Explore the Latest Research, Treatment, and Leadership at the 2021 Rehabilitation Nursing Conference

RN2RN: Using Peer Review to Enhance Nursing Practice

Elizabeth Riepe, RN and Kristine Murphy, BSN RN CIC

Excellence and evidence-based care; is the goal of all nurses in their professional practice. Reviewing nursing practice through peer review fosters a continuous learning environment and promotes safety in culture. Nurses of the same rank collect care information, assess care against professional standards, and recommend to improve the practice.

Establishing a Culture of Nursing Excellence Through Nurse Empowerment at an Inpatient Rehabilitation Hospital: A Road Map for the Journey

Anne Hubling, DNP MHSA RN CPHQ NEA-BC

A culture of nurse empowerment is foundational to support excellence in clinical and patient outcomes. This presentation will describe the development of a culture of professional autonomy through unit practice councils and nurse manager engagement. The key drivers identified to create a culture of nurse empowerment include: shared leadership at the unit level, nursing dashboards, and nurse manager engagement.

Pandemic Prep: Cross-Training Interdisciplinary Staff for Rehab Nursing

April Schultz, MPH MSN APRN AGCNS-BC CRRN, and Vanvy E. Nguyen, MSN RN CRRN

During the early phases of the COVID-19 pandemic in Spring 2020, hospitals across the nation cancelled elective procedures and closed ambulatory clinics, resulting in a large pool of healthcare workers becoming available for redeployment to high-need areas. Our six-unit inpatient rehabilitation hospital system approved redeployment for ambulatory nursing staff as well as inpatient and outpatient therapists to perform various patient care duties that were traditionally performed by inpatient nursing staff. The Rehab Clinical Nurse Specialist and Service Line Educator created a cross-training program that was tailored to the clinical knowledge of redeployed staff and covered policies, procedures, equipment, and practices specific to inpatient rehabilitation populations. This presentation will review methods of cross-training and discuss both challenges and benefits of the experience.

Challenges Faced by the Rehabilitation Nursing Staff During the COVID-19 Crisis

Lilibeth DeClaro, BSN RN

This presentation will discuss the stressors encountered by rehabilitation nurses and other nursing staff during the surge of the COVID-19 pandemic. The implication of understanding the issues and concerns of nursing staff helped the nursing leader to provide support and identify the needs of the nursing staff in their job performance and confidence in the clinical area. Exploring their feelings alleviate feeling of uncertainty and enhance staff in preparedness in the event of future resurge of pandemic. As the Nurse Manager of the neurological rehabilitation unit, reflecting on my own reaction to COVID-19,and projecting positivity are my salient instruments in keeping the unit morale and improve their coping through the tough times. Its incredibly important that the nursing leader continuously encourages the nursing staff to practice self-care techniques. This presentation will also identify, strategies learned how to cope and increase resilience during staff response to COVID-19.

Improving Patient Access to Inpatient Rehabilitation Facility by Reducing Payor Denials

Lisa Larose, BSN RN CRRN CBIS, and Susan Kometz, MBA BSN RN CRRN CBIS

A process improvement to decrease commercial insurance denials thereby providing greater access to patients requiring Acute Inpatient Rehabilitation. This process resulted in the improvement of medical necessity documentation in the Pre-Admission Assessment by the Clinical Referral Liaison, with a reduction in initial commercial insurance denials. As a result of this process, the department implemented utilizing expedited appeals resulting in an increase in overturning Medicare Advantage denials.

