Assistant Professor Kennedy Krieger Institute Baltimore, Maryland, United States
Objectives: Our primary objective is to continuously improve the quality of aquatic therapy for spinal cord injury (SCI) patients while reducing the incidence of skin abrasions utilizing the PDCA (Plan, Do, Check, Act) System. Our specific aim is to reduce the highest incidence of skin abrasions revealed by quality surveillance.
Design: Using the PDCA (Plan, Do, Check, Act) format for continuous improvement we designed and implemented a three phase program. Phase I consisted of data mining. In phase II, policy and procedures were written. Phase III consisted of education and implementation of the new policies and procedures.
Results: Between 2010 and 2018 only 1.08% of all patients (1,203) were identified as having skin abrasions acquired during their aquatic therapy sessions. Of the total number of aquatic therapy appointments (16,804) during that same time period, the incidence of skin abrasions was even lower, at only .08%.
During aquatic therapy sessions, patients were experiencing scrapes and abrasions predominantly affecting their limbs. Initial verbal reporting by therapists and nursing staff led to a paper tracking system starting in 2010. In phase II, we implemented policy and procedures outlining appropriate steps to prevent skin abrasions during aquatic therapy sessions. In phase III, therapists received additional training and education to lessen potential abrasions for patients and protective foot wear became obligatory for ambulatory patients.
Conclusions: Consistent communication, reporting and tracking, combined with education and effective preventative measures dramatically lessened the incidence of skin abrasions during aquatic therapy and utilizing PDCA these outcomes can be sustained.