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Five Simple Steps for Treatment of Spasticity with Botulinum Toxin (BoNT) | Pharmacy QI | Mar 2020

March 2020 | Practical Tips for Quality Improvement | View PDF

  1. IDENTIFY
    Use RAI-MDS* tool to identify candidates for spasticity assessment. PSW** can assist nurse in identifying
    candidates.
  2. REFER
    Nurse communicates need to the attending physician. The physician signs the referral to specialist for spasticity assessment.
  3. ASSESS
    Specialist assesses resident and obtains informed consent to treat.
  4. TREAT
    1. Medical Pharmacies provides botulinum toxin (BoNT).
    2. Spasticity nurse educates, prepares the injections.
    3. PSW ensures the resident is ready for the treatment.
    4. Specialist injects BoNT.
  5. FOLLOW-UP
    Multidisciplinary approach (e.g., PSWs, Physiotherapist). Specialist provides functional assessment 3–4 months post-injection.
QI Tips

Candidates for a spasticity assessment will have restricted joint motion or spasms that may also lead to:
• Pain and discomfort
• Difficulty dressing or performing daily hygiene
• Wound or ulceration
• Difficulty with movement or positioning in bed or chair

A neurologist or a specialist in physical medicine and rehabilitation (physiatrist) is able to diagnose spasticity through a physical examination and an evaluation of a resident’s medical history. Medical Pharmacies can facilitate your access to spasticity specialists.


* RAI-MDS: Resident Assessment Instrument-Minimum Data Set

** PSW: Personal Support Worker

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