Proactive Training and Implementation of a Pediatric Emergency Plan

Nicholette Andrews, NS SPRN PCNS-BC

The purpose of this case study is to discuss the approach used to create an emergency plan for a pediatric patient, who coded in the first 30 minutes of their initial admission. Pediatric codes are infrequent so staff were traumatized and fearful when they heard the patient was being readmitted after a short acute stay. This presentation will discuss how the Clinical Nurse Specialist worked with staff, nursing and Allied Health, to design a plan that proactively addressed risk factors which contributed to cardiac instability. The proactive approach and specific interventions concurrently reduced staff anxiety. In this presentation, we will discuss the customizable plan of care which was created to meet the unique needs of this patient. We will examine the situation and focus on prioritization of an intervention strategy. We will review how this patient offered the team a unique opportunity for collaboration and communication. We will also focus on the role nurses play when planning care for patients and families with special needs.

Educating Patients and Families: Determining Readiness to Learn

Donna Williams, MSN RN CRRN FARN

Rehabilitation nurses have the opportunity to educate patients and families with each interaction they have. Education may impact successful transitions to home and may also reduce risk of emergency room visits and hospital readmissions. Not all patients or families learn in the same way and short hospital stays may impact both the speed that education needs to be completed and the ability to accept or absorb the information presented. This presentation will discuss areas for nurses to assess in determining how and when to engage patients and families in task-specific education as well as how to determine a plan for providing information needed for long-term self-care and maintenance. Learning styles will be addressed and social and environmental factors will be explored. Options to enhance the learning experience will be discussed.

Providing Education During the COVID-19 Pandemic: Challenging Opportunities and Creative Solutions

Ann Gutierrez, MSN RN CBIS CNRN CRRN RN-BC FARN

As the COVID-19 pandemic hit with its intensity and volume, many challenges arose for clinical nursing educators causing them to re-examine how to provide education for staff. As the need to limit exposure to the virus became apparent and clinics and procedure rooms began to limit procedures and visits and ultimately cancelled all not emergent surgeries, there became the need to cross-train staff from these areas to help to meet the care needs of the inpatients. Also there continued to be the need to provide orientation for new staff an, ongoing education to current staff on all of the new changes that were occurring on a daily basis, and to continue to provide continuing education to meet staff needs.

In order to provide the needed education, the clinical nurses educators faced many challenges that had to be overcome. Some of these challenges were social distancing, need for proper PPE, classroom space, need for a different format, i.e. technology. The clinical nurse educators began to explore different ways to meet the many challenges that they faced on a daily basis and came up with creative solutions to be able to provide cross-train staff, provide orientation for new staff, and also provide ongoing and continuing education for nurses.

Staying Connected: Caregiver Training on a Brain Injury Unit During COVID-19 Restrictions

Carolain Paredes Gallegos, BSN RN CRRN, and Margorie Valle, MSN RN Medsurg-BC, CRRN

During this presentation we will discuss the interventions the ABI Nurse Educators implemented to ensure family and caregiver training continued during the COVID-19 pandemic restrictions. Family and caregiver training are important to ensure that our patients are discharged safely to the community. At our facility, we believe that education starts on day one. With the COVID-19 pandemic restrictions in early 2020, our facility, like many others, chose to restrict visitors to prevent the spread of COVID to our patients. This meant, things like education and social time for our families and caregivers had to be done remotely.

Anosognosia for Hemiplegia After Stroke

Elizabeth Byrd, PhD RN CNS; Christianne Strang, PhD MA BS; Xiaofei Qiao, PhD MPA; Rebecca Miltner, PhD RN CNL NEA-BC; Lori A. Loan, PhD RN FAAN; and Rita Jablonski, PhD CRNP FGSA FAAN

Inpatient falls on acute stroke rehabilitation units remain a significant issue that negatively affects healthcare costs and causes physical and psychological injury. The prevalence of falls in the stroke rehabilitation population may be due to the presence of anosognosia for hemiplegia (AHP), which is an unawareness of physical disability. Though the link between AHP and falls has been suggested in the literature, a formal investigation has not been conducted to address the relationship between the variables. To explore the association between the presence of anosognosia for hemiplegia after stroke and patient fall events while admitted to an inpatient rehabilitation program. A prospective, correlational research design was utilized. Logistic regression analysis was then performed between a priori variables. The Visual Analogue Test for assessing Anosognosia for motor impairment (VATA-m) was utilized to assess for AHP.

