1.2
PENILAIAN ASAS (MEASUREMENT TOOLS) Bil 1
ITEM Vital sign
-
MEASUREMENT TOOLS GCS Tekanan darah Kadar denyutan jantung Intracranial pressure (ICP) Respitory rate SPO2 Pulse rate ECG ABG
2
Pain
-
Visual Analog Scale
3
Range of motion
-
Goniometer Inclinometer Tape measure
4
Kardiorespiratori
-
Capillary filling Chest Expansion Chest Measurement Pulse rate ratio Adjunct physiotherapy (spirometer/triflow/peak flow meter)
5
Muskuloskeletal
-
Muscle bulk measurement Swelling measurement Leg length ROM Muscle Testing Special Orthopedic Tests
6
Pediatrik
-
Milestone Primitive reflexes
62
1.3
OUTCOME MEASURE
NUM.
OBJECTIVE
DISCIPLINE
OUTCOME MEASURE
1
MUSCLE POWER
Musculoskeletal
Oxford Scale MRC- Muscle Strengthening
2
MUSCLE TONE
Neurology
Modified Ashworth Scale
3
BALANCE
Geriatric/ Neurology
Functional Reach Test Timed Up & Go Test Berg’s Balance Scale Dynamic Gait Index
4
ENDURANCE/ TOLERANCE
Cardiorespiratory
Six Minutes WalkTest Borg Scale
5
BODY FUNCTION
Paediatric
Gross Motor Functional Measurement Gross Motor Function Classification System (GMFCS) Hammersmith Neonatal Neurological Examination Motor Assessment Scale ASIA Scale Functional Independence Measure (FIM) Algofunction Score Disability Arm, Shoulder & Hand Score Neck Disability Index Revise Oswestry Disability Index (RODI) Amputee Mobility Predictor Jammar Hand Evaluation Tool Kit
Neurology
Musculoskeletal
Amputation
Hand
63
PART 1
MUSCLE TESTING
64
1.1
OXFORD SCALE SOURCE AIMS
SCORING INSTRUCTION
INTERPRETATION OF SCORE
Self-report questionnaire designed to measure strength of the muscle: i Upper limbs ii Lower limbs iii Abdominal iv Back v Neck i
TOOL a. The patient's strength is graded on a scale of 0-5.
ii
PROCEDURE : Complete the scale
Grade 5: Muscle contracts normally against full resistance. Grade 4: Muscle strength is reduced but muscle contraction can still move joint against resistance. Grade 3: Muscle strength is further reduced such that the joint can be moved only against gravity with the examiner's resistance completely removed. As an example, the elbow can be moved from full extension to full flexion starting with the arm hanging down at the side. Grade 2: Muscle can move only if the resistance of gravity is removed. As an example, the elbow can be fully flexed only if the arm is maintained in a horizontal plane. Grade 1: Only a trace or flicker of movement is seen or felt in the muscle or fasciculation are observed in the muscle. Grade 0: No movement is observed.
65
MUSCLE STRENGTH : OXFORD SCALE UNIT FISIOTERAPI HOSPITAL ______________________ NAME
_____________________________
IC NUMBER DIAGNOSIS
________________________________
NO 1
R/N ________________P____ AGE ______________
____________________
JOINT SHOULDER
MUSCLE
GRADE
ANTERIOR DELTOID POSTERIOR DELTOID SUPRASPINATUS/ MIDDLE DELTOID ADDUCTOR
2
ELBOW
BICEPS TRCEPS
3
WRIST
FLEXOR EXTENSOR RADIAL DEVIATOR ULNAR DEVIATOR
4
HIP
ILIOPSOAS GLUTEUS MAXIMUS GLUTEUS MEDIUS ADDUCTOR
5
KNEE
HAMSTRING QUADRICEPS
6
ANKLE
ANTERIOR TIBIALIS GASTROCNEMIUS POSTERIOR TIBIALIS EVERSOR
66
PART 2
MUSCLE TONE
67
2.1 MODIFIED ASHWORTH SCALE SOURCE AIMS SCORING INSTRUCTION
Modified Ashworth Scale 1987 (Bohannon & Speed) Measures muscle hypertonia instead of spasticity i
TOOL : Modified Ashworth Scale
ii
PROCEDURE The Modified Ashworth Scale (MAS) has a 6-point scale that assists with stroke patients.
INTERPRETATION OF SCORES GRADE
TONUS
0
No increase in muscle tone.
1
Slight increase in tone with a catch and release or minimal resistance at end of range.
2
As 2 but with minimal resistance through range following catch
3
More marked increase tone through ROM.
4
Considerable increase in tone, passive movement difficult.
5
Affected part rigid.
68
MODIFIED ASHWORTH SCALE UNIT FISIOTERAPI HOSPITAL ______________________ NAME
_____________________________
R/N ________________P____
IC NUMBER DIAGNOSIS
________________________________
AGE _____________
____________________
GRADE RT/LT
MUSCLE UNDER STRETCH
DATE
DATE
DATE
69
Part 3
Balance
FUNCTIONAL REACH TEST i
Duncan, PW, Weiner DK, Chadler J, Studenske S. Functional reach: A new clinical measure of balance. J Gerontol. 1990; 45:M192.
ii
Duncan, PW, et al: Functional reach: Predictive validity in a sample of elderly male veterans. J Gerontol. 1992; 47:M93.
SOURCE
70
Quick screen for balance problems in older adults. AIMS i
PROCEDURE a. The patient must be able to stand independently for at least 30 seconds without support, and be able to flex the shoulder to at least 90 degrees. b. A yard stick is attached to a wall at about shoulder height. The patient is positioned in front of this with fingers touching the tip of the yard stick. Patient lean forward from ankles and therapist take the reading. c. The examiner takes a position 5-10 feet away from the patient, viewing the patient from the side.
INTERPRETATION OF SCORE
i.
≤ 6 inches
=
Increased risk for falls
ii.
6 – 10 inches
=
Moderate risk for falls
AGE RELATED NORMS Age (years) 20-40 41-69 70-87
General (inches) 14-17 13-16 10-13
Men (inches) 16.7 + 1.9 14.9 + 2.2 13.2 + 1.6
Women (inches) 14.6 + 2.2 13.8 + 2.2 10.5 + 3.5
FUNCTIONAL REACH TEST UNIT FISIOTERAPI HOSPITAL ____________________ NAME: _____________________________________ R/N : _________________ IC NUMBER: ________________________________ AGE: _________________ DIAGNOSIS : ________________________________________ 71
Date
3.2
1
st
Distances ( in inches ) 2nd 3rd
Average
Interpretation
TIMED UP & GO TEST
72
SOURCE AIMS SCORING INSTRUCTION
Measure & predict the probability for falls i
TOOL a. Arm chair b. Tape measure c. Tape d. Stop watch
ii
PROCEDURE a) Begin with subject sitting correctly on chair with arms, back should resting on the back of the chair. The chair should be stable and positioned such that it will not move when the subject moves from sitting to standing. b) Place a piece of tape on the floor 3 meters away from the chair. c) Instructions to subject: i. “On the word GO you will stand up, walk to the line on the floor, turn around and walk back to the chair and sit down. Walk at your pace.” d) Start timing on the word ‘GO’ and stop timing when the subject is seated again correctly on the chair with their back resting. e) The subject should be given a practice trial that is not timed before testing.
INTERPRETATION OF SCORE
≤ 10 seconds = Normal ≤ 20 seconds = Good mobility, can go out alone, mobile without a gait aid < 30 seconds = Problems, cannot go outside alone, requires a gait aid
73
TIME UP & GO TEST (TUG) UNIT FISIOTERAPI HOSPITAL ____________________ NAME: _____________________________________ R/N : _________________ IC NUMBER: ________________________________ AGE: _________________ DIAGNOSIS : ________________________________________
Date
Time 1st
2nd
3rd
Average
Interpretation
74
3.3
BERG’S BALANCE SCALE SOURCE
AIMS SCORING INSTRUCTION
Lusardi, M.M. (2004). Functional Performance in Community Living Older Adults. Journal of Geriatric Physical Therapy, 26(3), 14-22 14-item scale designed to measure balance of the older adult. i
TOOL a. b. c. d. e.
12’ Ruler 2 standard chairs (one with arm rests, one without) Footstool or step Stopwatch or wristwatch 15 ft walkway
a) PROCEDURE b) Begin by demonstrating. Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item. c) A five-point ordinal scale, ranging from 0-4. “0” indicates the lowest level of function and “4” the highest level of function. The total score is 56 d) In most items, the subject is asked to maintain a given position for a specific time. e) Progressively more points are deducted if: f) The time or distance requirements are not met g) The subject’s performance warrants supervision h) The subject touches an external support or receives assistance from the examiner. i) Subject should understand that they must maintain their balance while attempting the tasks. j) The choices of which leg to stand on or how far to reach are left to the subject. k) Poor judgment will adversely influence the performance and the scoring. Score Interpretation INTERPRETATION OF SCORE
0-20
High fall risk
21-40
Medium fall risk
41-56
Low fall risk UNIT FISIOTERAPI
HOSPITAL ______________________ NAME
IC NUMBER
75
R/N
AGE
DIAGNOSIS
ITEM
DESCRIPTION
1
Sitting to standing INSTRUCTIONS: Please stand up. Try not to use your hand for support.
SCORE 4 3 2 1 0
2
Standing unsupported INSTRUCTIONS: Please stand for two minutes without holding on.
4 3 2 1 0
3
4
Sitting with back unsupported but feet supported on floor or on a stool INSTRUCTIONS: Please sit with arms folded for 2 minutes. Standing to sitting INSTRUCTIONS: Please sit down.
4 3 2 1 0 4 3 2 1
5
Transfers INSTRUCTIONS: Arrange chair(s) for pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair.
0 4 3 2 1 0
DATE
DATE
DATE
Able to stand without using hands and stabilize independently Able to stand independently using hands Able to stand using hands after several tries Needs minimal aid to stand or stabilize Needs moderate or maximal assist to stand Able to stand safely for 2 minutes Able to stand 2 minutes with supervision Able to stand 30 seconds unsupported Needs several tries to stand 30 seconds unsupported Unable to stand 30 seconds unsupported Able to sit safely and securely for 2 minutes Able to sit 2 minutes under supervision Able to able to sit 30 seconds Able to sit 10 seconds Unable to sit without support 10 seconds Sits safely with minimal use of hands Controls descent by using hands Uses back of legs against chair to control descent Sits independently but has uncontrolled descent Needs assist to sit Able to transfer safely with minor use of hands Able to transfer safely definite need of hands Able to transfer with verbal cuing and/or supervision Needs one person to assist Needs two people to assist or supervise to be safe
76
ITEM
DESCRIPTION
6
Standing unsupported with eyes closed INSTRUCTIONS: Please close your eyes and stand still for 10 seconds.
SCORE 4 3 2 1 0
7
Standing unsupported with feet together INSTRUCTIONS: Place your feet together and stand without holding on.
4 3 2 1 0
8
Reaching forward with outstretched arm while in standing. INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.)
4 3 2 1 0
DATE
DATE
DATE
Able to stand 10 seconds safely Able to stand 10 seconds with supervision Able to stand 3 seconds Unable to keep eyes closed 3 seconds but stays safely Need help to keep from falling Able to place feet together independently and stand 1 minute safely Able to place feet together independently and stand 1 minute with supervision Able to place feet together independently but unable to hold for 30 seconds Needs help to attain position but able to stand 15 seconds feet together Needs help to attain position and unable to hold for 15 seconds Can reach forward confidently 25 cm (10 inches) Can reach forward 12 cm (5 inches) Can reach forward 5 cm (2 inches) Reaches forward but needs supervision Loses balance while trying/requires external support
77
ITEM
DESCRIPTION
9
Retrieving object from floor INSTRUCTIONS: Pick up the shoe/slipper, which is in front of your feet.
SCORE 4 3 2 1 0
10
11
Turning to look behind INSTRUCTIONS: Turn to look directly behind you over toward the left shoulder. Repeat to the right. (Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.) Turning 360 degrees INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
4 3 2 1 0 4 3 2 1
12
Placing alternate foot on stool INSTRUCTIONS: Place each foot alternately on the step/ stool. Continue until each foot has touched the step/stool four times.
0 4 3 2 1 0
DATE
DATE
DATE
Able to pick up slipper safely and easily Able to pick up slipper but needs supervision Unable to pick up but reaches 2-5 cm(12 inches) from slipper and keeps balance independently Unable to pick up and needs supervision while trying Unable to try/needs assist to keep from losing balance or falling Looks behind from both sides and weight shifts well Looks behind one side only other side shows less weight shift Turns sideways only but maintains balance Needs supervision when turning Needs assist to keep from losing balance or falling Able to turn 360 degrees safely in 4 seconds or less Able to turn 360 degrees safely one side only 4 seconds or less Able to turn 360 degrees safely but slowly Needs close supervision or verbal cueing Needs assistance while turning Able to stand independently and safely and complete 8 steps in 20 seconds Able to stand independently and complete 8 steps in > 20 seconds Able to complete 4 steps without aid with supervision Able to complete > 2 steps needs minimal assist Needs assistance to keep from falling/unable to try
78
ITEM
DESCRIPTION
13
Retrieving object from floor INSTRUCTIONS: Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should approximate the subject’s normal stride width.) Turning to look behind INSTRUCTIONS: Stand on one leg as long as you can without holding on.
14
SCORE 4 3 2 1 0
4 3 2 1 0
DATE
DATE
DATE
Able to place foot tandem independently and hold 30 seconds Able to place foot ahead independently and hold 30 seconds Able to take small step independently and hold 30 seconds Needs help to step but can hold 15 seconds Loses balance while stepping or standing
Able to lift leg independently and hold > 10 seconds Able to lift leg independently and hold 510 seconds Able to lift leg independently and hold L 3 seconds Tries to lift leg unable to hold 3 seconds but remains standing independently. Unable to try of needs assist to prevent fall
TOTAL (MAXIMUM SCORE=56)
79
3.4
DYNAMIC GAIT INDEX
SOURCE
AIMS SCORING INSTRUCTION
1. Herdman SJ. Vestibular Rehabilitation. 2nd ed. Philadelphia, PA: F.A.Davis Co; 2000. 2. Shumway-Cook A, Woollacott M. Motor Control Theory and Applications, Williams and Wilkins Baltimore, 1995: 323-324 Developed to assess the likehood of falling in older adults. Designed to test eight facets of gait. i TOOL a. Box (Shoebox) b. Cones (2), Stairs c. 20’ length and 15” wide walkway ii
PROCEDURE a. b. c. d.
