IntroductionFall prevention remains one of the most challenging patient safety issues in hospital setting. Prevention of fall is complex and multifaceted. Safe environment is one of the crucial factors to reduce fall risk in hospital. Patient Care Assistant (PCA) supporting staffs assist nurses to take care patients. Their knowledge deficit, improper technique and less awareness would affect patient safety. Studies (1, 2) had proved that enhancement training could strengthen their knowledge and practical skill, increase awareness on patient safety, enhance supportive teamwork and improve quality outcomes. Thus, “SMART” Fall Prevention Enhancement Program was introduced to PCA in TWEH.Objectives- Strengthen PCA’s updated knowledge and practical skill on fall prevention. - Increase PCA’s alertness on safe environment to prevent fall. - Promote the ‘Patient Safety & Comfort (PSC) Round’ at workplace.MethodologyThe “SMART (Safety, Measures, Alertness, Round and Teamwork)” Program for PCA was designed and implemented in year 2018 as follows: 1. Strengthen “Safety” knowledge on patient fall with lecture, use of fall prevention video show and education leaflet. 2. Enhance fall preventive “Measures” with scenario-based hands-on skill practice exercises. 3. Increase “Alertness” on ward environmental safety and be more sensitive to patients’ need with appropriate care provided such as offer assistance with patient’s toileting, address patient’s special need and ensure patient reach personal item. 4. Educate how to conduct PSC “Round” regularly with practical tips on systematic check from patients’ area to ward environment, hospital bed and patient’s comfort care provision. 5. Engage staff with “Teamwork” through recognition of “SMART” Ambassadors「精靈醒目巡視員」.Results & OutcomeThe “SMART” Program was practical and easily applied by Patient Care Assistants at workplace. The program could increase their alertness as well as strengthen ‘Patient Safety & Comfort Round’ by PCA in clinical setting. Total 48 PCAs completed the training with active participation on skill-based practice exercises. A six-point Likert Scale from (1) very unsatisfactory to (6) very satisfactory for staff satisfaction rating was adopted with 5.4 over 6 achieved. All participants agreed that the program was practical, easy to apply to their daily operations, could enhance their fall prevention knowledge & skill. They learned how to address patient comfort needs proactively, and to conduct ‘PSC Round’ systematically at workplace. Staff compliance audit was conducted with 100% compliance rate achieved.  

IntroductionNew nurse graduates often experience distress related to theory-to-practice gaps when transitioning to the professional clinical nurses. Caring for increasingly complex patients with multiple comorbidities also is their challenge. A Graduates Reasoning Advanced Interactive Nursing Skills (GRAINS) Program has designed for 2018 new nurse graduates in PYNEH to assist their transition. Through interactive scenario-based workstations, they can equip themselves with basic and advanced clinical skills on common nursing practices and enhance clinical competence.Objectives(1) to equip new nurse graduates with common and advanced nursing procedures to facilitate their role transition ensuring safe practice and critical thinking; (2) to evaluate the effectiveness of GRAINS Program in improving knowledge, ability and confidence levels of new nurse graduates.MethodologyThe design of the GRAINS Program was based on the comments from the past new nurse graduates and the clinical preceptors. It integrated lectures, scenario drills and hand-on practices. From October 2018 to December 2018, four identical one-day classes had been organized with 7 topics including naso-gastric tube care, urethral catheterization, wound care, chest drain care, peritoneal dialysis care, tracheostomy care and central venous catheter care. The participants rated their own knowledge, ability and confidence levels before and after training by completing self-evaluation questionnaires. The scale was ranged from very low (1), low (2), moderate (3) to High (4). Mean scores were compared. Besides, the participants’ feedbacks were collected by evaluation questionnaires. Results & OutcomeThere were 108 new nurse graduates attended the GRAINS Program. The evaluation response rate was 99%. The overall mean score of self-rating in knowledge, ability and confidence levels increased from 2.48 to 3.26. The three highest topics with significant improvement were central venous catheter care, chest drain care and tracheostomy care and, mean scores increased from 2.07 to 3.09, from 2.26 to 3.19 and from 2.35 to 3.17 respectively. Also, 98% of participants were satisfied with the program as a whole. In conclusion, GRAINS Program could enhance knowledge, ability and confidence levels of the new nurse graduates to master 7 selected common nursing practices. Besides, through this program, safe nursing practice could be ensured.   