Case Management for Southwestern Hospice Organization

Christopher Rumsey, DNP JM MBA CHPN NEA-BC

RN-Case Managers are inadequately prepared to care for patients requiring hospice and palliative care (home-based care). This leads to inadequate delivery of home-based hospice/palliative care. Reasons include inadequate curriculum, along with a lack of structured education related to hospice/palliative care and symptom management. This leads to inadequate delivery of home-based hospice/palliative care management. The SWHO triage call line received 321 calls for urgent patient-related hospice/palliative care needs during off-hours for Q2FY19, putting significant strain on the caregiver and exemplifying less than optimal patient planning and care. With needed improvement determined and simulated education identified as an optimal learning tool, an initiative was developed and launched by SWHO leadership. Given SWHO current afterhours home hospice/palliative triage call volume, does simulated hospice and palliative RNCM education for nurses when compared to current standards alone improve quality patient care?

Sleep Self-Management of Older Dyads Using a Wearable Personal Sleep Monitoring Device

Cynthia Jacelon, PhD RN CRRN FAAN; Sara Mamo, AuD PhD; Sarah Fiske, PhD(c) MS RN; Raeann G. LeBlanc, PhD DNP APRN; Maral Torossian, PhD(c) MS RN 

Normally occurring changes in sleep patterns can affect behavior, safety, and function in older individuals. In addition, altered sleep of these individuals can affect the functioning of their partners and lead to fatigue and diminished functioning of both members of the pair. We tested an intervention using personal sleep monitoring devices (PSMD) with dyads comprised of individuals who were 70 years old or older, and slept in the same house. Aims: 1) Establish the feasibility of sleep self-monitoring using PSMDs, to improve sleep patterns of a dyad of older individuals. 2) Establish the feasibility of PSMD data sharing among members of the dyad to improve sleep self-management, and 3) Evaluate the usability of PSMDs and data sharing for dyads of older individuals. Over the course of a five-week trial, we used a mixed-methods approach. Data included daily sleep diaries, data from the PSMD, weekly questionnaires regarding sleep patterns and function, and qualitative interviews focused on sleep, self-management within the dyad, and the usability of the PSMD. Depending on the type, data were analyzed using qualitative and statistical methods. Findings indicated that use of the PSMD increased awareness of sleep patterns at the individual and dyad levels, but that the limitations of the PSMD were frustrating at times. Participants valued being able to have a graphic image of how their daily activities affected their sleep patterns. We determined that the dyadic approach was effective in improving sleep patterns for older individuals and that using over-the-counter activity monitoring devices could provide a relatively inexpensive way to assist older adults to improve their sleep self-management. These findings have positive implications for employing technology to improve the self-management of individuals. Research reported here was supported by the National Institute Of Nursing Research of the National Institutes of Health under Award Number P20NR016599.

Collaboration and Goal Setting with Chronic Complications of Brain Injury

Amanda Murray, BSN RN CRRN

Inpatient rehabilitation nursing staff are typically very well-versed in the management and care requirements for patients with acquired brain injury. However, when nearly a year has passed since the initial injury without necessary evaluation or intervention, problems such as skin breakdown, contractures, and activity intolerance become much more difficult to address. Managing the behaviors of the patient and engaging an unmotivated caregiver can make this process even more challenging. Interdisciplinary collaboration and communication are doubly vital in ensuring the best outcomes possible. For a patient presenting with these barriers to care, nurses partnered with physical therapy to measure and apply effective pressure relief in the bed and wheelchair, including proning the patient despite extensive contractures. Nursing also worked closely with the ethics team and the care manager to reestablish family trust and rapport, enabling caregiver participation and education to facilitate a home discharge. Collaboration with the medical team and wound nurse were essential in treating chronic wounds. This case study exemplifies the unity between disciplines when caring for a patient with chronic complications from a brain injury.

