REHABTech conducts clinical, technical, engineering and information technology services with a number of collaborative centres.
It does this with the financial assistance of REHABTech Supporters.

REHABTech Quick find Choose... REHABTech home Calendar of events Australian Employment Services REHABTech publications Research Staff Education & Training ------------------------- Site updated : 26th August, 2008

This course has been held in a number of places around the world including the USA, Hong Kong and Australia.
It has been conducted in part using videoconferencing and has also been customised for single facilities, Technician programs and Prosthetic and Orthotic tertiary programs.

Aim
The aim of this workshop was to provide prosthetic and orthotic practitioners  as well as technicians with a clear overview of the material science that governs aspects of clinical & technical principles.
This will give an understanding of what can go wrong and how to avoid it !
By understanding the clear scientific reasons behind these practices, patient safety can be maximised and failures can be minimised.
This course is part of the overall quality process that is in place to ensure the best outcomes for your clients.

What you will learn:

•     You'll learn the main problems with O&P devices that result in malpractice litigation.
•     Find out what triggers litigation, how to avoid it, and what to do to defend yourself against frivolous claims.
•     You'll learn proven methods to maximize the structural integrity of a prosthesis or orthosis, without adding excessive weight or bulk to the device.
•      You will understand the basics of current ISO Standards, now mandatory in  many countries, and the impact of such regulations on your practice in the future.
•      The course is worth  PCE (AAOP) credits.

   Bill Contoyannis, MBE - REHAB Tech
  John Michael, MEd, CPO, FISPO, FAAOP
 

Program
If you are a supporter or have attended this course, and cannot access these presentations, please email here!

