Authors (including presenting author) :
Tsang WM, Cheung CCC, Kan WY, Cheng YY, Yik WMJ, Yip CH, Tang MKC
Affiliation :
Department of Medicine & Geriatrics, Princess Margaret Hospital
Introduction :
Clinical nursing practice is guided by various guidelines, protocols and nursing standards. Nursing audits are commonly conducted to identify potential problems and maintain quality nursing care. Regular annual hospital-wide audits can only infrequently serve a random case checking. Medical incidents involving high-risk procedures, such as artificial tube feeding and tracheostomy care in daily nursing duty can seriously affect patient safety especially when junior nurses are incompetent. Quick Audit Checklist on potential high risk procedures have been implemented in the Department of Medicine and Geriatrics (M&G), Princess Margaret Hospital (PMH) since August 2018. The Checklist is an one-page tool with 10 points audit criteria which designed by Discharge Planning Coordinators (DPC). Percutaneous endoscopic gastrostomy (PEG) care is identified for quick audit once patient is admitted to M&G wards in the pilot trial.
Objectives :
1.To facilitate self-learning and promote nursing quality and safety among nursing colleagues.
2.To guide hands-on care and documentation, and serve education purpose for new-comers and junior nurses.
3.To describes the standard of care in a specific task with critical items marked clearly for staff alertness, continuous review and nursing practice monitoring.
Methodology :
DPC would perform spot one-day compliance audit on all relevant cases by using same checklist. Samples were collected from all M&G wards to reflect the real situation in the department. Immediate feedback would be given to concerned nurses and ward in-charges for clarification, education and follow-up action. The results of compliance check would be sent to Ward Manager (WM) for review and trend record, and shared in department nursing meeting.
Result & Outcome :
Whenever a patient with PEG is admitted to ward, cubicle nurse in-charge should print out the Checklist, in addition to the PEG Alert Card to guide the nursing practice on daily PEG care. Compliance check would be conducted and announced regularly to encourage strive for perfect score on the Checklist. There are total 13 cases in M&G department being assessed. After the promulgation and the implementation of the Checklist in August 2018, the compliance rate was tremendously improved to 83%. With repeated promotion and education on the importance and the use of the Checklist, there was a steady growth on the Checklist compliance. In December 2018, M&G had already achieved 97.7% compliance on the Quick Audit Checklist for PEG care. Ward nurses expressed satisfaction on the simple use of the Checklist. The one-page precise Checklist was useful for immediate point-of-care quick guide or reference for daily nursing practice and clinical documentation. It also raised all nurses’ awareness on performing high-risk procedures and motivated them to deliver high-quality nursing care to patients with confidence and compliance.
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