Improve the competency of nursing staff in caring patient with Non-Invasive Ventilation (NIV) in general medical ward

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Authors (including presenting author) :
Lit MPK, Lee KH, Chow PS, Yeung HT, Ng CK, O WH & Chan WMJ
Affiliation :
Respiratory Division, Department of Medicine, Queen Elizabeth Hospital
Introduction :
Nurses play an important role in initiation, monitoring, titration, optimizing patient’s comfort level and complications prevention which significantly contributed to the success the NIV treatment.
Objectives :
To evaluate the effectiveness and sustainability of the competency of nursing staff in caring patient with NIV after a series of remedial action
Methodology :
A pre and post criterion-based audit via convenient sampling method was carried out in March of 2017 and 2018. The audit form was adopted from HAHO Advanced Nursing Standard for Patient-Care. The patient of pre-remedy audit was recruited from basic support service in non-designated NIV beds (NDNIV) and augmented-support in designated NIV beds (DNIV) in Department of Medicine. The audit form consisted of 15 items including NIV machine set up and interface fitting, patient tolerance, complication prevention and treatment effectiveness. A follow up remedy action which includes 3 identical 1-hour educational sessions with 1-hour skill workshops were conducted. A pre & post educational sessions & skill workshop assessment were required to assess their knowledge. The non-compliant items was monitored and reinforced during daily Bipap ward round by respiratory nurses . Post-actions audit was performed one-year later in (NDNIV).
Result & Outcome :
The 1st audit with 17 and 10 patients in DNIV and NDNIV were recruited with compliance rate (CR) 89.8% (NDNIV) and 97.3% (DNIV) respectively. The prevalent rate (PR) for setting-up appropriate alarm-limits was higher in DNIV (80% vs. 6% p< 0.05). The air leakage in DNIV can meet the standard range with < 50L/min whereas NDNIV is higher with 70 -80L/ min.The mask-related skin lesion was higher in NDNIV (90% vs.76% p< 0.05). Fifty nurses enrolled in the educational programme and forty-seven nurses (94%) completed the pre and post-tests. The mean score has improved after the programme. (36.7 pre-test vs. 59.7 post-test p< 0.05). Post-actions audit was performed in NDNIV with CR increased from 89.8% to 97.76%. The PR for setting-up appropriate alarm-limits was significantly high (6% vs.77.8%). The air leakage were markedly improved.(< 50L/min vs. 70-80L/min). The prevention of mask related skin lesion was significantly enhanced (97.2% vs.76%). The success of NIV-application depends largely on nurse competency. Setting-up a well-run service with good support structures, local protocols, audit and training is crucial to ensure patient’s quality.

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