Authors (including presenting author) :
CHAN WC(1), WONG KL(1), LAI WC(1), LAI SH(1), WONG KF(1), CHEUNG PS(2), TSUI SN(2), NG SW(1), HO SM(1), NG YB(2), CHU CM(2)
Affiliation :
(1) Ward 13A, Department of Medicine and Geriatrics, United Christian Hospital (2) Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
The ever increasing use of Non Invasive Positive Pressure Ventilator (NIPPV) for patients who have chronic respiratory failure in an aging population is no longer surprising. Consequently, challenges, such as time constraints and nurse competency, have to be overcome, given that more than 50% of nurses have less than 4 years experience in the ward. To enhance the quality and safety in handling such complex cases, a service enhancement program in domiciliary NIPPV is of utmost need to achieve a smooth transition between a chronically ventilated patient from hospital to home under the respiratory team of Ward 13A, at the Department of Medicine and Geriatrics in United Christian Hospital.
Objectives :
1. To establish standard workflow for managing domiciliary NIPPV and patient education 2. To equip frontline nurses in mastery of essential care competency in managing of domiciliary NIPPV advanced care
Methodology :
Reorganization A stocktake of domiciliary NIPPV and related accessories was done in Mid-2017. The machines and accessories were updated and reorganized in medical equipment room according to different models and functions under 5S principle. Reform A standardized workflow was reformed to align frontline nurses to follow in a systematic and evidence based way. The reformed workflow included completely from titration, NIPPV selection, mask selection to individualized patient and carer education by an assigned primary nurse. Return-demonstration An individual education session for all nurses was carried out in September 2017, aiming to consolidate nurse knowledge and align the practice. Introduction of the newly reformed workflow, machine and mask types, and patient education and empowerment were given. Nurses were required to return-demonstrate the selection of machine and accessories according to the scenario set prior and to independently educate the patients and carers on NIPPV care. Registry of patients A registry for domiciliary NIPPV record was established for risk stratification and follow up purposes. It was a comprehensive record containing all demographic data, problems encountered in using NIPPV and its related solutions, patient and carer assessment and return-demonstration checklist in handling NIPPV.
Result & Outcome :
Result The NIPPV storage was reorganized in user friendly manner with clear pictures and labeling. A total of 47 patients who had chronic respiratory failure were recruited in 2017-2018. The mean age was 74.3 (ranging from 36 to 94 years old), including 40 female and 7 male. All cases were educated and empowered by trained nurses according to the workflow. Fruitful learning, useful information and confidence gained were reported from 100% of the participated nurses. Clinical telephone hotline and nursing follow up were given, and patients all verbalized appreciation and satisfaction towards domilicaty NIPPV launching process. Conclusion The service need of chronic respiratory failure is increasing as the population in serviced district is remarkably aging. It is vital to maintain high quality service in limited in-patient time and well trained nurses. With this service enhancement, the benefit goes to all staff and patients.
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