Implementation of Vital Sign and Activity Guidelines for the Outpatient Therapist

Abstract

Despite having training to assess vital signs (heart rate, blood pressure, and oxygen saturation), monitoring in outpatient therapy clinics is infrequent, and no guideline existed to support therapists. The goal of this project was to implement an evidence-based guideline in the outpatient therapy setting with the primary goal of improving patient safety by detecting asymptomatic, dangerously high blood pressure. With stakeholder involvement across the organization, an evidence-based vital sign guideline was created and implemented across the 25 Good Shepherd Penn Partners outpatient therapy clinics (occupational, physical, and speech therapy) over a three-year period. Competency completion, volume of guideline-appropriate medical event reports, and documentation of vital signs were used to measure success. The interventions were studied in a phased approach over a three-year period and included therapist education and competency, assessment of guideline application and utilization, and knowledge translation to clinical practice. All outpatient therapists (N=185) completed the guideline education and competency within the expected six-month time period. A statistically significant increase in the number of medical events was reported across outpatient clinics, from six preceding implementation to 66 after project completion (p-value=0.02). Upon project completion, therapists correctly applied the guideline 94% of the time. This project developed and implemented an evidence-based guideline to improve the consistency of blood pressure monitoring across our organization’s entire outpatient therapy service line. By substantially increasing blood pressure monitoring, we were able to proactively identify known or unknown abnormalities to positively impact patient safety in the ambulatory setting.