INTERPRETATION OF SCORE
Has 8 items. Each item ranging from 0-3 Grading the lowest category that applies. Total Score is 24 0 3 Lowest level of function to the highest level of function
Less than 19 = Predictive of falls in the elderly More than 22 = Safe ambulators
80
81
UNIT FISIOTERAPI HOSPITAL _____________________ NAME: ________________________________________
R/N: ______________________
IC NUMBER:____________________________________
AGE: ______________________
DIAGNOSIS: _______________________________________________
No Scale
Activity
1
Gait level surface
2
Instructions: Walk at your normal speed from here to the next mark (20’) Normal: Walks 20’, no assistive devices, good speed, no evidence for imbalance, normal gait pattern Mild Impairment: Walks 20’, uses assistive devices, slower speed, mild gait deviations. Moderate Impairment: Walks 20’, slow speed, abnormal gait pattern, evidence for imbalance. Severe Impairment: Cannot walk 20’ without assistance, severe gait deviations or imbalance.ain is mild and comes and goes. Change in gait speed
3 2 1 0
3 2
1
0
Date
Date
Date
Instructions: Begin walking at your normal pace (for 5’), when I tell you “go,” walk as fast as you can (for 5’). When I tell you “slow,” walk as slowly as you can (for 5’). Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds between normal, fast and slow speeds. Mild Impairment: Is able to change speed but demonstrates mild gait deviations, or not gait deviations but unable to achieve a significant change in velocity, or uses an assistive device. Moderate Impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, or changes speed but has a significant gait deviation, or changes speed but loses balance but is able to recover and continue walking. Severe Impairment: Cannot change speeds, or loses balance and has to reach for wall or be caught.
82
No Scale 3
Activity
Date
Date
Date
Gait with horizontal head turns Instructions: Begin walking at your normal pace. When I tell you to “look right,” keep walking straight, but turn your head to the right. Keep looking to the right until I tell you, “look left,” then keep walking straight and turn your head to the left. Keep your head to the left until I tell you “look straight,“ then keep walking straight, but return your head to the center. 3
Normal: Performs head turns smoothly with no change in gait.
2
Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid. Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk. Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall. Gait with vertical head turns
1 0 4
Instructions: Begin walking at your normal pace. When I tell you to “look up,” keep walking straight, but tip your head up. Keep looking up until I tell you, “look down,” then keep walking straight and tip your head down. Keep your head down until I tell you “look straight,“ then keep walking straight, but return your head to the center. 3
Normal: Performs head turns smoothly with no change in gait.
2
Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid. Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk. Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.
1 0
83
No Scale 5
Activity
Date
Date
Date
Gait and pivot turn Instructions: Begin walking at your normal pace. When I tell you, “turn and stop,” turn as quickly as you can to face the opposite direction and stop. 3 2 1 0
6
Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance. Mild Impairment: Pivot turns safely in > 3 seconds and stops with no loss of balance. Moderate Impairment: Turns slowly, requires verbal cueing, requires several small steps to catch balance following turn and stop. Severe Impairment: Cannot turn safely, requires assistance to turn and stop. Step over obstacle Instructions: Begin walking at your normal speed. When you come to the shoebox, step over it, not around it, and keep walking.
3 2 1 0
Normal: Is able to step over the box without changing gait speed, no evidence of imbalance. Mild Impairment: Is able to step over box, but must slow down and adjust steps to clear box safely. Moderate Impairment: Is able to step over box but must stop, then step over. May require verbal cueing. Severe Impairment: Cannot perform without assistance.
84
No Scale 7
Date
Activity
Date
Date
Step around obstacles Instructions: Begin walking at normal speed. When you come to the first cone (about 6’ away), walk around the right side of it. When you come to the second cone (6’ past first cone), walk around it to the left. 3 2 1 0
8
Normal: Is able to walk around cones safely without changing gait speed; no evidence of imbalance. Mild Impairment: Is able to step around both cones, but must slow down and adjust steps to clear cones. Moderate Impairment: Is able to clear cones but must significantly slow, speed to accomplish task, or requires verbal cueing. Severe Impairment: Unable to clear cones, walks into one or both cones, or requires physical assistance. Steps Instructions: Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn around and walk down.
3
Normal: Alternating feet, no rail.
2
Mild Impairment: Alternating feet, must use rail.
1
Moderate Impairment: Two feet to a stair, must use rail.
0
Severe Impairment: Cannot do safely. TOTAL SCORE
85
PART 4 ENDURANCE & TOLERANCE 86
4.1
SIX MINUTE WALK TEST
SOURCE - Texas Heart Institute Journal AIMS - Is designed to assess the progression of a respiratory or cardiac disease (eg: improvement or worsening of the patient’s condition) aerobic (cardiovascular) fitness level based on how quickly heart rate returns to normal after exercise. TOOLS
Countdown timer or stopwatch Mechanical lap counter Two small cones to mark the turn around points A chair that can be easily moved along the walking course Worksheets on a clipboard A source of oxygen Sphygmomanometer Telephone Automated electronic defibrillator
PROCEDURE 1. Preparation for subject: Comfortable clothing should be worn. Appropriate shoes for walking should be worn. Subjects should use their usual walking aids during the test (Cane, walker, etc.). The subject’s usual medical regimen should be continued. A light meal is acceptable before early morning or early afternoon test. Subjects should not have exercised vigorously within 2 hours of beginning the test. 2. Establish a walking course length of at least 98.5 feet (30 meters). Situating the course near a wall will allow subjects to rest against it if needed during the test. 3. Mark the length of the course every 3 meters with the small stickers. 4. Mark the turn around points at each end of the course with a piece of masking tape or another type of marker that will be easily visible to the subject. 5. The person conducting the test should be prepared with the following: a Borg scale for subject assessment of dyspnea and fatigue and a timer set to 6 minutes.
87
6. Preparation for subject:
Comfortable clothing should be worn. Appropriate shoes for walking should be worn. Subjects should use their usual walking aids during the test (cane, walker, etc.). The subject’s usual medical regimen should be continued. A light meal is acceptable before early morning or early afternoon test. Subjects should not have exercised vigorously within 2 hours of beginning the test
7. Establish a walking course length of at least 98.5 feet (30 meters). Situating the course near a wall will allow subjects to rest against it if needed during the test. 8. Mark the length of the course every 3 meters with the small stickers. 9. Mark the turn around points at each end of the course with a piece of masking tape or another type of marker that will be easily visible to the subject. 10. The person conducting the test should be prepared with the following: a Borg scale for subject assessment of dyspnea and fatigue and a timer set to 6 minutes. 11. INSTRUCTIONS TO SUBJECT: "The object of this test is to walk as far as possible for 6 minutes by walking back and forth on this course defined by these markers. Six minutes is a long time to walk, so you will be exerting yourself. You will probably become out of breath or exhausted. You may slow down, stop, and rest as necessary. You may lean against the wall while resting, but resume walking as soon as you are able. You will be walking back and forth around the markers here. You should pivot briskly around the markers and continue back the other way without hesitation. Now I’m going to show you. Please watch the way I turn without hesitation." INTERPRETATION OF SCORE Distance of ≤300 m is a simple and useful prognostic marker of subsequent cardiac death in patients with mild-to-moderate heart failure.
88
UNIT FISIOTERAPI HOSPITAL ______________________ NAME
______________________
R/N
_______________
AGE
_______________
IC NUMBER
__________________________ _ DIAGNOSIS __________________________ _
SIX MINUTES WALKING TEST (6MWT)
Test Date
BP
Resting HR
Borg’s scale
Pulse 1minute (after recovery)
SPO2 (%)
Distance (m)
Remarks
1 2 3 4 5
89
4.2
BORG SCALE AIMS
SCORING INSTRUCTION
To measure your sensation of breathlessness during various activities. i. ii
TOOL : Borg’s Scale PROCEDURE :
a. Show and explain patient the scale on how to rating their breathlessness before activity. b. Explain the precautions of not over exerting themselves during activities. 6 means ‘no exertion at all’ and 20 means ‘maximal exertion’. Choose the number from below that best describes their level of exertion. c. After activity is done, patient subjectively rate their exertion level according to the scale. INTERPRETATION OF SCORE
90
PART 5 BODY FUNCTION
5.1
GROSS MOTOR FUNCTIONAL MEASUREMENT (GMFM) 91
SOURCE AIMS SCORING INSTRUCTION
Mac Keith Press, 2001 To measure gross motor function in children with cerebral palsy i TOOL : GMFM questionnaire ii
PROCEDURE: Consist 4 items which are; A. B. C. D.
Lying & rolling Sitting Standing Walking, Running & Jumping
Each item has specific instructions. Refer the questionnaire. INTERPRETATION OF SCORE
The scoring scale is based on below: 0 1 2 3 NT
does not initiates initiate partially complete completes Not tested
See GMFM PDF version
5.2
GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM (GMFCS) 92
SOURCE AIMS SCORING INSTRUCTION
http://motorgrowth.canchild.ca/en/GMFCS/resources/GMFCS-ER.pdf A classification system of children with CP based on GM function. TOOL : GMFCS questionnaire i ii
5 levels across 4 age bands Quick and easy in a few minutes. iii Classification can be made based on general familiarity with a child’s motor abilities (even without an observational assesment). iv Emphasis is on the child’s usual performance at home, school and community setting. INTERPRETATION OF SCORE
See GMFCS questionnaire sheets
See GMFCS PDF version
93
5.3 MOTOR ASSESSMENT SCALE (MAS) SOURCE AIMS
Carr J, Shepherd R et al (1985) Investigation of a new Motor Assessment Scale for stroke patients. Physical Therapy 65, 2, 175-180 i. ii.
SCORING INSTRUCTION
i ii
To assess the return of function following a stroke or other neurological impairment. The test looks at a patient’s ability to move with low tone or in a synergistic pattern and finally move actively out of that pattern into normal movement. TOOL : Motor Assessment Scale Questionnaire PROCEDURE Staff-completed scale measuring physical disability. Consists of 8 hierarchical areas of every day motor function and one item to rate muscle tone. Each motor item is assessed 3 times, the best performance being rated on a scale of 0-6. Also included are criteria to aid grading (some measuring quality, others time) and a set of general rules for carrying out the assessment. Following reliability studies the authors suggest dropping the muscle tone section.
INTERPRETATION OF SCORE
The higher the score – the higher functioning the patient is on the affected side. High Score: 54 Low Score: 0
94
UNIT FISIOTERAPI HOSPITAL ______________________ NAME R/N
___________________________ ___________________ AGE : ______
IC NUMBER DIAGNOSIS
_____________________ _____________________
MOTOR ASSESSMENT SCALE (MAS) If the patient cannot complete any part of a section score a zero (0) for that section. There are 9 sections in all. 1. 1 2 3 4 5 6
2. 1 2 3 4 5 6
3. 1 2 3 4 5 6
4. 1 2 3 4 5 6
5. 1 2 3 4 5 6
MOVEMENT Supine to Side-lying onto intact side (starting position: supine with knees straight) Uses intact arm to pull body toward intact side. Uses intact leg to hook impaired leg to pull it over. Actively moves impaired leg across body to roll but leaves impaired arm behind. Impaired arm is lifted across body with other arm. Impaired leg moves actively & body follows as a block. Actively moves impaired arm across body. The rest of the body moves as a block. Actively moves impaired arm and leg rolling to intact side but overbalances. Rolls to intact side in 3 seconds without use of hands. Supine to Sitting over side of bed Pt assisted to the side-lying position: Patient lifts head sideways but can’t sit up Pt may be assisted to side-lying & is assisted to sitting but has head control throughout Pt may be assisted to side-lying & is assisted with lowering LEs off bed to assume sitting. Pt may be assisted to side-lying but is able to sit up without help. Pt able to move from supine to sitting without help. Pt able to move from supine to sitting without help in 10 seconds. Balance Sitting Pt is assisted to sitting and needs support to remain sitting. Pt sits unsupported for 10 seconds with arms folded, knees and feet together & feet on the floor. Pt sits unsupported with weight shifted forward and evenly distributed over both hips / legs. Head and thoracic spine extended. Sits unsupported with feet together on the floor. Hands resting on thighs. Without moving the legs the patient turns the head and trunk to look behind the right and left shoulders. Sits unsupported with feet together on the floor. Without allowing the legs or feet to move & without holding on the patient must reach forward to touch the floor (10 cm or 4 inches in front of them) The affected arm may be supported if necessary. Sits on stool unsupported with feet on the floor. Pt reaches sideways without moving the legs or holding on and returns to sitting position. Support affected arm if needed. Sitting to Standing Pt assisted to standing – any method Pt assisted to standing. The patient’s weight is unevenly distributed & may use hands for support. Pt stands up. The patient’s weight is evenly distributed but hips and knees are flexed – No use of hands for support. Pt stands up. Remains standing for 5 seconds with hips and knees extended with weight evenly distributed. Pt stands up and sits down again. When standing hips & knees are extended with weight evenly distributed. Pt stands up and sits down again 3 x in 10 seconds with hips & knees extended & weight evenly distributed. Upper Arm Function Supine: Therapist places affected arm in 90 degrees shoulder flexion and holds elbow in extension – hand toward ceiling. The patient protracts the affected shoulder actively. Supine: Therapist places affected arm in above position. The patient must maintain the position for 2 seconds with some external rotation and with the elbow in at least 20 degrees of full extension. Supine: Patient assumes above position and brings hand to forehead and extends the arm again. (flexion & extension of elbow) Therapist may assist with supination of forearm. Sitting: Therapist places affected arm in 90 degrees of forward flexion. Patient must hold the affected arm in position for 2 seconds with some shoulder external rotation and forearm supination. No excessive shoulder elevation or pronation. Sitting: Patient lifts affected arm to 90 degrees forward flexion - holds it there for 10 seconds and then lowers it with some shoulder external rotation and forearm supination. No pronation. Standing: Have patient’s affected arm abducted to 90 degrees with palm flat against wall. Patient must maintain arm position while turning body toward the wall.
