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Early outcomes of the implementation of physiotherapist independent prescribing in a specialist rehabilitation service for persons with lower limb amputation
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The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
POS046 Development, management and leadership in cardiorespiratory physiotherapy: a case study from Greece A. Spinou ∗ , G. Pepera, A. Peristeropoulos, A. Christakou, I. Laoutaris Panhellenic Physiotherapists’ Association (PSF), Cardiovascular and Respiratory Physiotherapy – Rehabilitation (TKAFA), Athens, Greece Relevance: Panhellenic Physiotherapists’ Association (PSF) is the official organisation for physiotherapy in Greece. The successful development of a new section within the PSF is a case study that could serve as an example of planning organisational developments. Purpose: To create a cardiorespiratory scientific group/section within the PSF. This group aims to support colleagues, collaborate with international corresponding associations, and promote excellence in cardiorespiratory physiotherapy. Approach/evaluation: A group of physiotherapists with a special interest in cardiorespiratory physiotherapy and members of the PSF committee agreed on their mutual intention to create a scientific group. PSF published an announcement of interest and facilitated the first meeting (24 physiotherapists) for planning the group establishment and development. Our group, the Association of Cardiovascular and Respiratory Physiotherapy-Rehabilitation (TKAFA), was approved to include three main directions: cardiovascular, respiratory, and intensive care unit (ICU). A small team of physiotherapists with relevant postgraduate studies and clinical experience developed the aims, proposed structure and initial planning of TKAFA. A second meeting was organised and a 5-member committee was elected by PSF members. The committee of TKAFA created a website (www.tkafa.gr) to present its aims and activities and enhance communication. It also organised small working groups, called nuclei, according to its three main directions (cardiovascular, respiratory, ICU), to facilitate the project management. The nuclei consist of one coordinator and six members, all members of the PSF and TKAFA with postgraduate qualification, clinical experience and interest in the projects of the corresponding direction. Outcomes: All directions, with the assistance of the nuclei members, organised a seminar (each) on cardiovascular, respiratory and intensive care physiotherapy. Speakers were widely acknowledged Greek and international professionals. The seminars were very successful, with more than 500 participants in total and considerable finance income. TKAFA developed collaborations with other associations, such as the Hellenic Thoracic Society that was also a co-organiser of the seminar on respiratory physiotherapy. TKAFA created patient information leaflets, an assessment and intervention
ICU protocol, and translations of European guidelines on cardiovascular and critical ill patients, which were published in scientific journals and websites. An audit for the physiotherapy role in ICU and two proposals to the National Health System have being conducted. Social activities with medical interest were organised, such as a visit to the Sotiria Hospital museum. TKAFA generates position statements for the public and distributes an electronic 3-month newsletter, with the aim to inform members of the association on scientific activities, maintain engagement, provide support and disseminate good news. From March 2014 to March 2016, TKAFA has recruited 250 members. Discussion and conclusions: TKAFA was created as a section of PSF to promote the clinical application, recognition, research and education of cardiorespiratory physiotherapy-rehabilitation in Greece, in accordance with the existing professional guidelines. Impact and implications: TKAFA has increased public awareness about the role, responsibilities and benefits of cardiovascular, respiratory and ICU physiotherapy and has advanced physiotherapy clinical practise through educational activities, proposals and ongoing research. This organisational development could promote prevention and treatment and result in future patient benefits and financial savings of the National Health System. Funding acknowledgement: TKAFA, PSF. http://dx.doi.org/10.1016/j.physio.2016.10.104 POS047 Early outcomes of the implementation of physiotherapist independent prescribing in a specialist rehabilitation service for persons with lower limb amputation L. Tisdale Royal Wolverhampton Trust, Amputee Rehabilitation, Wolverhampton, United Kingdom Relevance: Following campaigning by the Chartered Society of Physiotherapy to increase prescribing rights for Physiotherapists, Independent Prescribing rights were given to Physiotherapists in England in 2013, with appropriate training made available at the beginning of 2014. The development of Physiotherapist Independent Prescribing has been a positive step for Physiotherapy and those receiving Physiotherapy treatment. This presentation will aim to demonstrate the outcomes of a review of the new Physiotherapy practice (my own) developed within a specialist rehabilitation service for persons with lower limb amputation as a result of this change. Purpose: To improve the quality of care provided to those referred to a regional rehabilitation service for individuals having undergone amputation, through streamlining access to pharmacological treatment of neuropathic pain, muscu-
