Authors (including presenting author) :
So WS(1), Po YT(1), Ku WNH(1), Kong SBB(1), Cheung SF(2)
Affiliation :
(1)Occupational Therapy Department, Yan Chai Hospital
(2)Clinical Service Department- Medicine, Yan Chai Hospital
Introduction :
Continuous ambulatory peritoneal dialysis (PD) is a commonly used renal replacement therapy for patient with end-stage renal failure. Increased incident of peritonitis can be resulted by poor connection technique (Lok et al. 2019). Reduced upper limb strength and hand dexterity also lead to difficulty in self-care PD tasks such as operating the clamp or minicap and failure in lifting up the bag to designated place. Patient with difficulty in self-care PD would be referred to Occupational Therapy (OT) for assessment and prescription of PD connection devices when indicated. A new OT clinical pathway was developed with the combination of PD connection device prescription and upper limb and hand function training program to empower patient on self-care PD and increase efficiency of OT service.
Objectives :
(1)Identifying the functional impairment and needs of patient on self-care PD
(2)Setting up a triage system to provide personalized OT service
(3)Promoting patient’s independence of self-care PD
(4)Increasing efficiency of OT service
Methodology :
All new patients who needed to perform self-care PD except (1) patients with age below 50 and not diagnosed as diabetic mellitus (2) patient with helper in PD and (3) old age home resident would be referred and assessed by OT. A comprehensive set of upper limb and hand function assessments combined with simulated critical task assessments including manual lifting, connection of Ultrabag transfer set, management of clamp and performance component assessments including pinch strength, hand grip strength and hand dexterity (nine-hole peg test (NHPT)) would be conducted. After OT assessments, patients would be triaged into three groups: 1.Direct prescription of PD connection device 2.Upper limb and hand function training program 3.No immediate need of OT service, continue usual nursing care.
Result & Outcome :
From June 2020 to November 2020, following the clinical pathway, 20 patients were recruited. Two patients were triaged for direct PD connection device assessments and prescription, six patients for upper limb and hand function training program.
On 30th November 2020, four patients had completed the program and two patients were still receiving training. After the training, their upper limb and hand function were improved (Right: Power grip 20.5%, Tripod Pinch: 12%, NNPT: 0.9SD) (Left: Power grip 34.5%, Lateral Pinch: 9.5%, Tripod Pinch: 22.8%, Index finger pinch: 22.8%, NHPT: 0.66SD). Two patients were progressed to achieve 100% hit of the connection of Ultrabag transfer set independently. They successfully weaned off PD connection device. The efficiency of OT service was improved and patients have more time to familiar with the PD connection device.