Date
Date
Date
95
6.
7.
Hand Movements Pt assisted to standing – any method. Sitting at a table (Wrist Extension): Affected forearm resting on table. Place cylindrical object in palm of patient’s hand. Patient asked to lift object off table by extending the wrist – no elbow flexion allowed. Sitting at a table (Radial Deviation of Wrist): Therapist should place forearm with ulnar side on table in mid-pronation / supination position. Thumb in line with forearm and wrist in extension. Fingers around cylindrical object. Patient is asked to lift hand off table. No wrist flexion or extension. Sitting (Pronation / Supination): Affected arm on table with elbow unsupported at side. Patient asked to supinate and pronate forearm (¾ range acceptable). Place a 5 inch ball on the table so that the patient has to reach forward with arms extended to reach it. Have the patient reach forward with shoulders protracted, elbows extended, wrist in neutral or extended, pick up the ball with both hands and put it back down in the same spot. Have the patient pick up a polystyrene cup with their affected hand and put it on the table on the other side of their body without any alteration to the cup. Continuous opposition of thumb to each finger 14 x in 10 seconds. Each finger in turn taps the thumb, starting with the index finger. Do not allow thumb to slide from one finger to the other or go backwards. Advanced Hand Activities
1
Have the patient reach forward to pick up the top of a pen with their affected hand, bring the affected arm back to their side and put the pen cap down in front of them.
1 2 3 4 5 6
2 3 4 5 6
8.
Place 8 jellybeans, (beans), in a teacup an arms length away on the affected side. Place another teacup an arms length away on the intact side. Have the patient pick up one jellybean with their affected hand and place the jellybean in the cup on the intact side. Sitting (Pronation / Supination): Affected arm on table with elbow unsupported at side. Patient asked to supinate and pronate forearm (¾ range acceptable). Have the patient pick up a pen/pencil with their affected hand, hold the pen as for writing, and position it without assistanceand make rapid consecutive dots (not strokes) on a sheet of paper. Goal: at least 2 dots a second for 5 seconds. Have the patient take a dessert spoon of liquid to their mouth with their affected hand without lowering the head toward the spoon or spilling. Have the patient hold a comb and comb the back of their head with the affected arm in abduction and external rotation, forearm in supination. Walking
1
With assistance the patient stands on affected leg with the affected weight bearing hip extended and steps forward with the intact leg.
2
Walks with the assistance of one person.
3
Walks 10 feet or 3 meters without assistance but with an assistive device.
4
Walks 16 feet or 5 meters without a device or assistance in 15 seconds.
5
Walks 33 feet or 10 meters without assistance or a device. Is able to pick up a small object from the floor with either hand and walk back in 25 seconds.
6
Walks up and down 4 steps with or without a device but without holding on to a rail 3 x in 35 seconds.
1
TONUS Flaccid, limp, no resistance when body parts are handled.
2
Some resistance felt as body parts are moved.
3
Variable, sometimes flaccid, sometimes good tone, sometimes hypertonic.
4
Hypertonic 50% of the time
5
Hypertonic all of the time
6
Consistently normal response Total score:
Sign & cop physiotherapist:
5.4 ASIA SCALE
96
SOURCE AIMS SCORING INSTRUCTION
Impairment scale describes a person’s functional impairment as a result of their spinal cord injury. i TOOL : a. ASIA scale sheet
ii
INTERPRETATION OF SCORE
PROCEDURE: a. Determine sensory levels for right and left sides. b. Determine motor levels for right and left sides. c. Determine the single neurological level. d. Determine whether the injury is Complete or Incomplete e. Determine ASIA Impairment Scale Grade
The ASIA impairment scale describes a person’s functional impairment as a result of their spinal cord injury. A- Complete No motor or sensory function in the lowest sacral segment (S4-S5) B- Incomplete Sensory function below neurologic level and in S4-S5, no motor function below neurologic level C- Incomplete Motor function is preserved below neurologic level and more than half of the key muscle groups below neurologic level have a muscle grade less than 3. D- Incomplete Motor function is preserved below neurologic level and at least half of the key muscle groups below neurologic level have a muscle grade 3. E- Normal Sensory and motor function is normal
97
See ASIA Scale PDF version
5.6 NO 1
DISABILITY ARM, SHOULDER & HAND SCORE (DASH)
SOURCEITEM
CRITERIA
TEST 1
TEST 2
TEST 3
Pain & discomfort
AIMS 1.1 During nocturnal bedrest SCORING 1.2 Morning INSTRUCTION
Self-report questionnaire designed to measure physical function and None or insignificant symptoms in people with any of several musculoskeletal disorders of on movement or in certain theOnly upper limb. i
positions With no movement
TOOL
1 min or less
: DASH questionnaire
stiffness or PROCEDURE : Complete regressive painii More than 1 but less than 15 min after rising 15 min or more INTERPRETATION
OFAfter SCORE standing for 30 min 1.4 While ambulating
None
the questionnaire
DASH DISABILITY/ SYMPTOM SCORE = [ (Sum of n response) - 1 ] x 2 n
ambulating someofdistance * Only n is after equal to number completed responses ** DASH score may not be calculated if there are greater than 3 Early after initial ambulation and increase continue ambulation missingwith items After initial ambulation, not increase
INTERPRETATION While getting up from sitting without help of arms 2
Walking distance Maximum distance walked (may walk with pain)
OF DASH DISABILITY/ SYMPTOM SCORE
Percentage Score 80% - 100%
Unlimited
60% - 79% 40% - 59%
More than 1 km, but limited About 1 km (≥ 0.6 m) in about 15 min
20% - 30% 0% - 19%
From 500 to 900 m in about 8 to 15 min From 300 to 500 m
Level of Disabilities Extreme Disabilities Severe Disabilities Moderate Disabilities Mild Disabilities No Disabilities
*** Discharged at mild or no disabilities
From 100 to 300 m Less than 100 m
FISIOTERAPI With one walkingUNIT stick or crutch
HOSPITAL ______________________
NAME 3
With 2 walking sticks or crutches IC _______________________________ Physical function NUMBER
R/N
______________________ 3.1 Able to climb up a standardAGE: flight_______ of stairs 3.2 Able to climb down a standard flight of stairs
__________________________ _ DIAGNOSIS __________________________ _ 98
3.3 Able to squat or bend on the knees ALGOFUNCTION 3.4 Able to walk on uneven ground
SCALE
UNIT FISIOTERAPI HOSPITAL ______________________ NAME
_______________________________
IC NUMBER
R/N
______________________
DIAGNOSIS
AGE: _________
________________________
DISABILITY ARM, SHOULDER & HAND SCORE (DASH) Please rate your ability to do the following activities in the last week by circling the number below the appropriate response. 1 – No Difficulty 3 – Moderate Difficulty
2 – Mild Difficulty 4 – Severe Difficulty
5 – Unable
99
No
Date
Activities
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Open a tight or new jar. Write. Turn a key. Prepare a meal. Push open a heavy door. Place an object on a shelf above your head. Do heavy household chores (e.g., wash walls, wash floors). Garden or do yard work. Make a bed. Carry a shopping bag or briefcase. Carry a heavy object (over 10 lbs).
12. 13. 14. 15. 16. 17.
Change a lightbulb overhead. Wash or blow dry your hair. Wash your back. Put on a pullover sweater. Use a knife to cut food. Recreational activities which require little effort (e.g., card playing, knitting, etc.). Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.). Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.). Manage transportation needs (getting from one place to another). Sexual activities.
18. 19. 20. 21.
Please rate your ability to do the following activities in the last week by circling the number below the appropriate response. 1 – Not at all
2 – Slightly
3 – Moderate
4 – Quite a bit
No
Activities
1.
During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups?
5 – Extremely Date
Please rate your ability to do the following activities in the last week by circling the number below the appropriate response. 1 – Not limited at all 4 – Very limited No 2.
2 – Slightly limited 5 – Unable
3 – Moderate limited
Activities
Date
During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? 100
Please rate the severity of the following symptoms in the last week. 1 – None
2 – Mild
3 – Moderate
4 – Severe
No
Activities
3. 4. 5. 6. 7.
Arm, shoulder or hand pain. Arm, shoulder or hand pain when you performed any specific activity. Tingling (pins and needles) in your arm, shoulder or hand. Weakness in your arm, shoulder or hand. Stiffness in your arm, shoulder or hand.
5 – Extreme Date
Please rate your ability to do the following activities in the last week by circling the number below the appropriate response. 1 – No Difficulty 3 – Moderate Difficulty
2 – Mild Difficulty 4 – Severe Difficulty
No 8.
5 – Unable
Activities
Date
During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand?
Please rate your feelings in the last week by circling the number below the appropriate response. 1 – Strongly disagree 2 – Disagree 3 – Neither agree nor disagree 4 – Agree 5 – Strongly agree No 9.
Activities
Date
I feel less capable, less confident or less useful because of my arm, shoulder or hand problem. TOTAL SCORE
5.7
NECK DISABILITY INDEX (NDI) SOURCE
AIMS
Vernon H. and Hagino C., 1987. Vernon H, Mior S. The Neck Disability Index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics 1991; 14:409-415. Copied with permission of the authors. Measures the disability status of the neck.
SCORING INSTRUCTION
1. Each of the 10 sections is scored separately (0 to 5 points each) and then added up (max. Total = 50). EXAMPLE: Section 1. Pain Intensity Point Value A. ______ I have no pain at the moment 0 B. ______ The pain is very mild at the moment 1 C. ______ The pain is moderate at the moment 2 D. ______ The pain is fairly severe at the moment 3
101
E. ______ The pain is very severe at the moment 4 F. ______ The pain is the worst imaginable 5
2. If all 10 sections are completed, simply double the patients score. 3. If a section is omitted, divide the patient’s total score by the number of sections completed times 5. FORMULA: DISABILITY
PATIENT’S SCORE
X 100 =
________ %
# OF SECTIONS COMPLETED X 5 EXAMPLE: If 9 of 10 sections are completed, divide the patient’s score by 9 X 5 = 45; if…….. Patient’s Score: 22 Number of sections completed: 9 (9 X 5 = 45) 22/45 X 100 = 48 % disability
INTERPRETATION OF SCORE
0-4 5 – 14 15 - 24 25 – 34 above 34
= No disability = Mild = Moderate = Severe = Complete
UNIT FISIOTERAPI HOSPITAL ______________________ NAME R/N
_______________________________ _____________________ AGE :_________
IC NUMBER DIAGNOSIS
________________________ _________________________
NECK DISABILITY INDEX (NDI) THIS QUESTIONNAIRE IS DESIGNED TO HELP US BETTER UNDERSTAND HOW YOUR NECK PAIN AFFECTS YOUR ABILITY TO MANAGE EVERYDAY - LIFE ACTIVITIES. PLEASE MARK IN EACH SECTION THE ONE BOX THAT APPLIES TO YOU. ALTHOUGH YOU MAY CONSIDER THAT TWO OF THE STATEMENTS IN ANY ONE SECTION RELATE TO YOU, PLEASE MARK THE BOX THAT MOST CLOSELY DESCRIBES YOUR PRESENT -DAY SITUATION. Each of the 10 sections is scored separately – 0 to 5 points each .
SECTION 1
Date PAIN INTENSITY I have no pain at the moment. The pain is very mild at the moment. The pain is moderate at the moment. The pain is fairly severe at the moment. The pain is very severe at the moment. The pain is the worst imaginable at the moment. 102
2
3
4
PERSONAL CARE I can look after myself normally without causing extra pain. I can look after myself normally, but it causes extra pain. It is painful to look after myself, and I am slow and careful. I need some help but manage most of my personal care. I need help every day in most aspects of self -care. I do not get dressed. I wash with difficulty and stay in bed. LIFTING I can lift heavy weights without causing extra pain. I can lift heavy weights, but it gives me extra pain. Pain prevents me from lifting heavy weights off the floor but I can manage if items are conveniently positioned, ie. on a table. Pain prevents me from lifting heavy weights, but I can manage light weights if they are conveniently positioned. I can lift only very light weights. I cannot lift or carry anything at all. WORK I can do as much work as I want. I can only do my usual work, but no more. I can do most of my usual work, but no more. I can't do my usual work. I can hardly do any work at all. I can't do any work at a
103
SECTION
Date
5
HEADACHES I have no headaches at all. I have slight headaches that come infrequently. I have moderate headaches that come infrequently. I have moderate headaches that come frequently. I have severe headaches that come frequently. I have headaches almost all the time.
6
CONCENTRATION I can concentrate fully without difficulty. I can concentrate fully with slight difficulty. I have a fair degree of difficulty concentrating. I have a lot of difficulty concentrating. I have a great deal of difficulty concentrating. I can't concentrate at all.
7
SLEEPING I have no trouble sleeping. My sleep is slightly disturbed for less than 1 hour. My sleep is mildly disturbed for up to 1-2 hours. My sleep is moderately disturbed for up to 2-3 hours. My sleep is greatly disturbed for up to 3-5 hours. My sleep is completely disturbed for up to 5-7 hours.
8
DRIVING I can drive my car without neck pain. I can drive as long as I want with slight neck pain. I can drive as long as I want with moderate neck pain. I can't drive as long as I want because of moderate neck pain. I can hardly drive at all because of severe neck pain. I can't drive my care at all because of neck pain.
9
READING I can read as much as I want with no neck pain. I can read as much as I want with slight neck pain. I can read as much as I want with moderate neck pain. I can't read as much as I want because of moderate neck pain. I can't read as much as I want because of severe neck pain. I can't read at all.
