A Specialized Program for Prevention and Surveillance of Skin Abrasions During Aquatic Therapy for Patients With Spinal Cord Injury: A Successful Quality Assurance Initiative With Sustained Impact

Abstract

Background and Purpose: The primary objective of this research was to continuously improve the quality of aquatic therapy for patients with spinal cord injury (SCI) while reducing the incidence of skin abrasions using the PDCA (Plan, Do, Check, Act) system. The specific aim was to reduce the incidence of skin abrasions revealed by quality surveillance. Methods: Using the PDCA format for continuous improvement, a 3-phase program was designed and implemented. Phase I consisted of data mining. Phase II entailed the development of policy and procedures, and phase III consisted of education and implementation of the new policies and procedures. Results: Between 2010 and 2018, only 1.08% of all patients (N = 1203) were identified as having skin abrasions acquired during their aquatic therapy sessions. Of the total number of aquatic therapy appointments during that same time period, the incidence of skin abrasions was even lower, at only 0.08% (16 804). Discussion: 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 footwear became obligatory for ambulatory patients. Conclusion: Consistent communication, reporting, and tracking, combined with education and effective preventive measures, dramatically lessened the incidence of skin abrasions during aquatic therapy and using the PDCA system these outcomes can be sustained.