Stares 2 rotation 4

Stares 2 Rotation 4

Situation

Although I am on a neurology placement, I am really on a restorative unit at a relatively small hospital. This means I am often called up to the ward to treat chests and carry out complex mobility reviews. I received a referral to see Mrs M, an 80 year old lady who had suffered a fall and subsequent radial fracture. As the fracture was complicated, she received an ORIF. Post surgery she was suffering from delirium and the nursing staff were having difficulty mobilising her, reporting she was impulsive and very unsteady on her feet. On this particular day I had received 10 new physiotherapy referrals, this is a great deal considering on a usual day I would be likely to see around five patients on the ward in one afternoon. After carrying out a fairly superficial investigation of the patient notes, my main findings were that this patient was previously independent with mobility, living in a hostel. She also had a PMHx of dementure.

Task

Complete safe Ax and Rx of patient - aiming for mobilisation.

Action

Mrs M was very chatty when I initially went to asses her. TPP revealed orientation to place and person but not time. She was also unaware of her recent fall and subsequent surgery. Although it was clear Mrs M was not completely orientated, she seemed compliant.

I proceeded to a mobility review in bed. She was able to bridge, plantar flex and dorsiflex with 5/5 strength left and right and her quad strength was – 4/5 left and right. For the reasons outlined above, I deemed this patient safe to mobilise.

After organising Mrs M’s attachments and helping her to the edge of the bed with minimal assistance, I asked Mrs M to stand up. Half way through the stand she began to push back against my support. I had to hold her upright using my bodyweight and arm strength. While in this position, after allot of coaching I managed to get Mrs M into a full stand. She was still very frightened and confused. I asked Mrs M to take some steps on the spot, which she did with great difficulty. She wasn’t really following my commands, pushing her frame away from herself instead of walking with the frame. She was very unsteady on her feet. After realising that Mrs M was near the end of her tether, her confusion and resistance to instruction increasing, I tried to return her to bed. Again she was not responding to commands, she began arguing with my instructions and shouting obscenities at the top of her lungs.

Result

My physical wellbeing as well as the physical well being of the patient had been put at risk because I did not have enough support for the treatment. Although I was able to get the patient back in bed, I would say the result was quite unsafe.

Evaluation

In planning this treatment session I had not assessed to risk of the transfer thoroughly enough. This resulted in an unsafe treatment session. I could have minimised the risk of injury to myself and the patient by more closely assessing the patient’s cognitive state and further investigating what had happened on previous occasions when the nursing staff had attempted to get her out of bed. I think if I had better forward planning and a more thorough prior assessment of past interventions with this patient I could have better managed the risks of treating such a patient.

Strategies

I need to more thoroughly assess the patient’s notes. In this case the nursing staff were having particular trouble mobilising this patent, so I should have further investigated this in person with the staff.

Communicate more readily with other HCPs from other disciplines.

If in doubt I will not hesitate to ask for assistance.

I need to improve forward planning. I need to visualise what I need to do and what the patient might be like before seeing the patient. I think this will improve, the more experience I get.