10
RECREATION I have no neck pain during all recreational activities. I have some neck pain with all recreational activities. I have some neck pain with a few recreational activities. I have neck pain with most recreational activities. I can hardly do recreational activities due to neck pain. 104
I can't do any recreational activities due to neck pain. SCORE 5.8
REVISED OSWESTRY DISABLITY INDEX (RODI) SOURCE
Fritz JM, Irrgang JJ. A Comparison of a Modified Oswestry Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther 2001; 81:776-788.
AIMS
The ODI is a disease-specific disability measure is used to establish a level of disability, stage a patient’s acuity status1, and monitor change over time.
SCORING INSTRUCTION
i. i
TOOL : Modified Oswestry Low Back Pain Disability Questionnaire (ODI)
PROCEDURE a. The ODI is made up of 10 questions. Each question is scored from 0-5 (minimum to maximum). b. The point total from each section is summed and the then divided by the total number of questions answered and multiplied by 100 to create a percentage disability. The scores range from 0-100% with lower scores meaning less disability. ODI = (Sum of items scored/Sum of sections answered) X 100 c. Typically all items are filled out so you can just add up the score from each section and double it to get the final percentage score.
INTERPRETATION OF SCORE
105
UNIT FISIOTERAPI HOSPITAL ______________________ NAME R/N
______________________________ ___________________
AGE:__________
IC NUMBER DIAGNOSIS
________________________ ________________________
REVISED OSWESTRY DISABLITY INDEX (RODI) ARAHAN : Tandakan ( √ ) dalam kotak kosong di bawah mengikut skala 0 – 5. Scale No 1
2
Activity Pain Intensity
Personal Care (washing, dressing etc)
0
The pain is mild and comes and goes.
1
The pain is mild and does not vary much.
2
The pain is moderate and comes and goes.
3
The pain is moderate and does not vary much.
4
The pain is severe and comes and goes.
5
The pain is severe and does not vary much.
0
I do not have to change the way I wash and dress myself to avoid pain. I do not normally change the way I wash or dress myself even though it causes some pain. Washing and dressing increases my pain, but I can do it without changing my way of doing it. Washing and dressing increases my pain, and I find it necessary to change the way I do it. Because of my pain I am partially unable to wash and dress without help. Because of my pain I am completely unable to wash or dress without help. I can lift heavy weights without increased pain.
1 2 3 4 5 0
3
Lifting
1
4
I can lift heavy weights but it causes increased pain. Pain prevents me from lifting heavy weights off of the floor, but I can manage if they are conveniently positioned (ex. on a table, etc.). Pain prevents me from lifting heavy weights off of the floor, but I can manage light to medium weights if they are conveniently positioned. I can lift only very light weights.
5
I can not lift or carry anything at all.
2 3
Date
Date
Date
106
No 4
Scale
Activity Walking
0 1 2 3
5
Sitting
5 0
Sitting does not cause me any pain.
1
I can only sit as long as I like providing that I have my choice of seating surfaces. Pain prevents me from sitting for more than 1 hour. Pain prevents me from sitting for more than 1/2 hour. Pain prevents me from sitting for more than 10 minutes. Pain prevents me from sitting at all.
2 3 4 5 6
Standing
0 1 2 3 4 5
7
Sleeping
0 1 2 3 4 5
No 8
Date
Date
Date
I can stand as long as I want without increased pain. I can stand as long as I want but my pain increases with time. Pain prevents me from standing more than 1 hour. Pain prevents me from standing more than 1/2 hour. Pain prevents me from standing more than 10 minutes. I avoid standing because it increases my pain right away. I get no pain when I am in bed. I get pain in bed, but it does not prevent me from sleeping well. Because of my pain, my sleep is only 3/4 of my normal amount. Because of my pain, my sleep is only 1/2 of my normal amount. Because of my pain, my sleep is only 1/4 of my normal amount. Pain prevents me from sleeping at all.
Scale
Activity Social life
Date
I have no pain when walking. I have pain when walking, but I can still walk my required normal distances. Pain prevents me from walking long distances. Pain prevents me from walking intermediate distances. Pain prevents me from walking even short distances. Pain prevents me from walking at all.
4
Date
0
Date
My social life is normal and does not increase my pain. 107
1 2
My social life is normal, but it increases my level of pain. Pain prevents me from participating in more energetic activities (ex. sports, dancing, etc.) Pain prevents me from going out very often.
3 2012
9
Travelling
4
Pain has restricted my social life to my home.
5
I have hardly any social life because of my pain. I get no increased pain when traveling.
0 1 2 3 4 5
10
Employment/ 0 Housemaking 1 2
3 4 5
I get some pain while traveling, but none of my usual forms of travel make it any worse. I get increased pain while traveling, but it does not cause me to seek alternative forms of travel. I get increased pain while traveling which causes me to seek alternative forms of travel. My pain restricts all forms of travel except that which is done while I am lying down. My pain restricts all forms of travel. My normal job/homemaking activities do not cause pain. My normal job/homemaking activities increase my pain, but I can still perform all that is required of me. I can perform most of my job/homemaking duties, but pain prevents me from performing more physically stressful activities (ex. lifting, vacuuming) Pain prevents me from doing anything but light duties. Pain prevents me from doing even light duties. Pain prevents me from performing any job or homemaking chores.
GARIS PANDUAN PENGUMPULAN STATISTIK TOTAL SCORE
108
GARIS PANDUAN PENGUMPULAN STATISTIK 1.Pengenalan 109
Statistik adalah sebuah fakta atau sekumpulan data yang terdapat daripada sesuatu kajian yang diterjemah di dalam bentuk nilai berangka. Dalam sesebuah organisasi pengumpulan statistik adalah sangat penting. Ini akan memudahkan bagi mendapat output sebenar dan menganalisanya mengikut kehendak dan keperluan sesebuah organisasi itu sendiri berdasarkan produk dan matlamatnya. 2. Objektif Mengetahui beban kerja seseorang JPA Mengetahui beban dan skop sesebuah unit Menentukan keperluan modal insan Menentukan keperluan peralatan Menentukan keperluan kewangan / Program agreement Menentukan latihan yang diperlukan Menentukan Plan Of Action tahunan. Menetapkan Sasaran Kerja Tahunan 3. Keperluan material untuk mengumpul statistik Senarai pendaftaran harian pesakit Senarai rawatan harian pesakit (boleh didapati dari rekod harian pesakit) Borang-borang pengumpulan dari Sistem Maklumat Rawatan Perubatan (disenaraikan) - PER-06-0203B (Pindaan 2011) - PER-SS-203 (Pindaan 1/2003) Komputer (terutama bagi hospital yang berasaskan IT) 4. Proses untuk mengumpul statistic a) Statistik harian (Ini perlu di buat setiap hari) - Semak senarai pesakit untuk satu hari - Semak diagnosis pesakit dan punca rujukan (ini adalah untuk menentukan disiplinnya) - Semak jenis ujian / rawatan / modality yang dilaksanakan - Isi ke dalam rawatan harian pesakit. b) Statistik Bulanan - Kumpulkan data-data dari statistik harian - Asingkan mengikut disiplin, pesakit luar dan pesakit dalam - Isi borang PER-06-0203B (pindaan 2011) dan PER-SS-203 (Pindaan 1/2003) - Hantarkan borang PER-SS-203 (Pindaan 1/2003) yang telah lengkap di isi ke bahagian Rekod Perubatan sebelum atau pada 5 haribulan pada bulan berikutnya. c) Statistik Tahunan Ini dikumpul daripada statistik bulanan - Buat analisa dengan menggunakan graf – sebagai garis panduan untuk membuat plan of action tahun seterusnya. - Buat variance – sebagai garis panduan untuk menyediakan Program Agreement Tahunan KAEDAH PENGUMPULAN STATISTIK Jumlah Pesakit: 110
a) Pesakit baru - Dikira berdasarkan jumlah pesakit yang pertama kali mendapat rawatan fisioterapi. *** Pesakit yang dirujuk semula setelah ianya discaj dari rawatan fisioterapi dan pesakit yang ‘seen & off’ adalah dikira sebagai pesakit baru. b) Pesakit ulangan - Dikira daripada jumlah pesakit yang mendapat rawatan fisioterapi pada kali kedua dan seterusnya. *** Pesakit dalam yang dirawat lebih daripada 1 kali sehari adalah dikira sebagai 1 orang pesakit sahaja. c) Jumlah Rawatan - adalah di kira daripada jumlah setiap rawatan yang diberi pada pesakit. - Sekiranya sesuatu rawatan di beri 2 kali dalam satu hari bagi seorang pesakit maka ianya hendaklah didarab dengan 2. Kalau diberi 3 kali maka hendaklah didarab dengan 3 dan seterusnya. (Sila rujuk borang PER-SS-203) Kiraan mengikut disiplin a) Hospital yang mempunyai kepakaran (Tertiary Hospital) - Kiraan disiplin pesakit adalah mengikut punca rujukan (disiplin yang merujuk). b) Hospital yang tiada kepakaran atau cuma mempunyai kepakaran yang asas (Secondary hospital). Kiraan disiplin adalah mengikut kategori kes pada peringkat hospital yang mempunyai kepakaran Contoh; Kes yang dikategorikan di bawah perubatan am di peringkat tertiari e.g. Kes bronchial asthma akan dikategorikan di bawah di disiplin perubatan am. Kes yang dikategorikan di bawah Ortopedik di peringkat tertiari e.g. Kes fraktur akan dikategorikan dibawah di disiplin Ortopedik . Kes yang dikategorikan di bawah neurologi di peringkat tertiari e.g. Kes strok akan dikategorikan dibawah disiplin neurologi dan seterusnya c) Klinik kesihatan - Disiplin bagi kes yang dirujuk dari adalah mengikut punca rujukan - Semua kes yang dirujuk dari Jabatan Pesakit Luar adalah dikategorikan di bawah Jabatan Pesakit Luar / Klinik Kesihatan Nota: Sekiranya ada masalah dalam hal pengumpulan statistik ini sila hubungi Ketua Perkhidmatan Fisioterapi di peringkat negeri masing-masing.
Arahan untuk mengisi Borang Laporan PER-SS-203 (Pin 1/2003)
111
Angka (1 – 7) yang tercatit di bawah adalah merujuk kepada angka yang ditunjuk pada setiap column pada borang PER-SS-203 (Pin 1/2003).
112
1
Disiplin
Berdasarkan disiplin
pesakit itu dirujuk tetapi bukan berdasarkan
kondisinya. Contohnya; jika kes strok dirujuk dari perubatan am ianya harus diletakkan di bawah perubatan am bukan neurologi. Bagi hospital yang tidak mempunyai pakar ianya harus diletakkan dibawah perubatan 2
3
4
Bilangan Perawatan
am. Catatkan
– Pesakit dalam
sebulan / setahun bagi disiplin yang berkenaan.
Number of treatment
Jumlah ini boleh didapati daripada laporan di dalam borang PER-06-
in patient
0203B
Bilangan Perawatan
Catatkan jumlah perawatan yang diberi kepada pesakit luar untuk
– Pesakit Luar
sebulan / setahun bagi disiplin yang berkenaan.
Number of treatment
Jumlah ini boleh didapati daripada laporan di dalam borang PER-06-
out patient
0203B
Bilangan Perawatan
Catatkan bilangan perawatan yang diberi kepada pesakit dalam dan luar
– Jumlah
untuk sebulan / setahun iaitu ( 2 + 3)
jumlah perawatan yang diberi kepada pesakit dalam
Number of treatment - Total 5
Bilangan Pesakit –
Catatkan bilangan pesakit dalam yang dirawat oleh Ahli Fisioterapi
Pesakit dalam
untuk sebulan / setahun mengikut disiplin yang berkenaan. Nota:
Number of patients - In patient
i)
Seorang pesakit dalam mungkin diberi rawatan lebih daripada satu kali dalam sehari. Ianya tetap dikira sebagai seorang pesakit.
ii) Seorang pesakit dalam yang diberi rawatan fisioterapi berterusan lebih daripada sehari akan dikira untuk setiap hari dia menerima rawatan.Begitu juga kalau pesakit tersebut dipindahkan ke wad lain, kiraannya masih diteruskan. Contoh: Jika seorang pesakit duduk di ICU diberi senaman pernafasan sebanyak 3 kali sehari selama 4 hari. Ianya hendaklah dikira sebagai 4 pesakit dan 12 rawatan. Selepas itu dia ditukarkan ke Wad 9 dan berada di wad tersebut selama 2 hari dan menerima rawatan
senaman
pernafasan
1
kali
sehari
jadi
pada
keseluruhannya ianya dikira sebagai 6 pesakit dan 14 rawatan.
113 6
Bilangan Pesakit –
Catatkan disini jumlah pesakit luar yang dirawat oleh Ahli Fisioterapi
Garis Panduan Am -Borang Laporan PER-06-0203B 1. Tujuan borang laporan ini adalah untuk mengumpul data rawatan dan ujian fisioterapi bagi setiap modaliti yang diberi dalam sebulan / setahun. 2. Sumber data untuk melengkapkan borang ini adalah rekod-rekod harian pesakit. 3. Ahli Fisioterapi yang memberi rawatan / mendokumentasi rawatan adalah bertanggungjawab untuk melengkapkan borang ini. 4. Ahli Fisioterapi berkenaan akan menyerahkan borang PER-SS-203 yang telah lengkapkan diisi kepada pegawai yang bertanggungjawab bagi mengumpul statistik pada akhir bulan tersebut.
1.1.Arahan untuk mengisi Borang PER-06-0203B 1.1.1. Modaliti dan Ujian Modaliti Rawatan
Kaedah rawatan Fisioterapi yang digunapakai untuk merawat pesakit
Bilangan modaliti
Bilangan kekerapan sesuatu modaliti itu digunakan
rawatan Modaliti Ujian
Ujian-ujian yang dilaksanakan oleh Ahli Fisioterapi bagi menentukan masalah pesakit.
Jumlah Kecil
Bilangan kesemua modaliti rawatan pada jadual di sebelah kiri (A) atau kanan (B) borang.