Paroxysmal Sympathetic Hyperactivity (PSH): A Rehabilitation Nurses’ Guide to Assessment and Treatment

Tiffany LeCroy, MSN RN ACNS-BC CRRN FNP-C FARN, and Sumier Overcash, MSN RN CRRN

Paroxysmal Sympathetic Hyperactivity (PSH) is a disorder where a series of signs and symptoms reflecting exacerbated sympathetic activity may be present including tachycardia, arterial hypertension, tachypnea, hyperthermia, diaphoresis, and increased posturing. PSH is not a primary disorder but is secondary to brain injury. PSH has been described and reported in literature as early as the 1950s and may affect 10-20% of patients with severe brain injury. The symptoms of PSH are often misunderstood or overlooked by healthcare professionals that do not have brain injury expertise. Delayed recognition and uncontrolled symptoms of PSH may lead to secondary brain injury or even death. In addition, when PSH is unrecognized, unnecessary testing and treatment for other conditions may result in increased medical cost. Literature suggests that the duration of PSH is variable with most cases having onset within weeks of the brain injury with episodic symptoms lasting up to one year. Therefore, it is imperative that rehabilitation nurses working in the inpatient setting throughout the continuum are familiar with the signs and symptoms associated with this diagnosis, as they play a vital role in the assessment, recognition, and treatment of PSH. The Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM) is an evidence-based tool developed in 2014 that may be used to diagnose and guide treatment. This presentation will provide an overview of PSH and review a case study where the PSH-AM tool was used to diagnose, treat, and guide nursing interventions in the inpatient rehabilitation setting.

Integrating Best Practice Strategies For Bowel Program Management On The Inpatient Spinal Cord Injury Unit 

Angela DaNeal-Johnson, BSN CRRN, and Cecelia Williams, RN CRRN

The Spinal Cord Injury (SCI) team at Baylor Scott and White Institute for Rehabilitation-Dallas developed a plan to integrate best practices for bowel management of multiple patients on the inpatient SCI unit. The goals were to educate nursing staff on best practices, improve collaboration between SCI professionals on the care team, create opportunities for individualized patient-caregiver education, and produce successful bowel management outcomes for the patient. This presentation will serve a guide for inpatient rehabilitation teams to utilize a unit-based bowel program schedule for organizing successful patient outcomes.

'Bee Continent'—A Team Approach to Continence in the Acute Rehab Setting

Tina Roma Fisher, MSN RN CRRN FARN, and Shannon Miller, RN BSN CRRN 

This presentation will describe how an acute rehabilitation setting used an interdisciplinary approach to continence management with their patients. We had to address orders, documentation, communication and consistency. We involved the units shared governance council to help achieve our goal.

Using Quality Index Measures to Predict Falls and Individualize Interventions on An Acute Rehab Unit

Margaret Gulledge, OTD OTR/L; Jolaolu Jimoh, PT MEd; Renee Tokarczyk, MSN CRRN; and Adel Elmaghraby, PhD

This presentation describes a project using IRF PAI Quality Indicators to predict the likelihood of falling on an inpatient rehabilitation unit. A computer generated artificial intelligence model was used to create a prediction tool which identified risk for falls as well as specific contributing factors for each individual patient. This tool also identified patients unlikely to fall on the unit. This tool will be used to to create individualized plan of care and interventions to reduce falls and identify strategies to increase functional independence.