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
loskeletal pain and dermatological conditions, addressing presenting problems fully, whilst holistically, as part of the MDT in a timely and effective manner. Independent Prescribing allows a physiotherapist to autonomously prescribe within the Physiotherapy management plan supporting the patient’s compliance with the treatment. Approach/evaluation: Having gained dual qualification as an Independent and Supplementary Prescriber in June 2015, completing training that met the requirements of the Health and Care Professions Council (hcpc). Prescribing practice was commenced in January 2016. Medication choice for the initial formulary was based on the outcome of reviews of NICE guidance, where available, for the management of hyperhidrosis, musculoskeletal and neuropathic pain, or based upon knowledge gained through experience in the Prescribing Preparation time. Prescribing decisions are documented and reviewed with the supervising Consultant. Outcomes of prescribing will be reviewed and feedback gained from patients in receipt of this change in service delivery. Outcomes: It is envisaged that the review of the first 9 months of Prescribing by the Specialist Physiotherapist will demonstrate that this service development is a valuable addition to the role through improving the quality of the service. That practice will be commensurate with the evidence base and found to be cost effective in terms of supporting patient’s compliance with the use of the prescribed medication and more efficient use of Consultant sessions for the service. Discussion and conclusions: The purpose of Physiotherapist Prescribing is to enhance the care provided to the patient. The review will aim to establish how the addition to the scope of practice has improved quality of care, and how the practitioner has safely implemented the skills within their established practice. Has the prescribing practice supported pain management more than dermatological problems? With changes in the evidence base, how will the practitioner not only maintain safe prescribing skills but develop new ones? The review will describe the support structures available to the Physiotherapist in this role. Impact and implications: Whilst the number of Physiotherapist IPs annotated on the hcpc register has grown steadily since the right was given, few are currently working in rehabilitation of those who have undergone limb amputation services. It is hoped that this review will act as a basis for the development of others in this specialist Physiotherapy role and the services they work within. Funding acknowledgement: Fees and study leave for the Independent Prescribing course were provided by the Royal Wolverhampton NHS Trust. A presentation re the decision to develop the Specialist Physiotherapist role as an Independent Prescriber was given at ISPO World Congress 2015. http://dx.doi.org/10.1016/j.physio.2016.10.105
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POS048 Secondary care hospital reality in rehabilitation of bilateral lower limb amputees A. Coelho Hospital Professor Dr. Fernando Fonseca, EPE, Rehabilitation Department, Amadora, Portugal Relevance: Bilateral amputation is a challenge in rehabilitation, usually needing a more intense or prolonged period of rehabilitation. Goals in rehabilitation of these patients are usually related to their age, level of amputation, etiology of amputation/concurrent diseases and successful prosthetic use after first amputation. Purpose: To assess the prevalence, characteristics and prosthetic use in bilateral lower limb amputees in a secondary care hospital. Approach/evaluation: Retrospective and descriptive longitudinal study from the archives of clinical assessments of lower limb amputees evaluated and treated at our department. Statistical analysis was obtained using SPSS19.0. Outcomes: From a total of 501 lower limb amputees treated in our department, 68 (13.6%) were bilateral lower limb amputees. They were predominantly male (72.1%) and with an average age of 63.7 years (±12.8) at the time of their admission for treatments. Etiology of amputation was predominantly vascular (40 secundary to diabetes and 20 to atherosclerosis) followed by infectious (5 patients) and traumatic (3 patients). In this sample, 22 amputees had bilateral transtibial amputation, 17 bilateral transfemoral, 17 transtibial and transfemoral, 9 partial foot and transtibial, 2 partial foot and transfemoraI amputation and 1 had bilateral knee disarticulation. From all the bilateral lower limb amputees 42.6% were prosthetized. Excluding the single case of knee disarticulation (which was able to be adapted to prosthesis), patients with lower amputations were more frequently able to reach prosthetic use than the ones with higher amputation (78% of partial foot and transtibial amputation vs 18% of bilateral transfemoral amputation). Discussion and conclusions: The slightly lower prosthetization’ ratio In our sample, when compared to some other studies, is probably due to the age and etiology of amputation (and cardiovascular comorbidities associated with them) of our patients. Impact and implications: More success in prosthetic use in lower amputations is in order with the literature. Funding acknowledgement: No funding was used in the study design, in the collection, analysis and interpretation of