Jumlah besar
Bilangan kesemua modaliti rawatan A + B. Bilangan ini akan dimasukan ke dalam borang PER –SS-203
114
1.2.Data Statistik 2 3 4
Disiplin Bilangan Rawatan Bilangan Pesakit
Punca disiplin yang merujuk kes berkenaan Jumlah unit modaliti rawatan dari satu-satu disiplin Bilangan pesakit yang pertama kali dirawat di Unit
baru
Fisioterapi dalam satu-satu episod rujukan. Jika seseorang pesakit yang telah sembuh dan ditamatkan rawatan fisioterapi, dirujuk semula oleh doktor untuk rawatan fisioterapi bagi episod yang baru, maka ianya dikategorikan sebagai pesakit
5
Bilangan Pesakit
baru. Bilangan pesakit yang dirawat berulangkali dalam
6
lama Jumlah pesakit
satu episod rawatan. (4 + 5) di atas Tugas gantian - Tugas yang diambil alih dari pegawai
7 8
Catatan Beban kerja individu
yang bercuti atau yang bertugas di luar ibu pejabat. Catitkan sekiranya ada keterangan lanjut. Asingkan kerja-kerja (wad/kawasan), hakiki
& tugas gantian
seseorang
Ahli
Fisioterapi
daripada
kerja-kerja
(wad/kawasan) pegawai lain yang diambil alih Nota: Hanya borang PER-SS-203 sahaja akan dihantar ke bahagian rekod perubatan di hospital masing-masing. Borang-borang lain adalah untuk kegunaan di peringkat unit sendiri. Sekiranya ada masalah dalam hal pengumpulan statistik ini sila hubungi Ketua Perkhidmatan Fisioterapi di peringkat negeri masing-masing.
SISTEM MAKLUMAT PENGURUSAN KESIHATAN KEMENTERIAN KESIHATAN MALAYSIA LAPORAN BULANAN / TAHUNAN RAWATAN MENGIKUT DISIPLIN BAGI BULAN ………………. TAHUN………… HOSPITAL :
PER-SS-2033 (Pindaan
115
NEGERI
: BILANGAN RAWATAN PESAKIT PESAKIT JUMLAH DALAM LUAR
DISIPLIN
1
2
3
4
BILANGAN PESAKIT PESAKIT PESAKIT JUMLAH DALAM LUAR
5
6
7
PERUBATAN AM PAEDIATRIK DERMATOLOGI PERUBATAN RESPIRATORI PSIKIATRI PEMBEDAHAN AM ORTOPEDIK OTOLARYNGOLOGI OFTALMOLOGI GINEKOLOGI OBSTETRIK RADIOTERAPI & ONKOLOGI NEUROLOGI NEUROSURGERI NEFROLOGI UROLOGI KARDIOLOGI KARDIOTHORASIK PEMBEDAHAN PLASTIK & REKONSTRUKTIF PERGIGIAN PEMBEDAHAN TANGAN MIKRO BIUS (ICU) HEPATOLOGI HEPATHOBILIARI LAIN-LAIN
116
SISTEM MAKLUMAT PENGURUSAN KESIHATAN KEMENTERIAN KESIHATAN MALAYSIA LAPORAN UNIT RAWATAN DAN UJIAN FISIOTERAPI BULAN …………….TAHUN…………… NEGERI
:…………………………….
BIL
MODALITI RAWATAN & UJIAN ELECTROTHERAPY MODALITY (EL) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Shockwave Therapy Real Time Ultrasound Shortwave Diathermy (SWD) Ultrasound Therapy (US) Interferrential Therapy Farradic Stimulation (FS) Interrupted Direct Current (IDC) Direct Current Iontoporosis Didynamic Current TENS Functional Electrical Stimulation Laser Therapy Biofeedback Myofeedback Infra Red Therapy (IRR)
CHEST PHYSIOTHERAPY (CP) 1 2 3 4 5 6 7 8 9 10 11
Breathing Exercise Postural Drainage Percussion/Vibration/Shaking Suction Inspiratory Muscle Training Positive Expiratory Pressure Active Cycle Breathing Technique Inhalation Therapy Incentive Spirometer Nebuliser Use of Adjuncts In Respiratory care
MECHANICAL THERAPY (MT) 1 2 3 4
Cervical Traction Lumbar Traction Sequential Pumps(pneumatic) Continous Passive movement
SPECIAL TEST 1 2 3 4 5 6
Strength Duration Curve Voluntary Muscle Testing Computerize / Manual Hand Evaluation Vestibular Test Pelvic Floor Per vaginal / Ano Rectal Assessment Perinometer
HYDROTHERAPY (H) 1 2
Whirlpool Hydrotherapy
THERMAL AGENT (TA) 1 2
Hot Pack Wax Bath
PHOTOTHERAPY (PT) 1
Ultraviolet Light Therapy
JUMLAH KECIL A
BIL UNIT
HOSPITAL :…………………..…………………. BIL
PER-06-0203B (Pindaan 2011)
MODALITY RAWATAN & UJIAN
BIL UNIT
SPECIAL TECHNIQUE (ST) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Joint Mobilisation Mckenzie Technique Neurodevelopmental Therapy Acupressure Icing & Brushing Soft Tissue Manipulation (STM) Sensory Reeducation Special Hand Exercise Regime Bladder / Bowl Training Manual Lymphatic Drainage (MLD) Manag’t of Pelvic Floor Dysfunction Using Adjunct Special Protocol for Orthopaedic Conditions Lumbar / Cervical Stabilisation Cognitive Behavioural Therapy (CBT) Muscle Energy Technique (MET) Proprioceptive Neuromuscular Fasilitation Vestibular Rehabilitation
THERAPEUTIC EXERCISE (TE) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Active, Passive, Resisted Exercise Group Exercise Mechanical Exercise Ambulation Gait Analysis / Training Isokinetic Treadmill Pelvic Floor Muscle Exercise Counter Bracing Technique Ante and Post Natal exercise Relaxation Technique Circuit Training Therapeutic Ball Exercise Functional Activities Balance Training Suspension Therapy
CRYOTHERAPY (CRT) 1 Cryotherapy 2 Ice Pack BANDAGING (B) 1 Supportive 2 Compression STRAPPING (S) 1 Taping EDUCATION (ED) 1 Patient education LAIN-LAIN 1 2 JUMLAH KECIL B JUMLAH BESAR (A+B)
Nama Pegawai Bertugas……………………………………
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PROGRAM MENTORING FISIOTERAPI
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PROGRAM MENTORING FISIOTERAPI
1PENGENALAN Program mentoring adalah perhubungan profesional di antara mentor dan mentee, di mana persetujuan bersama dalam tujuan mencapai ekspetasi berorientasikan klinikal dan berfokuskan kepada kerjaya. Mentor berperanan sebagai ‘role model’, yang mempunyai kemahiran atau pengalaman, menjalankan khidmat nasihat, sokongan dan bimbingan untuk merangsang pembelajaran dan pembangunan kerjaya terhadap anggota baru serta belum mempunyai pengalaman. Di dalam persekitaran kerja, seseorang mentor memainkan peranan dalam peningkatan laluan kerjaya seseorang mentee dengan menyediakan sokongan kerjaya, khidmat nasihat kerjaya dan sebagai perantara untuk perhubungan di dalam sesuatu organisasi. Mengikut beberapa kajian proses mentoring telah terbukti memberi banyak manfaat kepada organisasi secara amnya, dan secara khususnya kepada mentor dan mentee. Antara faedah yang diperolehi adalah berkesan dalam membantu graduan baru membangun dan memperkasa profesyen, melalui pembelajaran interaktif, komunikasi terbuka dan maklum balas segera. Secara tidak langsung ia mengurangkan tekanan kepada mentee.
2 OBJEKTIF PROGRAM MENTORING FISIOTERAPI i. Menyediakan Ahli Fisioterapi yang kompeten dengan memastikan pengamalan kemahiran yang selamat , beretika dan bertanggungjawab. ii. Mengelakkan pengamal Fisioterapi berhadapan risiko mediko undang-undang. iii. Meningkatkan kemahiran mentee dari segi konseptual, teknikal dan interpersonal dalam melaksanakan perawatan Fisioterapi iv. Memudahkan mentee dalam peralihan mereka untuk menjadi seorang pengamal yang baik dan berfungsi secara efektif sebagai Ahli Fisioterapi
3
DEFINISI
MENTOR Seseorang yang membantu graduan baru Fisioterapi melalui galakan, nasihat dan memberi maklumbalas diatas setiap tindakkan dalam suasana kerjaya . Menunjukkan minat dalam pembangunan kerjaya dan memberi pengalaman kepada graduan baru Fisioterapi membuat keputusan bagi tujuan mencapai matlamat graduan. Seseorang yang berkelayakan dan berpengalaman serta mempunyai pengetahuan dan kemahiran yang luas, serta mempunyai sikap yang baik. MENTEE Merujuk kepada seseorang graduan baru yang memerlukan bantuan dan bimbingan dalam hubungan mentoring professional .
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4 TEMPOH MASA PROGRAM Tempoh program mentoring dijalankan adalah selama 6 bulan.
5
KRITERIA PEMILIHAN MENTOR
MENTOR i. ii.
Anggota yang mempunyai laporan prestasi yang memuaskan.
iii.
Berdedikasi dan berminat untuk menjadi mentor .
iv.
Mempunyai sikap yang positif dan berkredibiliti.
v.
Mempunyai ciri-ciri sebagai role model.
vi.
Menunjukkan keyakinan dan commitment serta mempunyai sikap terhadap pembelajaran berterusan.
vii.
Mempunyai accountability dan integriti
viii.
Boleh menyampaikan ilmu dengan jelas serta berkesan.
ix.
6
Ahli Fisioterapi yang berkelayakan dan berdaftar serta telah menjalani latihan mentoring.
Mempunyai emotional quotient yang tinggi
TERMA RUJUKAN MENTOR i. Menguruskan jadual untuk program mentor. ii. Merancang peruntukan perbelanjaan, dan tenaga kerja untuk mentoring iii. Menyediakan proses kerja dan pelan tindakan program mentoring. iv. Memberi orientasi kepada Mentee sebelum menjalankan tugas mentoring serta memberi khidmat nasihat v. Melakukan penilaian ke atas Mentee berpandukan buku log yang disediakan dan memberi maklumbalas prestasi Mentee vi. Merekod dan menyimpan laporan klinikal mentee dan data berkenaan program mentoring vii. Melakukan penilaian semula dan membuat penambahbaikan ke atas program
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7
PERANAN MENTEE i. Graduan baru dalam Program Fisioterapi dari kolej/universiti yang diiktifaf. ii.Menunjukkan minat serta bertanggungjawab dalam pembangunan kerjaya mereka. ii. Bersikap terbuka dalam menerima pendapat. iii. Bersedia untuk menyahut cabaran dengan melakukan semua tugasan yang diberikan. iv. Berfikiran positif dalam setiap perubahan dan perkembangan. v. Boleh mensasarkan matlamat dan tujuan mereka dalam profesyen ini. vi. Memberi tumpuan ke atas segala isu yang berkaitan kerjaya mereka. vi. Sentiasa mahu meningkatkan ilmu pengetahuan.
8
KRITERIA PEMILIHAN PENEMPATAN PROGRAM MENTORING
i.
Penempatan Program mentoring dijalankan di semua hospital kerajaan kecuali dalam keadaan hospital yang dipilih tidak dapat menampung keperluan mentoring. Jika situasi ini berlaku penempatan program mentoring boleh dijalankan di hospital swasta yang memenuhi syarat yang ditetapkan.
ii.
Program mentoring dijalankan di unit fisioterapi yang mempunyai tenaga kerja sekurang-kurangnya 2 orang Ahli Fisioterapi di mana seorang daripadanya merupakan Gred U32 ke atas.
iii.
Keutamaan diberi kepada hospital tertiari dan hospital yang mempunyai pakar.
iv.
Nisbah Mentor kepada kepada situasi semasa.
lawatan
Mentee dicadangkan 1: 4 bagaimanapun ia bergantung
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MEKANISMA SISTEM MENTORING i. Taklimat dan orientasi - Mengenai program dan matlamat mentoring - Senarai tugas/ tanggungjawab - Disiplin - Peraturan/ Akta - Organisasi / Unit - Log Book dan lain lain dokumen berkenaan ii. Operational Polisi dan Procedur Unit iii. CPD iv. Performance Appraisal - Pengetahuan dan Kemahiran Klinikal -
Penghasilan Kerja
-
Kualiti Peribadi
-
Kerja berpasukan
v. Laporan Mentoring akan dihantar ke Jawatankuasa Teknikal Fisioterapi Peringkat Kebangsaan yang akan dipanjangkan ke Bahagian Sains Kesihatan Bersekutu, Kementerian Kesihatan Malaysia vi. Clinical Review Meeting vii. Penambahbaikan Program Mentoring
10 LATIHAN UNTUK MENTOR i. Tempoh latihan dijalankan selama 1 minggu ii. Latihan adalah termasuk tatacara penggunaan log book. iii. Memahami cara-cara membuat Performance Appraisal.
11 PROSES KERJA DAN CARTA ALIRAN – PENGENDALIAN LATIHAN FISIOTERAPI KKM Seperti di lampiran 1 dan 2.
12 LOG BOOK Seperti di lampiran 3 dan 4.
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Lampiran I
CARTA ALIRAN PENGENDALIAN LATIHAN FISIOTERAPI LAPOR DIRI
Penempatan di Hospital
PENILAIAN
MEMUASKAN
TIDAK MEMUASKAN
Teguran lisan / bertulis
Mentee isi borang pelanjutan
Kelulusan Jawatankuasa Latihan Program Fisioterapi
Pelanjutan Tempoh Penempatan
Tamat Penempatan Mentee
Lampiran 2
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PROSES KERJA – PENGENDALIAN LATIHAN FISIOTERAPI KKM BIL
1
PROSES KERJA
CATATAN
LAPOR DIRI Terima Surat Tawaran Jawatan berserta dokumendokumen perlantikan daripada calon yang berjaya seperti berikut: a) Surat Setuju Terima Lantikan- SPA 6A. b) Surat Akuan Sumpah c) Surat Akuan Doktor (Am 402 Pindaan 4/87) dan Borang Pengesahan Urine. d) Borang Tapisan Keselamatan Kasar (jika berkaitan).