Nursing Assessment and Management of Agitation after Traumatic Brain Injury in an Inpatient Rehabilitation Setting

Conitra Williams, DNP-RN CRRN 

Annually, at least 1.7 million traumatic brain injuries (TBI) occur in the United States. The pathophysiology of TBI is complex in nature and results in physical, neurological, and psychosocial deficits that often require inpatient rehabilitation to overcome a life-long disability. Agitation is particularly evident in TBI patients and increasingly seen in inpatient rehabilitation settings. It can put the patient and others at risk for harm, and interrupt progression in rehabilitation, hindering recovery. It is important to assess different aspects of agitation for proper management. The Agitated Behavioral Scale (ABS) was proven to be a reliable and efficient tool to assess agitation. In addition, a behavior management algorithm was developed to serve as a guide in preventing agitation. A pilot program was initiated, in which the ABS and behavior management algorithm, was implemented by nursing for a 6-month trial at the Methodist Rehabilitation Center TBI unit. The participants were men and women 18 years of age and older diagnosed with a TBI. Diagnoses excluded were aneurysms, tumors, strokes, and neuropsychiatric illnesses, as well TBI patients on another unit. A total of 14 patients were included, only 5 had signs and symptoms of agitation occurring mostly among men. Thirty-three agitated episodes occurred with the majority,13, occurring on 3pm-11pm shift. The severity level of the agitated episodes was classified by the ABS as 4 (12.12%) mild, 13 (39.39%) moderate, and 16 (48.48%) severe. The most severe episodes occurred on 3pm-11pm shift. Touch, altered sleep patterns, and urinary retention were the most identified antecedents. Decreasing stimuli was the most used intervention and had 71% efficacy. Family assisted calming patients with 100% efficacy. A survey was given to the nurses and 63% thought the ABS and TBI Management Algorithm was useful and effective, while 100% of nurses thought both should be implemented into daily practice.

Sinking Skin Flap Syndrome: A Rehabilitation Nurses’ Guide to Recognition and Management

Tiffany LeCroy, MSN RN ACNS-BC CRRN FNP-C FARN, and Liv Nyankori, BSW BSN RN CRRN

Inpatient rehabilitation nurses specializing in brain injury often care for patients who have undergone a decompressive craniectomy (DC) in the acute trauma phase of care. A complication of DC, less familiar to the rehabilitation nurse, is sinking skin flap syndrome (SSFS). SSFS is defined as neurologic deficits with concave deformity and relaxation of the skin flap which tends to develop several weeks to months after a craniectomy which may present in the rehabilitation setting. Although SSFS is widely reported, the literature mostly consists of case reports. Therefore, the exact number or percentage of post craniectomy patients experiencing this syndrome is unknown. This syndrome is noted to have several potential causes: atmospheric pressure changes of an unprotected brain, cerebral blood flow disturbance, and cerebral spinal fluid circulation abnormalities which may negatively impact the patient. It is imperative that rehabilitation nurse can recognize neurological changes associated with SSFS, and initiate identified nursing interventions to support a favorable patient outcome. The purpose of this presentation is to provide an overview of SSFS, emphasizing the rehabilitation nurse’s role including recognizing neurological changes and implementing evidence-based interventions to prevent further medical sequela, coma or even death.

A Web-Based Clinical Decision Support Algorithm to Guide Interventions Post Indwelling Catheter Removal

Stephanie Yates, MSN RN ANP ANP-BC CWOCN

In an effort to decrease catheter-associated urinary tract infections (CAUTI), nurse-driven protocols have been established for removal of indwelling urinary catheters with the thought that "no catheter = no CAUTI." This session will describe the current literature and the process of developing a guide for the care of the patient after the catheter is removed. Participants will practice using the web-based algorithm with a variety of patient scenarios. 

Spasticity Symptom Clusters Trajectory in Stroke Patients

Rozina Bhimani, PhD DNP-APRN CNE CRRN, and Lisa Carney-Anderson, PhD

Stroke is a devastating illness that compromises mobility, function and quality of life. Post stroke spasticity is a significant challenge that impedes recovery. Spasticity, a neurogenic tight muscle is poorly understood and managed in clinical practice. Symptom of spasticity are accompanied with pain and fatigue experiences; however, understanding of spasticity as a symptom cluster is not available in the literature for stroke patients.The purpose of this study was to explore the trajectory of spasticity symptom clusters of pain and fatigue in stroke patients. UCSF symptom management theory guided the study. Using mixed-method design, twenty-two stroke patients were followed for 1-month. Spasticity, pain and fatigue were evaluated using numeric rating scores. Additionally, using NIH-PROMIS tools investigator collected the data on function and activities of daily living.