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
POS046 Development, management and leadership in cardiorespiratory physiotherapy: a case study from Greece A. Spinou ∗ , G. Pepera, A. Peristeropoulos, A. Christakou, I. Laoutaris Panhellenic Physiotherapists’ Association (PSF), Cardiovascular and Respiratory Physiotherapy – Rehabilitation (TKAFA), Athens, Greece Relevance: Panhellenic Physiotherapists’ Association (PSF) is the official organisation for physiotherapy in Greece. The successful development of a new section within the PSF is a case study that could serve as an example of planning organisational developments. Purpose: To create a cardiorespiratory scientific group/section within the PSF. This group aims to support colleagues, collaborate with international corresponding associations, and promote excellence in cardiorespiratory physiotherapy. Approach/evaluation: A group of physiotherapists with a special interest in cardiorespiratory physiotherapy and members of the PSF committee agreed on their mutual intention to create a scientific group. PSF published an announcement of interest and facilitated the first meeting (24 physiotherapists) for planning the group establishment and development. Our group, the Association of Cardiovascular and Respiratory Physiotherapy-Rehabilitation (TKAFA), was approved to include three main directions: cardiovascular, respiratory, and intensive care unit (ICU). A small team of physiotherapists with relevant postgraduate studies and clinical experience developed the aims, proposed structure and initial planning of TKAFA. A second meeting was organised and a 5-member committee was elected by PSF members. The committee of TKAFA created a website (www.tkafa.gr) to present its aims and activities and enhance communication. It also organised small working groups, called nuclei, according to its three main directions (cardiovascular, respiratory, ICU), to facilitate the project management. The nuclei consist of one coordinator and six members, all members of the PSF and TKAFA with postgraduate qualification, clinical experience and interest in the projects of the corresponding direction. Outcomes: All directions, with the assistance of the nuclei members, organised a seminar (each) on cardiovascular, respiratory and intensive care physiotherapy. Speakers were widely acknowledged Greek and international professionals. The seminars were very successful, with more than 500 participants in total and considerable finance income. TKAFA developed collaborations with other associations, such as the Hellenic Thoracic Society that was also a co-organiser of the seminar on respiratory physiotherapy. TKAFA created patient information leaflets, an assessment and intervention
ICU protocol, and translations of European guidelines on cardiovascular and critical ill patients, which were published in scientific journals and websites. An audit for the physiotherapy role in ICU and two proposals to the National Health System have being conducted. Social activities with medical interest were organised, such as a visit to the Sotiria Hospital museum. TKAFA generates position statements for the public and distributes an electronic 3-month newsletter, with the aim to inform members of the association on scientific activities, maintain engagement, provide support and disseminate good news. From March 2014 to March 2016, TKAFA has recruited 250 members. Discussion and conclusions: TKAFA was created as a section of PSF to promote the clinical application, recognition, research and education of cardiorespiratory physiotherapy-rehabilitation in Greece, in accordance with the existing professional guidelines. Impact and implications: TKAFA has increased public awareness about the role, responsibilities and benefits of cardiovascular, respiratory and ICU physiotherapy and has advanced physiotherapy clinical practise through educational activities, proposals and ongoing research. This organisational development could promote prevention and treatment and result in future patient benefits and financial savings of the National Health System. Funding acknowledgement: TKAFA, PSF. http://dx.doi.org/10.1016/j.physio.2016.10.104 POS047 Early outcomes of the implementation of physiotherapist independent prescribing in a specialist rehabilitation service for persons with lower limb amputation L. Tisdale Royal Wolverhampton Trust, Amputee Rehabilitation, Wolverhampton, United Kingdom Relevance: Following campaigning by the Chartered Society of Physiotherapy to increase prescribing rights for Physiotherapists, Independent Prescribing rights were given to Physiotherapists in England in 2013, with appropriate training made available at the beginning of 2014. The development of Physiotherapist Independent Prescribing has been a positive step for Physiotherapy and those receiving Physiotherapy treatment. This presentation will aim to demonstrate the outcomes of a review of the new Physiotherapy practice (my own) developed within a specialist rehabilitation service for persons with lower limb amputation as a result of this change. Purpose: To improve the quality of care provided to those referred to a regional rehabilitation service for individuals having undergone amputation, through streamlining access to pharmacological treatment of neuropathic pain, muscu-