2.
PEGAWAI YANG MELULUSKAN/ DI RUJUK
PT (Sumber Manusia) JKN
PENEMPATAN DI HOSPITAL-HOSPITAL Penempatan di tempatkan Hospital yang berkenaan -
Penerangan /orientasi diberi oleh Penyelaras Program Mentor. Jadual penempatan dan memberi log book.
3
MENJALANI PROSES MENTORING
4
- Menjalankan Mentoring selama 6 bulan - melengkapkan Log Book dan tugasan PENILAIAN PRESTASI - Melengkapkan borang “Clinical Practice Competency Evaluation Form” Lampiran 1 A)
Penyelaras Program Mentor
PENEMPATAN – TIDAK MEMUASKAN -
B) -
C)
Penyelaras Program Mentor
Terima aduan dari pihak sama ada secara bertulis/lisan daripada Mentor. Bincang dalam Mesyuarat Jawatankuasa Latihan Fisioterapi Penyelaras isi borang Pelanjutan (jika perlu dilanjutkan).Lampiran 2
Penyelaras Program Mentor
PENEMPATAN – MEMUASKAN
Penyelaras ProgramMentor
Pastikan Fisioterapi(Mentee) kembalikan Buku Log yang telah disemak oleh Mentor. Hantar certification of completion of training kepada BSKB, KKM
KKM
PENAMATAN POGRAM Sijil Tamat latihan akan diberikan kepada Mentee
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CONTENT OF LOG BOOK 1. PERSONAL PARTICULARS 2. CONTENTS 3. INTRODUCTION 4. OBJECTIVE OF PHYSIOTHERAPY INTERNSHIP TRAINING 5. GUIDELINES TO USE OF THE LOG BOOK 6. PERFORMANCE APPRAISAL: 6.1- ASSESSMENT OF ATTITUDE AND COMMUNICATION SKILLS 7. CERTIFICATION OF COMPLETION OF TRAINING (2 COPY)
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LOG BOOK
Personal Particulars
1. Name: ...................................................................... 2. I.C. No: .................................................................... 3. Period of Posting: From..............to........................ 4. Duration of Extension(if any):..........................days 5. Name of Supervisor: ............................................... 6. Designation of Supervisor: ............................... 7. Name of Hospital: ..................................................
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GENERAL AIMS AND OBJECTIVES AIMS 1. To provide opportunity for mentee to be a compentent practioner in clinical practice. 2. To facilitate mentee’s professional development through coaching. OBJECTIVE At the end of training period the mentee is expected to 1. Demonstrate profesionalisme and caring attitude in the process of patient care. 2. Equip oneself with adequate skills to perform all related clinical physiotherapy procedure competently and effectively. 3. Become a responsible physiotherapist fulfilling the aspiration of the Ministry of Health as a profesional healthcare provider.
GUIDELINES TO THE USE OF THIS LOG BOOK 1. This log book shall be carried by the mentee at all times to facilitate recording 2. This log book shall be assessed by the supervisor regularly. 3. The mentee is required to submit the log book to Mentor involved at the end of each posting for performance appraisal. A mentee who fails to submit this log book may be subjected to extension. 4. The Mentor will fill the summary report including the overall comment before certifying the Certification of Completion of Training 5. The overall comments and recommendations of each discipline (Form A) will be completed in duplicate and submitted to the mentor not later than 2 weeks after each posting. 6. At the end of the Mentee training period, the mentor shall complete and to be submitted to the BSKB, KKM. 7. A mentee who lost his/her log book shall report to the Mentor for further action to be taken. 8. The mentor shall compile and keep this log book for 5 years.
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MUSCULOSKELETAL LOG BOOK (FOR FRACTURES IMMOBILISED AND POST IMMOBILISED) DATE ACTIVITY 1 Attempt 2 Attempt REMARKS YES / NO YES /NO Date Date IMMOBILISED PHASE Measurement of walking aids : - crutches (axillary , forearm and elbow) - walking frame - walking stick - wheelchair. Teach usage of walking aids - correct method for all mentioned above - safe precautions including - correct gait patterns i) 2 point, 3 point,4 point ii) Swing through and Swing to - stairs climbing correctly with aids, without aids (up and down) - types of weight bearing. i)Non, Partial and full Prescription of exercises for patients - immobile in bed static quads and static glutei strengthening exercises for upper limbs and others non- involved limbs. Circulatory exercises Chest care Positioning Skin care Advice Assessment of limb Limb length measurements - apparent shortening and true shortening Assessment for swelling Assessment for atrophy R.O.M measurements for joints /Goniometry - All joints of upper limbs - All joints of lower limbs Muscle power testing/ Oxford scale - muscles of the upper limbs - muscles of the lower limbs
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ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /No Date
REMARKS
Protocols for - Bundle - TKR surgeries - AMP - THR and other joint replacements - Conservative fractures - Surgical treatment for fractures Transfer skills : With assistance /without assistance - bed to wheel chair - wheel chair to bed - wheelchair to toilet - sit to stand - stand to sit Bed mobility activities : Turn with assistance /without assistance - sit up - roll - pelvic control DATE
ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /NO Date
REMARKS
POST IMMOBILISATION Techniques to reduce swelling Mobilization techniques Exercise Prescription for immobilized limbs PNF Suspension Therapy STM Cryo Therapy Functional Activities 10 RM 1 RM Max
CARDIORESPIRATORY (ADULT) LOG BOOK
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DATE
ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /NO Date
REMARKS
Vital Sign Temp/ PR/ RR/ BP SPo2 ICP CVP ABG reading X-ray reading Identify deformities of chest wall Chest measurement Auscultation Position of patient Placement of stethoscope Interpretation of lung sound Lung Function (Spirometry) Demonstrate the technique Interpretation the result Exercise tolerance 6 / 3 min walk test Interpretation of findings Posture Positioning / relaxation Breathing Exercises Demonstrate eg diaphragmatic, lateral costal, apical Pursed lips breathing ACBT
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DATE
ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /NO Date
REMARKS
Airway clearance Percussion/ vibration Postural Drainage Coughing Huffing Assisted Splinting Suction Technique ETT / oral/ nasal Tracheotomy Thoracic mobility exercises Exercises for upper limb and lower limb Ambulation Patent’s on chest tube Patient’s on portable oxygen Cardiac Rehabilitation Program THR/ MHR Precaution during chest physiotherapy (eg: post surgery)- Viva
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NEUROLOGY (Adult) LOG BOOK DATE
ACTIVITY ASSESSMENT SKILLS
1 Attempt YES / NO Date
2 Attempt YES /NO Date
REMARKS
Measurement of Impairment: Muscle tightness Muscle Tone (using Modified Ashworth Skill) Rigidity ROM Cardiorespiratory Fitness Sensation /Tactile tests Pain Temperature Touch Pressure Proprioception test Streognosis 2 point discrimination Coordination test Rhomber’s sign Balance Reactions Equilibrium reaction Righting reactions Static/Dynamic Functional Reach Step Test Berg Balance Scale Global Measure Of Independence: Functional Independence Measure (FIM) Spinal Cord Independent Measure (SCIM) Tendon reflex Biceps Patella TA
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DATE
ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /NO Date
REMARKS
Measures Of Motor Performance MAS (Motor assessment scale) 6/ 10 meter walk test Timed get up and go test (TUG) Sit to stand test Gait – missing components. Hemiplegia gait Parkinsonian gait Sensory ataxic Cerebellar ataxic High Stepping gait Positioning Upper Limb Lower Limb Respiratory care Maintainance of Musculoskeletal Integrity Sensory training Bed mobility activities - turn with assistance /without assistance - sit up - roll - pelvic control
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DATE
ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /NO Date
REMARKS
Transfer skills With assistance /without assistance - bed to wheel chair - wheel chair to bed - wheelchair to toilet - sit to stand - stand to sit Training of Motor performance Activation of Motor/ Facilitation technique According to motor activity criteria Improve Functional activities related to task (MAS) Balance Training Mat activities Neurodevelopment technique (Bobath) Motor relearning programme PNF Gait training Parallel Bar Walking aids Treadmill External Auditory/ visual stimulation
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Special Target Log book DATE
ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /NO REMARKS Date
WOMEN HEALTH Practical / viva 1. Ante –post natal 2. Incontinence Pelvic Floor Pre Vaginal assessment Perineometer reading Myofeedback Biofeedback Pelvic Floor Educator Vaginal Cone Provocation test SPORT INJURIES Special Test Knee Ankle Management / Protocol on - ACL reconstruction - PCL and PLC reconstruction - Meniscus repair - Tendon repair and transplant - Shoulder Repair
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GERIATRIC DATE
ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /NO Date
REMARKS
Special Test a) b) c) d)
Functional Reach Test Time Up and Go Test Romberg Test Motor Assessment Scale (MAS) e) Berg’s Balance f) Dynamic Gait Index (DGI) g) Modified Clinical Test of Sensory Intergration on Balance (MCTSIB) Conduct Muscle performance tests a) Chair Rise Test b) Arm Curl Test c) Hand Gripping - use Jamar Hand dynamometer/similar equipment Conduct Aerobic capacity Test a) Lung Volume peak expiratory flow rate (PEFR): use peak flow meter and document the force b) 6 minute walk test c) Step test
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PEADIATRIC LOG BOOK DATE
ACTIVITY
1 Attempt YES / NO Date
2 Attempt YES /NO Date
REMARKS
Cardiorespiratory Vital Sign Temp/ PR/ RR/ BP Sao2 ICP CVP ABG reading X-ray reading Identify deformities of chest wall Auscultation Position of patient Placement of stethoscope Interpretation of lung sound Posture Breathing Exercises Airway clearance Percussion/ vibration Postural Drainage Coughing SuctionTechnique- Oral & nasal -ETT -Tracheostomy Precaution during chest physiotherapy (eg post surgery)- Viva Management for neonate Neurology Peadiatric Measurement of Impairment: Muscle tightness Muscle Tone (using Modified Ashworth Skill) Rigidity ROM Cardiorespiratory Fitness Reflexes JAWATANKUASA TEKNIKAL PROFESYEN FISIOTERAPI
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Babinski Moro Tonic neck reflexes ATNR STNR
Gait – missing components. Hemiplegia gait Scissor gait Sensory ataxic Cerebellar ataxic High Stepping gait Gross Motor Functional Movement Positioning Upper Limb Lower Limb Maintainance of Musculoskeletal Integrity Sensory training Bed mobility activities - turn with assistance /without assistance - sit up - roll - pelvic control Training of Motor performance Activation of Motor/ Facilitation technique According to motor activity criteria Balance Training Mat activities Neurodevelopment technique (Bobath) Motor relearning programme
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CHECK LIST OF CONDITIONS FOR EACH MENTEE TO BE EXPOSED.MINIMAL AT LEAST TO SEE 5 PATIENTS OF EACH CONDITIONS IF POSSIBLE Conditions
Number of cases treated
A. Pediatric conditions 1. Cerebral Palsy 2. Torticollis 3. CTEV 4. Congenital dislocation of hip 5. Spina Bifida 6. Erb’s palsy 7. Hydrocephalus 8. Muscular dystrophy
B. Geriatric conditions 1. 2. 3. 4. 5.
Parkinson’ s disease Osteoporosis Kyphosis Arthritis Spondylosis - lumbar - cervical 6. Low back ache 7. PID 8. Alzhimer’s disease 9. Frozen shoulder 10. Periarthritis shoulder 11. Fracture neck of femur 12. Common operations: - Total knee replacement - Hip and kneearthroplasty - DHS Fixation.
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C. Sport Conditions 1. Muscular injuries i) ii) iii) iv)
Quadriceps muscle tear / strain Hamstring muscle tear / strain Spinal muscle injuries Shoulder muscle injuries - Rotator Cuff injuries
2. Tendon injuries i) ii) iii) iv) v) vi) vii)
Tendo Archilles tendonitis Collateral ligament tendonitis Susprapinatus tendonitis Infraspinatus tendonitis Tennis elbow Golfer’s elbow Biceps Tendinitis
3. Ligament injuries i) Anterior cruciate ligament injury ii) Posterior cruciate ligament injury iii) Medial collateral ligament injury iv) Lateral collateral ligament injury v) Ankle Lateral ligament injury vi) Ankle Medial ligament injury (Deltoid Ligament) vii) Sprain ankle 4. Bursitis 5. Menicus injury 6. Synovitis 7. Other injuries - Strains - Sprains
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D. Women’s health conditions 1. Complications during pregnancy : - Ectopic pregnancy - Preeclampsia \ Eclampsia - Gestational Diabetes - Ante – Partum bleeding - Placenta praevia - High Risk Pregnancy 2. Pregnancy induced postural abnormalities 3. Breast cancer 4. Osteoporosis 5. Common operation - Hysterectomy - Mastectomy - Herniatomy - Surgery for stress incontinence 6.
Dysmenorrhoea
7.
Diastases Recti Abdominis
8.
Obesity
9.
Incontinence
10.
FTND
11.