Spasticity Symptom Clusters and Functional Outcomes in Stroke Patients

Rozina Bhimani, PhD DNP-APRN CNE CRRN, and Lisa Carney-Anderson, PhD

Spasticity, a symptom of neuromuscular dysfunction can occur with other symptoms of pain and fatigue (referred to here as a symptom cluster) in stroke patients. Trajectory of symptom clusters in stroke patients on functional outcomes is unknown. The purpose of this study was to identify spasticity symptom cluster trajectory, and determine association between this trajectory and functional outcomes over time.This study uses the TEAM Study definition of functional movement where the patients could assist using their own muscle strength and control. This does not exclude the patient receiving assistance from staff or equipment. This observational, longitudinal correlational study, we recruited twenty-two stroke patients with symptom clusters within seventy-two hours of admission to a rehabilitation unit. The participants were followed for three-days in the rehabilitation units. After discharge, participants were followed for additional three-days and once after 1-month when discharge to home/community.

Dysphagia-Related Caregiver Burden Following Stroke

Samantha Shune, PhD CCC-SLP 

Caregiver burden negatively impacts both stroke survivor and caregiver well-being. Thus, it is important to better understand the individual- and dyadic-level variables that may contribute to dysphagia-related caregiver burden. The aim of this study was to identify survivor-, caregiver-, and dyadic-specific factors associated with burden in couples experiencing post-stroke dysphagia. A volunteer sample of 28 adult stroke survivors with dysphagia (mean age 60 years; >3 months post-stroke) and their spouses (mean age 57 years) participated in an online survey. The dependent variable was dysphagia-related caregiver burden and the independent variables included swallowing-specific quality of life; stroke impact (Stroke Impact Scale; SIS); dietary restrictiveness (based on consumption of texture modified food and drink); and survivor, spouse, and dyadic congruence of appraisal of dysphagia’s impact on the social aspect and logistics of mealtimes (e.g., socializing during meals; meal preparation). Increased burden was significantly associated with greater survivor- and spouse-perceived impact of dysphagia on the logistics of mealtimes, but was not associated with dyadic congruence of perceived impact. Increased burden was also associated with increased dietary restrictiveness and decreased swallowing-specific quality of life. Finally, burden was not associated with measures of stroke impact/severity. Ultimately, factors related to dysphagia-related caregiver burden are multifactorial and include both survivor (dietary restrictiveness, swallowing-specific quality of life, perceived impact of dysphagia on mealtime logistics) and spousal (perceived impact of dysphagia on mealtime logistics) variables. These results support the interrelatedness of stroke survivor and caregiver health and well-being. There is a need for rehabilitation professionals to focus on the lived experience of patients and their families in developing treatment plans and incorporate dietary education and counseling into stroke management to facilitate reduced burden for this population.

Care of the Complex Patient: Transition to Home

Meghan Kilpatrick, RN BSN CRRN, and Kristine Longo, RN CRRN

The care of a young complex patient with a brain injury poses many obstacles. Communication, emotional, and socioeconomic difficulties further complicate the process for the patient, family, and staff. Encouraging family involvement early on was vital to create a plan for home but was impeded by geographical distance, financial issues, and denial about severity of disability. With the support of nursing management, a team effort was coordinated that ensured a successful transition to home for this medically compromised young woman despite incredible barriers.

