Room 421 May 14, 2019 oral abstract
Service Enhancement Presentation 13:15 - 14:29

Staff Engagement and Empowerment

“SMART” Fall Prevention Enhancement Program for Patient Care Assistant in TWEH
13:15 - 13:25
Presented by : L P CHENG

Introduction

Fall 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.

Methodology

The “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 & Outcome

The “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.

 

 

GRAINS Program: The Step Towards Clinical Competence of New Nurse Graduates
13:26 - 13:35
Presented by : Maggie Chung

Introduction

New 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.

Methodology

The 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 & Outcome

There 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.

 

 

Restructuring the service delivery process and empowering the non-clinical staff to enhance the efficiency of the Patient Support Call Centre (PSCC)
13:36 - 13:45
Presented by : Patty KWONG

Introduction

The 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.

Objectives

To enhance efficiency of PSCC services by restructuring service delivery process and empowering staff.

Methodology

The 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 & Outcome

With 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.

 

 

Nurses' attitude towards seasonal influenza vaccination in Tseung Kwan O Hospital
13:46 - 13:55
Presented by : S H LEUNG

Introduction

Vaccination 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.

Objectives

This study aimed to identify factors associated with nurses’ intention to influenza vaccination and their risk perception towards influenza and vaccination.

Methodology

A 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 & Outcome

Response 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.

 

 

Joint Departments Program: Looking Forward to "No Fall Day"
13:56 - 14:05
Presented by : Leung Wai Yi

Introduction

Fall 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.

Objectives

To 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 & Outcome

After 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.

 

 

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