LSCS
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E . Musculoskeletal conditions includes fractures Arthritis • Arthritis Overview ( Hip and Knee ) • Hemophiliac • Infectious Arthritis • Osteoarthritis • Rheumatoid Arthritis • Shoulder Arthritis • Thumb Arthritis • Hips • Arthritis • Dislocation of the hip • Hip Labral Tear • Inflammatory Hip Conditions • Osteonecrosis • Osteoporosis • Pelvis Fracture Knees • Anterior Cruciate Ligament (ACL) Injury • Arthritis • Articular Cartilage Injury of the knee • Bowlegs • Knock Knee • Meniscal Tear Leg, Ankle,and Feet • Arthritis • Broken Leg • Bunions the foot • Clubfoot • Diabetic Foot • Flat Foot
Foot Deformity Intoeing Sports Injuries to Sprained Ankle Tendonotis
Shoulders • Rotator Cuff Injuries • Shoulders Arthritis • Shoulder Instability • Shoulder Pain
Arm, Wrist , and Hands JAWATANKUASA TEKNIKAL PROFESYEN FISIOTERAPI
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• Carpal Tunnel Syndrome • Dislocated Elbow • Dupuytren’s Contracture • Thumb Arthritis • Trigger Finger Spine • Back Injuries • Chronic Low Back Pain • Herniated disc (Slip Disc) • Scoliosis (Curvature of the spine) • Spinal Stenosis / Degenerative Spondylisthesis • Spondylolisthesis Fractures • Shoulder girdle • Arm • Elbow • Forearm Hand and Wrist • Pelvis • Thigh • Knee • Leg • Ankle and Foot • Spine F. Cardio – Respiratory conditions A. Medical conditions. 1. Acute respiratory disorders - Acute respiratory failure - Acute respiratory distress syndrome (ARDS) - Acute pulmonary oedema 2. Obstructive diseases - Bronchial asthma - Acute and chronic bronchitis - Ephysema - Cystic fibrosis - Lung collapse - Respiratory failure - Bronchiectasis - Primary ciliary dyskinesia 3. Restrictive diseases - Tuberculosis JAWATANKUASA TEKNIKAL PROFESYEN FISIOTERAPI
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-
Pneumonia Lung abcess Lung cancer Pleural effusion Pneumothorax Interstitial lung disease
4. Endocrine conditions - Diabetes Mellitus - Thyrotoxicosis 5. Other medical conditions - Renal diseases - Liver diseases – Jaundice, Hepatitis - Anemia
-
6. Cardiac conditions Ischemic heart diseases Congestive cardiac failure Rheumatic heart diseases Hypertension Congenital heart diseases
7. Peripheral Vascular diseases - Vericose veins - Burgers diseases - Lymphoedema
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G. Surgical conditions 1.
Abdominal surgeries - Gastrotomy - Appendicetomy - Cholecystectomy - Colonostomy 2. Hernia repair 3. Mastectomy 4. Thyroidectomy 5. Pulmonary Surgery – Pneumenectomy, thorocotomies 6. Cardiac surgery - CABG, Vascular Surgeries. 7. Pulmonary rehabilitation 8. Cardiac Rehabilitation
9. Chest physiotherapy for an ICU patient
H. Common Neurology Conditions A. Neuromuscular disorders - Myasthenia gravis - Muscular dystrophy B. Degenerative disorders -
Multiple sclerosis Motor neuron diseases
C. Spinal cord lesions - Developmental abnormalities of spinal cord - Spinal cord injuries a. Paraplegia b. Quadriplegia D. Disorders of peripheral nervous system - Polyneuropathy - Plexus syndrome - Disorders of autonomic nervous system
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E . Peripheral nerve injuries - ulnar nerve lesions - radial nerve lesions - median nerve lesions - common peroneal nerve lesions F. Brain disorders - Deverlopmental anomalies of brain - Head injuries - Hemiplegia - Quadriplegia - Cerebrovascular disease - Movement disorders - Cerebellar lesions - Neoplasia Other neurological conditions - Tumors - Meningitis - Encephalitis
G. LIST DOWN OTHERS NOT IN LIST
FEED BACK FORM AND CERTIFICATION OF COMPLETION OF MENTORING JAWATANKUASA TEKNIKAL PROFESYEN FISIOTERAPI
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Name place of the training Centre: …………………………………………………. Name of the Mentee: ……………………………………I/C…………………………. Batch: ………………………. Duration From: ………………………..to……………………… Area of Posting: ………………………………………………... Please Tick the Appropriate Excellent
Good
Poor
Remarks
Punctuality and Regularity Knowledge in theory Skills and technique Professionals Ethics Dress Code Interest in implementing learning Objectives Competency of the Mentee Physiotherapist in completing any task or an assignment Comments……………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… ……………………………………………………………………………………….. This is to certify that Mr/ Ms ………………………………………………………..has satisfactorily completed training as a Physiotherapist in this Hospital…………... ………………………………………....................from …………………to………………
Signature of Mentor: …………………………………
Date: …………………….
Name: …………………………………………….. Designation: ……………………………………….. Official Cop: …………………………………………
SENARAI SEMAK ORIENTASI JAWATANKUASA TEKNIKAL PROFESYEN FISIOTERAPI
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NAMA UNIT TARIKH MASUK JAWATAN
HOSPITAL…………… : ……………………………………………… : ……………………………………………… : ………………………………………………
TANGGUNGJAWAB 1 .
Struktur Organisasi: 1.1 Objektif Jabatan 1.2 Visi / Misi 1.3 Carta Organisasi - Jabatan - Unit – unit 1.4 Lawatan ke unit – unit Sokongan
2 .
Struktur Unit: 2.1 Pengenalan kepada staf – staf lain 2.2 Penempatan
3 .
Peraturan dan Garis Panduan: 3.1 “Manual Prosedur Kerja” 3.2 Fail Meja 3.3 Care Protokol / SOP 3.4 Pekeliling 3.5 Rekod Staf (Buku Biodata / Fail Peribadi) 3.6 Cuti Rehat / Kecemasan / Sakit 3.7 “Punch” kad 3.8 Kod dan Etika Pemakaian Senarai Tugas / Tanggungjawab: 4.1 Senarai tugasan 4.2 Pengurusan nota pesakit 4.3 Pengurusan / Penjagaan Aset dan Peralatan
4
TANGGUNGJAWAB
TARIKH
TARIKH
JAWATANKUASA TEKNIKAL PROFESYEN FISIOTERAPI
DIBERI OLEH
DIBERI OLEH
TANDATANGAN
TANDATANGAN
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Sambungan…. 4.5 Pengumpulan Data Statistik 4.6 Dokumentasi laporan pesakit 4.7 Laporan “Incident” 4.8 Tugasan lain (seperti yg diarahkan) 4.9 Laporan Kerosakan 5.
6.
Rujukan Ke Unit – unit Lain: 5.1 Unit Fisioterapi 5.2 Unit Cara Kerja 5.3 Unit Lain - lain Pendidikan: 6.1 Latihan dalam perkhidmatan 6.2 CME
7.
“Universal Precaution”: 7.1 “Hand Washing” 7.2 “Clinical Waste”
8.
“Contingency plan”
ORIENTASI DIBERI KEPADA STAF TERSEBUT TELAH DISEMPURNAKAN TARIKH
:
TANDATANGAN STAF
:
TANDATANGAN KETUA PROFESSION / UNIT : TANDATANGAN STAF YANG MEMBANTU
:
CERTIFICATION OF COMPLETION OF MENTORING
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This is to certify that Mr/ Ms............................................................................................... Has satisfactorily completed training in Muscoluskeletal/ Cardiorespiratory/ Neurology/ Paediatric/ Special Target as mentee in this Hospital............................................................................................................................. from ............................... to.................................... (Including extension of mentoring period, where applicable). During that period he / she were engaged in employment in a resident Unit Fisioterapi post as required to my satisfaction.
Signature of Mentor: Name
:
Designation
:
Official Cop
:
Date
:
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CLINICAL PRACTICE COMPETENCY EVALUATION FORM EVALUATION CATEGORIES
WEIGHT AGE
5-EXCELLENT
4-GOOD
3-SATISFACTORY
2-POOR
Reliable, punctual and develops time management. Use the entire time on placement to enhance his/her skills.
Reliable, punctual and is developing time management. Use the most of the time on placement to enhance his/her skills.
Reliable, punctual and is developing time management. Needs to be prompted to use the time on placement to enhance his/her skills.
Needs to be constant reminder to be punctual and use the time on placement to enhance his/her skills.
1-VERY
POOR
PROFESSIONAL ROLES
PUNCTUALITY AND TIME MANAGEMENT
REACTION TO ADVICE AND CRITIC
COMMUNICATION WITH STAFF, COLLEAGUES, MULYIDISCIPLINARY TEAM (MDT) AND FAMILY
COMMITMENT TO LEARNING
1
1
1
1
Reacts positively to professional guidance/ criticism and willing to change.
Excellent communication. Always appropriate and professional.
Has clear objectives that he/she would like to achieve and seeks regular feedback on his/her progress.
Generally reacts Reacts to professional Fair responds to well to professional guidance/ criticism professional guidance/ criticism but needs support to effect guidance/ criticism. and willing to change Requires a lot of change effectively. guidance to change. Good communication. Appropriate most of the time.
Satisfactory verbal communication. Needs occasional prompting.
Poor. Needs frequent correction and advice.
Unreliable and does not improve time management despite constant reminder.
Does not react and change despite guidance/ criticism given.
Very poor or inappropriate communicator. Fails to improve his/her ability to communicate
Has clear idea that Has clear idea that he/she Needs a lot of help The student fails to set he/she would like to would like to achieve and to define and set or maintain any record of achieve and seeks seeks regular feedback on learning objectives independent learning regular feedback on his/her progress with of what he/she despite assistance. his/her progress. occasional prompt. should achieve and required regular prompting/ guidance.
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SCORE
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ASSESSMENT OF PATIENT
EXPLANATION
GATHERING SOURCES OF INFORMATION -case notes -X-rays -GP letter -verbal reports
SUBJECTIVE ASSESSMENT
1
1
2
OBJECTIVE EXAMINATION AND TREATMENT PLANNING
2
Independently and Able to inform purpose Able to inform purpose clearly inform the and procedure of and procedure of purpose and procedure assessment with assessment with of assessment. minimum assistance to moderate assistance ensure the patient to ensure the patient has understood what has understood what is being said. is being said. Independently search and use appropriate/ accurate information sources to assess and make informed clinical judgement.
Independently but takes some time to search and use appropriate/ accurate information sources to assess and make informed clinical judgement.
Poor explanation. Require maximum assistance to ensure the patient has understood what is being said.
Unable to explain the purpose and procedure of the assessment process despite prompting and/or correction.
search and use search and use Fails to search and use appropriate/ accurate appropriate/ appropriate/ accurate information sources to accurate information sources to assess and make information sources assess and make informed clinical to assess and informed clinical judgement with make informed judgement even directed occasionally prompting. clinical judgement to do so. when directed to do so.
Carries out a complete Carries out a complete Carries out a complete subjective assessment subjective assessment subjective assessment that is systematic that is systematic that is systematic and and logical and logical logical with occasional independently. independently but prompting. takes some time.
Carries out an incomplete subjective assessment and requires further questioning and direction from the physiotherapist.
Very poor subjective assessment. Doesn’t improve performance despite direction from physiotherapist.
Carries out a complete Carries out a complete Carries out a complete objective examination objective examination objective examination with safe and correct with safe and correct with safe and correct handling skills. The handling skills. The handling skills. The examination is a examination is a examination is a systematic and logical systematic and logical systematic and logical independently. independently but with occasionally takes some time. prompting.
Carries out an incomplete objective examination and requires further questioning and direction from the physiotherapist
Very poor objective examination. Doesn’t improve performance despite direction from physiotherapist.
153
PROBLEM LISTING AND IMPRESSION
2
TREATMENT GOALS 2
Able to identify and Able to identify and Able to identify and prioritize a complete list of prioritize a complete list Able to identify and prioritize a prioritize a incomplete patient’s problems that are of patient’s problems that complete list of patient’s list of patient’s problems that are relevant relevant and accurately problems that are are relevant and and accurately reflect the reflect the patient’s relevant and accurately reflect the patient’s condition with condition. accurately reflect the patient’s condition but occasionally prompting. patient’s condition takes some time. with direction from the physiotherapist.
unable to identify list of patient’s problems that are relevant and accurately reflect the patient’s condition despite direction from the physiotherapist.
Able to plan treatment Able to plan complete and Able to plan complete Able to plan treatment goals goals that are specific unable to plan treatment priorities treatment goals treatment goals that are that are specific measurable, goals that measurable, that are specific specific measurable, achievable, realistic and time achievable, realistic are specific measurable, measurable, achievable, achievable, realistic and frame with occasionally and time frame with achievable, realistic and realistic and time frame. time frame. prompting. maximum guidance. time frame despite maximum guidance.
IMPLEMENTATION OF TREATMENT
EXPLANATION
INTERVENTION
1
3
Independently and clearly Able to inform the inform the purpose and purpose and procedure procedure of the treatment. of the treatment with minimum assistance to ensure the patient has understood what is being said. Implement safe and effective modalities independently, with appropriate modification when necessary.
Able to inform the purpose Poor explanation. Unable to explain the ANALYSIS and procedure of Required maximum purpose and procedure of the treatment with moderate assistance to ensure the treatment process assistance to ensure the the patient has despite prompting and/ or patient has understood what understood what is correction. is being said. being said.
Implement safe and Implement safe and effective Implement intervention effective modalities modalities with occasionally under maximum independently, with prompting. guidance. appropriate modification when necessary but takes some time.
Fail to implement intervention despite maximum guidance.
VIVA CLINICAL REASONING -anatomy -pathology -PT management -social implication
1
DOCUMENTATION 1
Shows an excellent of clinical reasoning for someone of this experience.
Provides complete documentation to an excellent standard.
Shows a good level of clinical reasoning for someone of this experience.
Shows a satisfactory level of clinical reasoning for someone of this experience.
Shows only a poor degree of clinical reasoning for someone of this experience.
Shows a very poor level of clinical reasoning for someone of this experience.
Provides complete documentation to a good standard.
Provides complete documentation to a satisfactory standard.
Provides incomplete documentation.