Making Seated Pressure Injury Prevention Your Business

Wendy Worden, APRN CNS CRRN CWCN

Between 2014-2016, there was a decline in all hospital-acquired conditions due to nationwide efforts except in pressure injuries. Despite the best standards of care, pressure injuries remain the most common secondary complication with nearly 1/3 of new spinal cord injury (SCI) patients developing a pressure injury while hospitalized. This presentation will focus on the case of a patient with a high- level SCI who developed a severe pressure injury during an often-forgotten seated activity, toileting. Multiple comorbidities were present including dual diagnosis with traumatic brain injury impacting cognitive carry over of instructions. Remaining seated for extended periods of time on the toilet or commode can lead to soft tissue deformation between the seat and pelvic bones increasing the risk for pressure injuries and deep tissue injuries. There is limited published evidence on preventing pressure injuries during toileting activities. This case led to a quality improvement project focused on prevention of toileting related pressure injuries. The project included: review of current processes and identified gaps for those admitted as high risk for pressure injury development, creation of a multidisciplinary algorithm for identifying at risk patients on admission, early involvement of occupational therapy in pressure mapping and implementation of appropriate support surfaces for toileting. Patient and family education is critical to successful pressure injury prevention as many patients on the Rehabilitation unit require lifetime seating support and skin assessment. During this project, the team identified two types of cushions that were acceptable for use with this protocol and 12 patients meeting criteria used the most appropriate cushion based on pressure mapping. As a result we were able to decrease the number of hospital acquired pressure injuries related to seating.

Who You Gonna Call? Standardizing Interdisciplinary Communication using Technology in Inpatient Rehabilitation

Kathryn Williamson-Link, MSN RN CRRN CNML; Anne Hubling, DNP MHSA RN CPHQ NEA-BC; Larissa Pavone, MD; Amanpreet Saini, MD; Beau Bigelow, MD; and Melissa Burns, PT DPT NCS

Technology in healthcare is on the rise, and communication among healthcare providers is faster and easier than ever before. Vocera text messaging technology was recently integrated into the care model at Marianjoy Rehabilitation Hospital, however no specific expectations or protocols were rolled out concurrently. When a message can be sent at the click of a button, it often is incomplete and does not contain enough information. In a review of the Vocera messages sent from nursing to the Resident on Call (ROC) Nearly 80% of them lacked important SBAR information and nearly 90% do not follow SBAR format at all. SBAR (Situtation, Background, Assessment, Recommendation) is a communication tool that encourages safe patient care because it includes all necessary detail and the request of the asker. If SBAR information delivered from nursing staff to the ROC, whom is often unfamiliar with the patients they are fielding calls and texts for, it can be challenging to know if there is an urgent/emergent situation happening with the patient. In addition, inappropriate Vocera messages can interrupt important workflow, lead to medical errors, and can contribute to physician burnout. A quality improvement project was developed using the DMAIC Six Sigma methodology. A baseline relational coordination survey was collected, as well as Vocera text during a typical call shift to steer improvement interventions. From this data, improvements were developed which included: proactive rounding for the primary team and ROC, a decision tree to standardize whom to communicate with and when, an SBAR template was launched in the text platform, and a set of Vocera etiquette standards were deployed as well. The aim of this project was to improve workflow for the resident on call, nursing, improve patient safety through improved communication, and provide standardization so providers know who to communicate patient issues with, and when.

