Physical Therapy

Written by Polestar Pilates Rehab Practitioner Lorna Jarrett MS, LPTA, AIB/VR-CON, NCPT

Do you have an incident reporting system in your studio?

How safe are your instructors when taking in new clients alone? We can glean insight from patient safety interventions practiced in hospitals and ambulatory settings. One solution is an online universal portal, which can be used for incident reports of misses and near misses. It also captures recommendations for improvements. An online example is the Agency for Healthcare Research and Quality (AHRQ.gov).

Thinking about safety, how safe are grippy socks when working with a client with gait dysfunction? Just as ill-fitted socks in the hospital can be hazardous, I have found them to be hazardous, as the feet can slide within the socks preventing solid footing. I switched one client to socks with toes to avoid her feet sliding within the socks. These are the types of discussions that could be shared across a national platform.

These days our practitioner roles reach beyond minimum exercise planning and include meeting the extensive needs of the client.

Every year when we renew our liability insurance, we’re reminded of this truth. From the beginning, the administrative intake should focus on assuring that clients receive the care they need and prioritize identifying those who are not receiving proper care. Staff meetings and managing the practice population are priorities. An objective of meetings is to create an opportunity for team input and build a culture of buy-in and involvement to address the evolving needs of the clients (Wachter & Gupta, 2018). One of those evolving needs is patient/client safety.

A studio practitioner may view this information as only for an inpatient or outpatient medical setting. However, client safety should be a concern for our studios just as patient safety is a concern for hospitals or outpatient settings. If our outcomes were publicized as hospitals were, what kind of changes would we be willing to make? I will discuss solutions suitable for large organizations, however, the information can be tailored for any size organization, as the stakes for safety are equally as high.

Key steps would include: making a commitment to performance improvement, reviewing root cause analysis of misses or near misses to direct improvement, presenting analysis to the team or board to execute the plan, selecting appropriate tools suitable for the organization, generating an in-house marketing plan to support the initiative, naming leaders and stakeholders, establishing training curriculum and materials, determining an ongoing training schedule, and empowering safety coaches to mentor and foster changes in staff, patients, and the community (Brilli, McClead, Crandall, Stoverock, Berry, Wheeler & Davis, 2013).

The leaders of the safety system would include those who are empowered and educated to provide oversight and input into the areas of quality control, risk, compliance, and IT. A vigilant, emboldened team is needed to implement a safety system and any cultural change (Wachter & Gupta, 2018). One such method to embolden a team can be seen in establishing medication safety champions to model and point out positive and negative safety practices within the organization. (Brilli, McClead, Crandall, Stoverock, Berry, Wheeler & Davis, 2013; Wachter & Gupta, 2018). 

Safety Tips for the Pilates Studio

1.    View the facility from curb to front door and assure that there are no safety obstacles. Initiate the conversation with your patient/client regarding their home safety and community ambulation when necessary. Have resources for referral, such as a certified NAHB Aging in Place Specialist who can review their home and make recommendations for ADA compliance.

2.    Our Pilates programming should support and promote dynamic functionality outside of our space.

3.    Establish an incident reporting method within your studio without punitive repercussions. Our studios can learn from large medical organizations who have found that anonymity, along with recommendations for improvements, encourages reporting. The data collected is discussed regularly and provides a learning opportunity for all.

4.    Create a team culture of open communication. This takes mature leadership, and while it is not developed easily, it must be an organizational objective.

5.    Do a curb to front door observation, and then check from front door to each piece of equipment. Remove items on the floor that are not adhered to the ground i.e. half foam rollers, rugs, etc.

6.    With the flu, coronavirus, or airborne infections or viruses, utilize hand sanitary measures and ventilate the studio with fresh air once a day.

7.    Establish a safety program within your studio. Latest research can be shared with clients/patients to educate them and empower them to play a role in their own safety.

8.    Create a Fall Risk Screen for your studio:

• Do you use any assistive device to ambulate?
• Do you need any physical assistance with standing or walking (ie, walker, cane)?
• Do you have periods of forgetfulness or don’t know where you are at times?
• Have you had a fall in the past 6 months?

Whichever patient safety approach is taken or whatever risk mitigation is at the forefront, the ultimate objective is to be an organization of high reliability (Chassin & Loed, 2013). 

References

Brilli, R. J., McClead, Jr., R. E., Crandall, W. V., Stoverock, L., Berry, J. C., Wheeler, T. A., & Davis, J. T. (2013, December). A comprehensive patient safety program can significantly reduce preventable harm, associated costs, and hospital mortality.The Journal of Pediatrics, 163(6), 1638-1645.

Chassin, M. R. & Loeb, J. M. (2013). High Reliability Health Care: Getting there from here. The Milbank Quarterly, 91(3), 459-490.

Wachter, R. M., & Gupta, K. (2018). Understanding Patient Safety. [3rd Edition]. McGraw Hill: New York, NY.Surveys on Patient Safety (n.d.). retrieved from https://www.ahrq.gov/topics/surveys-patient-safety-culture.html