Enhancement Program on Parenteral Nutrition Care in Surgical wards

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Affiliation :
(1)Department of Surgery, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
In recent years, the number of patients require Parenteral Nutrition (PN) is increasing in surgical wards of Ruttonjee Hospital, especially for those patients with bowel operation or intestinal obstruction. Our current practice of PN care is only follow the previous experience from senior nurses. As there is no comprehensive formal Parenteral Nutrition Care program, nursing procedure guidelines, or formal in-house training for nurses in surgical wards. In view of the increasing demand of PN and evidence-based nursing practice, standardizing and enhancing the current nursing practice are vital important. Thus, a targeted multiple intervention program is designed to enhance Parenteral Nutrition care in surgical wards.
Objectives :
 To utilize the evidence-based practice results from the Department of Surgery, PWH.  To standardize and ensure safe nursing practice on Parenteral Nutrition administration and care  To enhance nurses’ knowledge and skills on the Parenteral Nutrition care.  To engage patients’ and their relatives’ participation on Parenteral Nutrition care.  To achieve zero infection rate of Parental Nutrition after the program.
Methodology :
1. Conduct systematic literature review from all databases and identify strategies for implementing the program. (Sept - Dec, 2017) 2. Conduct Pre knowledge test on Parental Nutrition Care to all nurses. (Sept – Dec 2017) 3. Ready the reference book for nurses to allow quick and easy reference. (Sept - Dec 2017) 4. Ready the information pamphlet on general information of Parenteral Nutrition Care to patients and their relatives. (Sept - Dec 2017) 5. Design “Nurse Opinion Survey on Parental Nutrition Care Program” and obtain pre-program nurses’ opinions. (Sept - Dec, 2017) 6. Conduct staff education and hands-on demonstration to all nurses. (Jan – Mar 2018) 7. Implement the program accordingly. (Mar – Sept 2018) 8. Conduct program evaluations including post knowledge test, nurse opinion survey and patient / relatives opinion survey. (Sept - Dec 2018) 9. Check infection rate from Mar 2018 to Sept 2018 total 32 cases related to Parental Nutrition (Sept – Dec 2018)
Result & Outcome :
Results 1. 30 staffs were interviewed 1.1 In General, over 80% staff agreed that the program can help to have a better understanding of nurses role in PN care and they agreed they have received sufficient training. Over 70% of them have more confident in providing care and managing complications. 94% of staff are more willing to have training afterwards. 1.2 The average mean score of the knowledge test was increased by 20% after training session. There is an great improvement on Q.1 Indications of PN (increased from 67% to 95% ), Q.2 Facts of PN (increased from 22% to 67%) and Q.8 Flushing techniques (increased from 56% to 80%). 2. 10 patients and carers were interviewed. They think the information pamphlet is useful and easy to understand. They have more confident in managing their situations. 3. No related infection rate was detected after implementation of the program. Conclusion This educational program has shown positive results and was welcomed by nursing colleagues, patients and carers with high satisfaction. It standardizes and provides a best and safe nursing practice on Parenteral Nutrition administration and care. With periodical review, further modifications of project would be made to achieve long term benefits. This education program will be promoted to all new comers regularly.
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