For his 540 job aid project, Paul Heidenrich addressed a need for medical staff to perform a procedure called iontophoresis. In the next paragraph, Paul explains the challenge and why he chose to use a job aid to support performance. At the bottom of the page is part of the final job aid he created.

Iontophoresis is a non-invasive procedure that delivers dexamethasone (an anti-inflammatory medication) into tissue. It is used as an alternative to cortisone injections for treatment of localized inflammatory conditions. Bursitis and tendonitis are common diagnoses for which this type of treatment is ordered.

At San Diego Rehabilitation Institute's Hand and Upper Extremity Program, iontophoresis (ionto) is ordered sporadically by referring physicians. The treatment is administered by both Occupational and Physical Therapists, whose degree of skill level and experience vary tremendously. The existing owner's manual for the ionto unit is large, contains excessive technical information about ionto transfer and provides scant information on how to operate the machine. Inexperienced therapists find little use in the manual because it doesn't support day to day use of the unit.

Due to the peculiarities of the ionto unit itself, its infrequent use, and the variety of therapists who may administer it, I proposed a job aid to standardize and simplify this procedure.

The goals were:

1. Create a resource for therapists that will organize the procedure in a simple step format.

2. Cue therapists to possible contraindications and precautions by way of achecklist.

3. Facilitate consistent, timely delivery of ionto with less likelihood of error.

During

1. Describe procedure to patient:
   • Ionto is a non-invasive alternative to cortisone injections for reduction of inflammation.

   • A small battery generates enough electricity to drive medication from an electrode into tissue.

   • Itching and tingling sensations are common during treatment.

   • Ionto is less painful than getting an injection.

   • Slight erythema under electrodes is common after procedure.

2. Clean treatment area with alcohol.

3. Draw 1.0 cc dexamethasone (4 mg/ml injectable) then draw 1.0 cc distilled water to make a total solution of 2.0 cc.

4. Saturate drug electrode with solution.

5. Place drug electrode over treatment site.

6. Place dispersive electrode at least 4 inches from drug electrode (over muscle or non-bony area).

7. Attach negative (black) lead to drug electrode.

8. Attach positive (red) lead to dispersive electrode.

9. Turn selector to "S1" (Set up) or If S1 set up complete, turn to S2

1. After beep, turn unit off via power switch

2. Remove electrodes

3. Check for skin irritation

   • -If irritated, counsel patient to keep area clean and dry

4. Discourage exercise or use of cold or heat to treatment area for 30 minutes.

5. Document response to treatment