Mindfulness Training of Rehabilitation Case Managers and Patient Response

Gail Sims, DNP RN CRRN FARN

Patients discharged from acute rehabilitation centers may experience stress in the transition to home. Nurse Case Managers (NCM) can impact this. This presentation is intended to share a quality improvement project was intended to determine if the implementation of McCraty’s HeartMath Resilience Advantage™ training program for NCM’s would impact the patients perception of their care on the Experience of Care (EOC) survey along with the Mindful Attention Awareness Scale (MAAS), in an acute care rehabilitation center in urban California. Watson’s caring theory provided the theoretical foundation. Using an independent t-test, results of the MAAS (n=15), pre-implementation revealed (M=3.56, SD=0.51, p= 0.00) and post-implementation revealed (M=4.57, SD=0.35 (t-value 7.88, p= 0.00), which was statistically significant in mindful awareness. Patient response to EOC surveys was a total of 115. Pre-implementation (n=49) of patients’ scores on courtesy and respect (M = 79.37, SD = 7.29) compared to post-implementation (n= 66) (M =88.56, SD=4.5, p= 0.14) were not statistically significant. Statistical significance was not found with the pre-implementation (n= 49) patients’ scores of understandability of information (M = 77.78, SD = 7.26) compared to post-implementation (n=65) (M =83.42, SD=3.79, p= 0.30). However, clinical significance was noted and recommendations were to sustain and expand HeartMath™ and educate others to utilize mindfulness techniques. This presentation is intended to provide evidence to support the implementation of mindfulness techniques by participants attending this session and promote implementation of training for other departments, patients, and their caregivers across the continuum.

Surfactant Based Gel Efficacy and Cost-Effectiveness When Used for Wound Healing in the Rehabilitation Setting

Michelle Martin, CRRN CWON

Many rehabilitation patients have wounds requiring debridement. Debridement is the removal of dead or necrotic tissue in a wound bed. This is crucial for the wound to move into the proliferative stage of wound healing. The two main options for debridement in the rehab setting are Enzymatic (use of concentrated enzymes to break down necrotic tissue) and Autolytic (use of the body’s own enzymes and white blood cells to break down necrotic tissue often in conjunction with gels/ointments to aid the process). Enzymatic debridement can be somewhat uncomfortable for the patient, labor intensive (requires daily dressing changes), and is often expensive. Autolytic debridement with use of a surfactant based gel has been shown to address these issues.

Long-Term Sequelae of Guillain Barre Syndrome: A Rehab Nurse's Story

Margaret Williams, PhD FNP-BC RN CRRN FABDA FARN

As rehabilitation nurses, we often care for patients with neurological disorders in the acute care setting. But, what happens after discharge? What issues may present themselves even years later? Forty years ago this author was diagnosed with Guillain Barre syndrome (GBS). After about 1 1/2 years it seemed that recovery was complete. But, then one problem presented itself and now 40 years later, another problem came to light, probably related to the history of GBS. As an experienced rehab nurse, shouldn't the problems have been recognized? Maybe this story of long term sequelae after a neurological disorder will help rehabilitation nurses provide anticipatory guidance to their patients with certain neurological disorders concerning long term management, recommended follow up with primary care and specialists and how certain common medical problems may be seen in a different light if a patient has a history of a neurological disorder. Some potential management options that may not be well known will also be discussed.

The Continued Care of the Covid Patient on the Rehab Unit

Susan Brindisi, RN MS Ed MA MSN CRRN

In the Fall of 2020, our hospital was mandated by the governor to increase bed capacity for a potential covid surge by 50%. This was six months after our rehab units had converted back from covid med surge units. For the second surge, one, not both of our two 25 bed units was converted to a COVID med surge unit. The second unit was charged to combine SCI and TBI patients. Since December 7, our rehab nurses have applied best practices to the care of the COVID med surge patient. While COVID is not a chronic health problem, it is an acute illness requiring nursing goals and interventions that rehab nurses regularly apply. Proning, for example, in the intensive care unit for the management of acute respiratory distress syndrome is an accepted standard of practice (Francisco, et. al, 2021).

My Patients Are In Pain. How Can I Help?

Amy Elizabeth Koyle, PT DPT MBA MHL PhD

Pain control is essential to allow rehab patients to be successful in meeting their functional goals, participate in self-care, therapy sessions and discharge home safely. But what do you do when your patients are limited by pain, refuse to get out of bed, attend therapy or cannot find pain relief through pharmacological means? What if they are limited in the types of prescription or non-prescription medications they can have? This presentation will provide an overview of pain, non-pharmacologic treatments and ways you can implement some of these ideas in your rehab to decrease patient-perceived pain levels to improve patient outcomes.