Provides poor documentation. /100
TOTAL SCORE
20
154
CLINICAL PRACTICE COMPETENCY EVALUATION FORM Over the course of this evaluation, this physiotherapist: Has adequate knowledge of moving and handling skills Is able to implement moving and handling skills with patients Performs safe and appropriate with any manual treatment or skill based intervention Prepares and maintains a safe environment for him/herself and his/her clients and colleagues Adheres to standard codes of practice and local guidelines Please Tick:
I agree
I don’t agree
If you don’t agree, the physiotherapist will fail the placement. Supervisor Final Remarks/ Recommendations: ……………………………………………………………………………………….. …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… ……………………………………….……………………………………
Signature: ………………………………………………… Date: …………………………………….. Name of Mentor: ……………………………………………………………… Physiotherapist Mentee Name: _______________________________ Batch: _________________________ Name the place of training: _________________________________ Date of attachment : _______________________________ Completion date of Mentoring: _______________________ Total Marks:______________________________
155
Kawasan…………………………………………………………… Hospital……………………………………………………………… Bil
1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Bil
DISIPLIN
Bil. Rawatan
2
3
Bilangan Pesakit Baru Lama Jumla h
4
5
6
Catatan
7
Perubatan Am Paediatrik Dermatologi Perubatan Respiratori Psikiatri Pembedahan Am Orthopaedik Otolaryngologi Oftalmologi Ginekologi Obstetrik Radioterapi & Onkologi Neurologi Neurosurgeri Nefrologi Urologi Kardiologi Kardiothorasik Pembedahan Plastik & Rekonstruktif Pergigian Pembedahan Tangan Mikro Bius (Icu) Hepatologi Hepathobiliari Lain-Lain Beban Kerja Individu Dan kerja Gantian
Bil. Rawatan
Bilangan Pesakit Baru Lama Jumlah
Catatan
156
2012
RONDAAN WAD
157
RONDAAN WAD Pengenalan: Ward rounds have a vital role in hospital care. Healthcare professionals are able to meet and develop an integrated plan of care (R. Hodgson, 2005). Ward rounds constitute a major part of a student attachment in general medicine. They are a great opportunity to improve skills in history taking, practice examining patients, and develop ability in clinical reasoning (R. Arasaratnam, 2008). It also enhances professional skills such as teamwork and communication (Ker et. al, 2008). A deliberate and planned approach to bedside teaching will make learning more effective (Ker et. al, 2008). Teaching on a ward round has been compared to walking a tightrope. A clinical teacher has to balance the differing needs of undergraduate and graduate learners while providing a comprehensive and safe clinical service. Teaching in the presence of patients is an additional tension because the patient plays a central role and also is the most attentive member of the audience (Ker et. al, 2008). Ward round teaching remains a powerful teaching context in medicine as it provides an authentic experience of the complexity of patient care and professional practice (Zwarenstein M. et al, 2007). The enduring value of the ward round lies in its potential to model professionalism, enhance clinical reasoning (Schmidt HG et al, 1990), and demonstrate the cultural norms of medical practice (Lave J. et al, 1991; Cope P et al, 2000) Objektif: 1. 2. 3. 4. 5.
Untuk meningkatkan kualiti kehidupan Untuk memperbaiki kemahiran komunikasi Untuk mengenalpasti masalah dan punca masalah pesakit Untuk merancang dan menilai perawatan Untuk meningkatkan lagi pengetahuan dan kemahiran profesyen
Kriteria: Rondaan wad adalah wajib bagi hospital yang mempunyai kriteria berikut: i. Hospital Besar Negeri ii. Hospital yang mempunyai kepakaran iii. Unit Fisioterapi yang mempunyai Jurupulih Perubatan (Anggota) U32 dan ke atas (minima 3 orang Jurupulih Perubatan (Anggota) dan Jurupulih Perubatan (Anggota) yang mempunyai 10 tahun pengalaman (minima 3 orang Jurupulih Perubatan (Anggota)
158
Disiplin: 1. Musculo-skeletal
– Wad Ortopedik - Wad Geriatrik - Unit Burns (MS approach)
2. Cardio-respiratori
-
Wad Perubatan Wad Pembedahan Program Pemulihan Jantung Fasa I Unit Penjagaan Kritikal (ICU & HDW)
3. Neurologi
-
Wad Neurologi (Medical Neuro / Surgical Neuro) Neurologi ICU
4. Paediatrik
-
Paeds ICU/HDU Wad Kanak-kanak Neonatal ICU
Jenis-jenis Rondaan Wad: 1. Grand ward rounds 2. General ward rounds Grand Ward Rounds 2. Anggota yang terlibat: – Ketua Jabatan – Pegawai Pemulihan Perubatan (Anggota) U41 – Pengurusan Kawasan – Penyelia – Jurupulih Perubatan (Anggota) yang berada dalam disiplin yang sama 2. Frekuensi -
Sebulan sekali bagi setiap disiplin
3. Hari/Masa -
Dijalankan sehari dalam seminggu di sebelah petang ( 2.00 petang – 4.00 petang)
-
4.00 petang ‘case study’ di bilik seminar wad atau di Unit Fisioterapi
-
20 - 30 minit / kes
4. Masa/kes 5. Bil minima -
4 kes / rondaan wad
6. Kes dipilih oleh penyelia untuk dibentangkan semasa ‘case study’ 7. ‘Case study’ dan perbentangan kes
159
Rondaan Wad mengikut Disiplin i.
Anggota terlibat
-
Pengurus kawasan / Penyelia Jurupulih Perubatan (Anggota) Pelatih Fisioterapi
ii.
Frekuensi
-
Dilakukan secara mingguan bagi setiap wad
iii.
Hari / masa
-
Ditetapkan oleh Penyelia Masa yang diambil sekurang-kurangnya 2 jam
iv.
Kes
-
Semua kes atau kes dipilih secara rambang dalam wad (Kes yang dirujuk untuk fisioterapi sahaja) Pesakit harus dirawat sekurang-kurangnya 3 kali sebelum rondaan wad dibuat.
v.
Memilih kes untuk Grand ward rounds (2 – 4 kes) dan 1 case study (Kes kompleks/ Sukar )
160
Senarai Tugas Jurupulih Perubatan (Anggota) U29 i.
Senaraikan semua kes yang dirujuk oleh doktor.
ii.
Telitikan semua kes
iii.
Cetakkan senarai kes pesakit dan menyerahkannya kepada penyelia SATU hari sebelum rondaan wad.
iv.
Membentangkan semua kes yang dirujuk kepada penyelia semasa rondaan wad: - Data pesakit ( nama, RN, umur, diagnosis, vital sign dll) - Aduan semasa - Faktor penyebab utama - Sejarah sosial - Informed consent - ‘Outcome measures’ yang digunakan - Penemuan yang penting semasa penilaian - Pelan perawatan semasa - Penggunaan skill khas - Kemajuan perawatan fisioterapi
v.
Berbincang dengan penyelia
vi. Pembentangan ‘case study’ kepada Ketua Jabatan/Unit / pengurus kawasan semasa Grand Ward Rounds (rujukan kepada iv) Penyelia i. Rondaan wad sepatutnya mengeksplotasikan cara memperolehi diagnosis fisioterapi dan proses kognitif. Jurupulih Perubatan (Anggota) yang junior harus melalui proses tersebut untuk membuat kesimpulan. ii.
Memilih kes untuk Grand Ward Round.
iii. Memilih kes untuk case study semasa Grand Ward Round iv. Senaraikan kes pesakit yang dicadangkan untuk Grand Ward Round. v.
Serahkan senarai tersebut kepada Ketua Jabatan/ Unit / pengurus kawasan sehari sebelum Grand Ward Round
vi. Bincangkan semua kes dengan Ketua Jabatan / Unit/ pengurus kawasan. vii. Laporan – Rondaan wad dan Grand Ward Round viii. Serahkan laporan kepada Ketua Jabatan/ Unit pada 5 hb setiap bulan.
161
Ketua Jabatan / U41/ Pengurus Kawasan i.
Terlibat dalam semua Grand Ward Round (Sekali seminggu dari jam 2.00 petang – 5.00 petang)
ii. Mengetahui semua kondisi dan perawatan fisioterapi bagi setiap kes yang akan dibentangkan semasa Grand Ward Round iii. Untuk menggalakkan Jurupulih Perubatan (Anggota) yang junior untuk menjalankan tugas dengan baik. iv.
Memberi clinical reasoning yang membina dan perawatan yang membina bagi setiap kes.
v.
Perbincangan ‘Case study’.
vi.
Kumpulkan semua laporan mengikut disiplin
vii.
Membuat ringkasan laporan berdasarkan laporan-laporan yang dikumpulkan.
viii. Menghantar ringkasan laporan kepada Ketua Profesyen Fisioterapi setiap 6 bulan. Senarai semak i.
Masukkan Carta Batuan ke dalam Takwim Tahunan Ketua Jabatan dan jabatan.
ii.
Laporan – Laporan Penyelia -
Ringkasan Laporan oleh ketua jabatan (Untuk dihantar kepada Ketua Profesyen Fisioterapi)
iii.
Senarai semak semasa rondaan wad
iv.
Sistem fail -
Fail jabatan (File Rondaan Wad mengikut disiplin) Ketua Profesyen Fisioterapi: Setiap 6 bulan (Ringkasan laporan)
162
Lampiran 1 Carta Perbatuan (Grand Ward Round) (Contoh: masukkan ke dalam takwim jabatan) Bil
Januari Wk1 Wk2
1
MS
CR
Wk3
Februari Wk4
Neuro Paeds
Wk1 Wk2 MS
CR
Wk3
Mac Wk4
Neuro Paeds
Wk1 Wk2 MS
CR
Wk3
Wk4
Neuro Paeds
163
Lampiran 3 Laporan i.
Disiplin:
ii.
Rondaan Wad: Wad …………………. …………………
iii.
Pembentang: ……………………………………..
iv.
Bil Kes: …………….. Kes
v.
Ringkasan kes Bil
R/N
Diagnosis
Masalah
Tarikh:
Outcome Measure
Rawatan/ Skill Khas
Catatan
1 2 3 4 5 6 7 8 9 10 vi.
Prestasi pembentang : Lemah / Sederhana / Baik Nota: Lemah – Memerlukan pemantauan dan bimbingan Sederhana – Berdikari, menggunakan sekurang-kurangnya 2 ‘Outcome measure’, sama ada menggunakan skill khas atau tidak. Baik – Memberi ‘clinical reasoning’, menggunakan sekurang-kurangnya 2 ‘Outcome Measure’ dan kemahiran khas.
vii.
Penambahbaikan untuk perawatan: ……………………………………………………………………………………………… ………………………………………………………………………………………………
viii.
Case study: Bil
RN
Diagnosis
Masalah
Outcome Measure
Rawatan/ Skill Khas
Prestasi
1
164
ix.
Soft skill: ……………………………………………………………………………………………. ……………………………………………………………………………………………. ……………………………………………………………………………………………..
x.
Kehadiran : Bil
Nama
Gred Jawatan
1 2 3 4 5 6 xi.
Cadangan untuk meningkatkan prestasi: ……………………………………………………………………………………………… ………………………………………………………………………………………………
……………………………… (Penyelia : Nama dan cop ) Tarikh:
……………………………… (Ketua Jabatan : Nama dan cop ) Tarikh:
165
Lampiran 2 Senarai Semak Fisioterapi Rondaan Wad Wad: BIL 1 2.
TINDAKAN DIAMBIL
Jurupulih Perubatan (Anggota): CONTOH
Senyum dan salam kepada pesakit Menanyakan keselesaan pesakit
YA Tidak
- Selamat pagi / tengahari / petang - Dapatkah anda tidur dengan selesa? - Apa khabar?
3.
Membuat penilaian keatas masalah dan keperluan semasa pesakit
- Meneliti rekod perubatan pesakit - temuramah pesakit - memperolehi informed consent - Menjalankan penilaian fizikal - penggunaan outcome measure
4.
Menjalankan perawatan fisioterapi – berdasarkan masalah pesakit
5.
Menilai rawatan fisioterapi – mengikut pelan penjagaan fisioterapi
6.
Menyediakan informasi kesihatan yang berkaitan
- Pendidikan kesihatan berkaitan dengan kondisi pesakit
7.
Merangsang interaksi dan komunikasi
- Tanya pesakit jika beliau ada apa-apa soalan/ masalah
8.
Mendokumentasikan dengan betul dan sempurna
- Carta audit klinikal
- memberi keutamaan pada masalah - Akur pada SOP Fisioterapi - Menentu dan mengimplimentasikan pelan penjagaan - Kemahiran khas digunakan - Pendidikan pesakit/penjaga - Program senaman di rumah - penilaian - keberkesanan - temuramah pesakit - Menetapkan semula dan implementasikan pelan penjagan
…………………………………….. (Penyelia : Nama & Cop) Tarikh :
166
Lampiran 4 Ringkasan Laporan Grand Ward Round Hospital/Negeri: Hospital…………………………………..
Negeri: Pahang
Bil Kes Bil
Hospital
Prestasi
Catatan
MS CR Neuro Paeds 1 2 3 4 5 6 7 8 9 10 Kadar Prestasi bergantung kepada : i) Senarai Semak Lampiran 2 ii) Borang Laporan Lampiran 3
…………………………………….. (Ketua Jabatan/Ketua Profesyen: Nama & Cop) Tarikh:
167
References: 1. Cope P, Cuthbertson P, Stoddart B. Situated learning in the practice placement. J Adv Nurs2000;31:850-6. 2. Jean Ker, Peter Cartillon, LucyAmbrose. Teaching on a Ward Round. BMJ 2008; 337:a1930. 3. Lave J, Wenger E. Situated learning: legitimate peripheral participation. New York: Cambridge University Press, 1991. 4. Manias E & Street A. (2000) Nurse-doctor interaction during critical care ward round. Journal of Clinical Nursing, 10, 442 – 450 5. Reuben Arasaratnam. Medical Ward Round. Student BMJ 2009; 17:98-99/March 6. Richard Hodgson. A survey of wrad round practice. The Psychiatrist (2005) 29: 171 -173. Dol: 10.1192/pb.29.5.171 7. Schmidt HG, Norman G, Boshuizen H. A cognitive perspective on medical expertise. Theory and Implications1990;65:611-21. 8. Thong Lim C, Yap a., Sim Lim C. Approaching your first clinical year. Student BMJ 2008; 16:112 -3 9. Warenstein M, Bryant W. Intervention to improve collaboration between doctors and nurses. Cochrane Database Syst Rev2007;(3):CD000072.
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