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
loskeletal pain and dermatological conditions, addressing presenting problems fully, whilst holistically, as part of the MDT in a timely and effective manner. Independent Prescribing allows a physiotherapist to autonomously prescribe within the Physiotherapy management plan supporting the patient’s compliance with the treatment. Approach/evaluation: Having gained dual qualification as an Independent and Supplementary Prescriber in June 2015, completing training that met the requirements of the Health and Care Professions Council (hcpc). Prescribing practice was commenced in January 2016. Medication choice for the initial formulary was based on the outcome of reviews of NICE guidance, where available, for the management of hyperhidrosis, musculoskeletal and neuropathic pain, or based upon knowledge gained through experience in the Prescribing Preparation time. Prescribing decisions are documented and reviewed with the supervising Consultant. Outcomes of prescribing will be reviewed and feedback gained from patients in receipt of this change in service delivery. Outcomes: It is envisaged that the review of the first 9 months of Prescribing by the Specialist Physiotherapist will demonstrate that this service development is a valuable addition to the role through improving the quality of the service. That practice will be commensurate with the evidence base and found to be cost effective in terms of supporting patient’s compliance with the use of the prescribed medication and more efficient use of Consultant sessions for the service. Discussion and conclusions: The purpose of Physiotherapist Prescribing is to enhance the care provided to the patient. The review will aim to establish how the addition to the scope of practice has improved quality of care, and how the practitioner has safely implemented the skills within their established practice. Has the prescribing practice supported pain management more than dermatological problems? With changes in the evidence base, how will the practitioner not only maintain safe prescribing skills but develop new ones? The review will describe the support structures available to the Physiotherapist in this role. Impact and implications: Whilst the number of Physiotherapist IPs annotated on the hcpc register has grown steadily since the right was given, few are currently working in rehabilitation of those who have undergone limb amputation services. It is hoped that this review will act as a basis for the development of others in this specialist Physiotherapy role and the services they work within. Funding acknowledgement: Fees and study leave for the Independent Prescribing course were provided by the Royal Wolverhampton NHS Trust. A presentation re the decision to develop the Specialist Physiotherapist role as an Independent Prescriber was given at ISPO World Congress 2015. http://dx.doi.org/10.1016/j.physio.2016.10.105
eS101
POS048 Secondary care hospital reality in rehabilitation of bilateral lower limb amputees A. Coelho Hospital Professor Dr. Fernando Fonseca, EPE, Rehabilitation Department, Amadora, Portugal Relevance: Bilateral amputation is a challenge in rehabilitation, usually needing a more intense or prolonged period of rehabilitation. Goals in rehabilitation of these patients are usually related to their age, level of amputation, etiology of amputation/concurrent diseases and successful prosthetic use after first amputation. Purpose: To assess the prevalence, characteristics and prosthetic use in bilateral lower limb amputees in a secondary care hospital. Approach/evaluation: Retrospective and descriptive longitudinal study from the archives of clinical assessments of lower limb amputees evaluated and treated at our department. Statistical analysis was obtained using SPSS19.0. Outcomes: From a total of 501 lower limb amputees treated in our department, 68 (13.6%) were bilateral lower limb amputees. They were predominantly male (72.1%) and with an average age of 63.7 years (±12.8) at the time of their admission for treatments. Etiology of amputation was predominantly vascular (40 secundary to diabetes and 20 to atherosclerosis) followed by infectious (5 patients) and traumatic (3 patients). In this sample, 22 amputees had bilateral transtibial amputation, 17 bilateral transfemoral, 17 transtibial and transfemoral, 9 partial foot and transtibial, 2 partial foot and transfemoraI amputation and 1 had bilateral knee disarticulation. From all the bilateral lower limb amputees 42.6% were prosthetized. Excluding the single case of knee disarticulation (which was able to be adapted to prosthesis), patients with lower amputations were more frequently able to reach prosthetic use than the ones with higher amputation (78% of partial foot and transtibial amputation vs 18% of bilateral transfemoral amputation). Discussion and conclusions: The slightly lower prosthetization’ ratio In our sample, when compared to some other studies, is probably due to the age and etiology of amputation (and cardiovascular comorbidities associated with them) of our patients. Impact and implications: More success in prosthetic use in lower amputations is in order with the literature. Funding acknowledgement: No funding was used in the study design, in the collection, analysis and interpretation of