IntroductionThe Patient Support Call Centre (PSCC), established in 2009 under Hospital Authority, entails the application of information and communication technology to deliver high-volume telephone calls of professional advices by trained nursing staff to support target patients living in the community. Shortfall in the workforce was constantly faced by PSCC. In response to the tight manpower situation, PSCC needed to develop new methods to deliver services more efficiently.ObjectivesTo enhance efficiency of PSCC services by restructuring service delivery process and empowering staff. MethodologyThe operation workflow of the 2 main services in the PSCC, High Risk Elderly (HRE) Program and Chronic Disease Management on Diabetes Mellitus [CDM(DM)] Program was examined and analyzed to identify the steps and areas that could be transferred to non-clinical staff. The service delivery process of both HRE Program and CDM(DM) Program were re-designed and the telephone Call-logging System was modified in order to support the real-time communication in job transfer between nurses and non-clinical staff. Documentation was facilitated through the enhanced IT system. To facilitate the implementation, training was provided to all staff with on-going monitoring by supervisors. Non-clinical staffs were empowered to participate in patient care for both High Risk Elders and DM patients.Results & OutcomeWith in-depth analysis, work that could be transferred to non-clinical staff had been identified. These included, calling High Risk Elders for outpatient appointment arrangement after assessment by PSCC nurses and providing recruitment call to DM patients to introduce CDM(DM) service through structured scripts. Careful workflow restructuring, IT system enhancement and staff training (included communication technique, IT system usage and documentation skills) enabled safe service delivery by non-clinical staff for both HRE and DM patients. 4 non-clinical staff had been trained with over 13,000 calls were handled by non-clinical staff in 2018. The restructuring not only sparing nurses more time to perform patient care but also increasing job satisfaction of non-clinical staffs by undertaking new role with more direct patient contact in the PSCC. Conclusions: The answer to the nursing workforce shortage is not only more staff. Modification in work flow and work transfer could help alleviate the situation and improve clinical staff efficiency. The smooth work transfer in service delivery relied also on the strong support from IT system enhancement. Wider workforce by empowering the non-clinical staff is essential to the future service development in the PSCC.   

IntroductionVaccination is an important cost-effective measure for preparing against influenza. CDC advises all healthcare providers to receive flu vaccination annually. However, uptake rate of flu vaccination was low among nurses worldwide. In Hong Kong, it was even lower, less than 30% in HA hospitals in 2017/2018. It is crucial to investigate the factors that influence nurses’ attitude and perception towards flu vaccination.ObjectivesThis study aimed to identify factors associated with nurses’ intention to influenza vaccination and their risk perception towards influenza and vaccination. MethodologyA cross-sectional questionnaire survey was conducted in January to February 2018. 300 nurses, who worked in Tseung Kwan O hospital, were recruited by convenience sampling from 12 departments. Descriptive statistics, univariate analysis and binary logistic regression analysis were used.Results & OutcomeResponse rate was 91.6%. For the coming year, 66 (24.6%) respondents were willing to receive influenza vaccine, 133 (49.6%) refused to be vaccinated, and 69 (25.7%) were undecided. For respondents who refused vaccination, factors “the flu vaccine may not be safe” (40.6%) and “the vaccine may not good for health” (21.1%) were statistically significant associated with outcome with p-value ≤ .05. In adjusted logistic regression model, variables related to the intention of vaccination were “Previous experience of vaccination” (OR=62.69, 95% CI [15.69-250.53]), “Taking seasonal influenza vaccination could effectively protect me from being infected with influenza” (OR=48.34, 95%CI [9.97-234.5]) and “likelihood of being infected in the coming influenza season” (OR=3.34, 95%CI [1.03-10.82]). These results facilitated 2018/19 flu vaccination promulgation strategies. Education and promotion activities which focus on vaccination safety and effectiveness were implemented. Information sessions about flu vaccination for new joint staff were arranged. Emphasizing the likelihood of contracting influenza can increase awareness and vaccination uptake rate among nurses. Flu vaccination uptake rate among nurses increased from 34.8% in 2017/2018 to 52.5% in 2018/2019. Conclusion: Exploring the factors which influence nurses’ attitude and perceptions towards flu vaccination is important. These research findings facilitated the planning and implementation of flu vaccination promulgation strategies. Higher uptake rate of influenza vaccination among nurses was obtained when compared with previous year.  

IntroductionFall prevention is always a big challenge in our surgical units. Not only elderly, even the young adult fell due to their illness status or medication side-effect. The fall incident rate was rising as only in the 1st quarter(1Q) of 2018 was 0.59. (n=5), while the fall rate was 0.4 (n=3) in 1Q 2017. On-going series of fall prevention strategies has been introduced and implemented after reviewing and analysing the past fall incidents each year. According to the fall incidents, fall audit and spot check results last year, there were some rooms to improve over the existing preventive interventions.ObjectivesTo promote patient safety and minimize the fall rate in the surgical department and orthopaedic & traumatology (O&T) department. To improve the existing fall preventive practice.Methodology(1) Analyse the past fall incidents, audit and spot check result to plan the improvement work in the departments. (a) Design eye catching pictures on the existing patrol record. b) Revise the red flag system of surgical department to increase staff alertness. (c) Proactive utilise the assistive device e.g. Alarm Mat on fall prevention to the high risk cases. (d) Count the number of “NO fall day” with reward in every 100 days without fall incidents in ward / department to encourage staff’s day-to-day work on the fall prevention. (2) Provide program briefing and education / refreshing the use of alarm mat to staff (3) Evaluate the program by conducting the spot check on the compliance of fall scheduled round and nursing audit on fall prevention.Results & OutcomeAfter program implemented in 2 surgical wards and 1 orthopaedic ward for 4 months, the fall rate of the departments reduced from 0.44 to 0.19. The usage rate of alarm mat increased from 51% to 73% in the department. The maximum days without fall in an individual ward was 256 days and 71 days in departments. The staff compliance rate was 98% in the department. To sum up, the results showed the positive outcome as the fall rate was reduced. The longer the no fall periods, the lesser the number of fall incidents. We are looking forward to the number of “NO fall day” keep rising.  