	TOPIC	Content	Resource
	Introduction to Course	What are course objectives and the delegates expectations? The course will address the material science aspects of ensuring quality practice as well as cover the some system aspects of the quality practice. We then focus on material science and issues affected by material considerations. This includes: Manufactured components Custom fabricated devices What's the theory behind what the P&/or O does?  We will simply cover / explain some of the theory behind what the clinicians "intuitively" know. Finally. . this course will focus on the details of the device, both the bits we use and the bits we make and how we can influence what we do with these to minimise failure and litigation.	Introduction
		Systems that we have in place in P&O to maximize Patient safety
	Introduction to Quality Management in P&O Design	This looks at overall Prosthetic and Orthotics practice and design.  Are we including principles of quality management of overall systems?  How they are applied, what  do they involve? We cover breifly CQI -Continuous Quality Improvement and / or (TQM) Total Quality Management.  Are we thinking about what we are doing in all aspects of the treatment/ service cycle. - from scheduling the client visit through to training the client with their device back through to scheduling the client visit! (a complete cycle) Why do we do things a certain way? Is it because that's the way we've always done them?, or is it because we are improving on how we used to do it? ....or because we were sued and therefore have to change?!?!  We can cover other aspects of the system (info management, recall notice, benchmarking of the other aspects of practice  another time, but may touch on them briefly.	Introduction to Quality Management
	Contemporary Standards for P&O Design	What standards are relevant to P & O practice? [ISO 9000, ISO 10328, K-levels]  Systems and standards covering P&O including  ISO 10328, ISO 9000 (series)- K0 -K4 activity levels.  (Terminology) Do we know the standards covering the components we use?  Can we know how they are used, can we predict what will happen, how often they should be reviewed?  We know what they've been designed for and for what conditions of use, so how do we apply this?	Standards a list of standards relevant in P&O
	When Things Break: Malpractice Litigation	Live presentations on malpractice cases. Questions - (Good thought provokers!)  Has anyone been sued? Yes - EVERYONE is affected indirectly due to -premiums etc  Does anyone die due to poor P or O practice?  Yes - indirectly  Does something need to fail for a client to take action? - Not structurally, only a failure of system.  ABCD Most commonly, a lack of information/understanding seems to be the reason for new lawsuits.	When Things break  Failure review report  Cases Fracture (Pyramid) Functional Hazard alerts
	Avoiding & Defending Malpractice Suits	Principles for avoiding and defending!! Systems that help,	Avoiding and defending Maximizing component service life  Sample acknowledgment form Protocols for use of Unknown or beyond weight limit components
		The science behind maximizing patient safety.
	Introduction to Materials Science: Prosthetic & Orthotic Components	What's the theory behind what the P&/or O does. We will simply cover explain some of the theory behind what the clinicians "intuitively" know. The first session looks mostly at the components we use (and we will do the theory and then apply it to the practical situation)	Introduction to Material Science
	Custom Made Structures in Prosthetics & Orthotics	The second session looks mostly at the practices that we have, particularly at the custom made/designed aspects of the devices (and again we will do the theory and then apply it to the practical situation)	Custom Manufacturing
	[Mechanical & Structural Theory]	Brief overview and the practical application. A refresh of fundamental structural theory and material properties. How are things designed and applied.  Elastic deformation, plastic deformation, yield point, ultimate tensile strength.	Mechanical & Structural Theory
	[Types of Stress]	What are the overall stresses involved in the use of these devices. Which are the critical ones. Can they be avoided? How can we maximise use, while minimising the potential of failure. Stress, strain, shear forces, shear strain, torque.	(as above)
	[Moments of Inertia]	What is the moment of Inertia (second moment of area) and how do we apply it to maximise the efficiency of what we do in terms of improving strength, durability etc of the devices we design.  This is the shape strength factor. It defines the strength of the device based on shape rather material.	Moment of Inertia
		The science of mass produced commercial components.
	[Stress Concentrations]	What are they and again how do they influence.	Stress Concentrations
	[Types of Failures]	In terms of the material science, (not system failures)The types of things that go wrong - structural and functional	Failures Process for checking Service fault and Breakdown form Failure reviews on line
	[Fatigue]	What is the influence of fatigue on failures. How do we determine this influence and how does it relate to the common activities of our clients.	Fatigue
		The science behind custom fabricated components.
	[Composites Theory]	Applying the theory specific to these combined with the mechanical theory of the first day, how should we be doing the custom designed parts of any device.	Composite Theory Laminated Socket properties Bo Klasson article
	[Thermoplastic Theory]	Applying the theory specific to these combined with the mechanical theory of the first day, how should we be doing the custom designed parts of any device.	Thermoplastics
	[Common Failures in Custom P&O Structures]	Alignment, work hardening, mix and match, and general assembly and disassembly techniques. Why the practice contributes to the problem and how we can make it such that the practice improves it!	Common Failures and practices
		Putting the science into practice
	Assembly & Disassembly Theory	A critical overview of things to consider from assembling a new device, to reviewing an existing, to pulling apart and discarding a device. Inspection techniques	as above
	Common Failures in Custom P&O Structures]	Alignment, work hardening, mix and match, and general assembly and disassembly techniques. Why the practice contributes to the problem and how we can make it such that the practice improves it!	failure review failure database
	Case Studies: Failures of P&O Devices - Part I	Practical application of material science theory, how it helps avoid problems.	Cases
	Case Studies: Failures of P&O Devices - Part II	Cover component failures that have been brought in (cases can come in any way!) Hopefully a lot of what we discussed can already be applied. HOWEVER it is now hoped that intelligent questions will get asked!. Service fault and breakdown report forms	Service fault form
	Fatigue	How do we avoid fatigue failure! uhmmm how does the TechGUIDE help??? How do we determine the fatigue influence and how does it relate to the common activities of our clients. How can we set parameters for it. CAn we measure it using things like the StepWatch	TechGUIDE Inspection Interval Calculation
	The Practical Role of the material science Part I	Basically an overview of what's been covered theoretically and how we translate that practically, particularly in mass produced devices. Looks at using metals, alloys. Drilling bending etc	Practical Role of material science -overview
	The Practical Role of the material science part II	Basically an overview of what's been covered theoretically and how we translate that practically, particularly in custom fabricated devices. Looks at using thermoplastics and fibre/resin laminations. Practical review of custom manufacturing techniques and processes
	The Practical Role of Quality Management	Quality Management - device considerations, client considerations, 'tools' for a quality practice - Basically an overview of what's been covered and how it should fit into the overall quality management process you should have in place.	Practical Quality application for patient safety - overview Patient Information tool (read the Help section)
	Dual Issues Amputee obesity and the current popularity of lightweight prostheses	Presented at the 2004 AAOP meeting, this  presentation  investigates the obesity trend and how best to manage it whilst considering the safest  options for the patient.	Amputee obesity and the current popularity of lightweight prostheses
		Recommended reading and resources
		Must read:  Bo Klasson article - P&O Int Aug 1995 vol 19 No 2 pg 74- 91  Strength of Materials in O&P design - Thomas R Lunsford - AAOP  Must read:Chapter 1, 5, 6,8,9 Recommended: Chapter 7  Not vital: Chapter 2,3,4 Other reading: "Lawsuits against Practitioners are on the rise" Graff,J. O&P Almanac, September 1998 p33 "Preventing Patient Lawsuits" Chasen, A., O&P Almanac, September 1997 p49 "How to minimise Claim exposure" Grosse E., O&P Almanac, June 1992 p61 "Outcome Measures: Moving from Theory to practice" Polliack A., September 1997 p85 Web References: Medical Devices Directorate (UK) Guidance Notes for manufacturers of Prosthetic and Orthotic devices - EC Medical Devices Directorate Prosthetic and Orthotics Newsletter A Claiming and Blaming Society-TV Documentary

 

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