IntroductionThe utilization of simulation training has been proved to be useful in increasing staff confidence and competence in managing high risk or challenging clinical situations. Simulation training for outreaching staff on both physical and mental emergency situation was designed in 2014 with lots of positive feedback. In 2018, we designed brand new inter-professional scenario-based simulation training for staffs working in both community and in-patient services in managing various clinical high stress circumstances.Objectives1. To inspire participants to evaluate their professional accountability on caring of patients, carers and staffs. 2. To strengthen the awareness of clinical / community psychiatric situation through real scenarios. 3. To provide a platform to explore the most appropriate management of similar situational scenarios through discussions and experience sharing.MethodologyEight scenarios were selected and modified from real situations of which the highest stress score was rated by our staff. 4 scenarios were chosen for maximum 12 mental health professionals including Doctors, Nurses, Medical Social Workers and Occupational Therapists in each half day class. Some frontline staff was invited to be the actors to let them experience the feeling of being cared and treated. Interactive debriefing was conducted with self-reflection and learning consolidation, feelings sharing, encountering limitations and experiences. Quantitative and qualitative evaluations were collected at the end of the training.Results & Outcome12 classes with 106 participants in total were trained. Very positive feedbacks as demonstrated by high rating from 100% participants who perceived the classes were useful and practical with realistic scenarios. Qualitative data reflects that the debriefing is impressive and meaningful, good sharing and inspiration in a comfortable and relax atmosphere, increasing confidence and competence in dealing with similar clinical situations and deeper understanding on the benefits of caring the relatives and staff concern. With the persistent encouraging feedbacks, it is highly suggestible that this kind of simulation training is worth to be rolled out more widely and in on-going basis.  

IntroductionRecent sentinel events demonstrated incompetent tracheotomy care at frontlines in HA hospitals. Tracheostomy is used to sustain life by keeping patient’s airway patent. The investigation panel recommended to enhance staff’s awareness on different types of tracheostomy and management; as well as to improve handover communication. Spot check of Tracheal cuff pressure measurement was done in 2017 for 27 cases with 96.3% compliance in Department of M&G but also revealed inconsistency and suboptimal standard that posed great potential risk to both patient and staff safety.ObjectivesTo achieve compliance to Guideline on Tracheostomy Care for Adult Patient (2016) Hong Kong: Hospital Authority. To standardize tracheostomy care and to enhance nursing standard in respiratory practice in the department.MethodologyBased on HAHO Guideline, enhancement program was implemented in Department of M&G. Daily Inspection round with onsite respiratory nurse coaching starting from 2Q2017. Alert labels for tracheal tube securing method and tracheostomy kit at bedside are mandatory in all wards. Two ward-based identical Train-the-trainer lectures on Tracheal cuff pressure measurement were launched achieving 100% nurses training. From 1Q2018, Alert Signage for Permanent Tracheostomy must be placed at bedhead. In 2Q2018, eCare Plan on Tracheostomy care was developed. In 3Q2018, Quick audit tool was developed based on the essences reviewed after the above improvement actions. Hospital joint department Tracheostomy Workshops had been held in 4Q2018.Results & OutcomeGreat decreased 71.67 % (2Q2017 to 3Q2018) of overall frequency trend of alert triggers in daily ward inspection round. In 2Q2018 to 3Q2018, no alert on securing the tracheal tube; decreased alert from 6 to 1 in checking tracheal cuff pressure; decreased alert from 5 to 2 in patency of tracheal tube. In Oct 2018, Quick audit on tracheostomy care was performed in one snap shot in all M&G wards for all existing 12 real cases, overall compliance rate was 93.33%. Tracheostomy quick audit served as a regular clinical practice review and immediate refreshment, especially for junior nurses with inadequate clinical experience in high risk critical care, and more importantly to align nursing practice mandatory in the department. The result provided evidence based implications on tracheostomy care for ongoing evaluation of team effectiveness and could be generalized to all general ward settings that every nurses could be equipped as the auditor.