Service Enhancement Presentation Room 421 oral abstract
May 14, 2019 04:15 PM - 05:30 PM(Asia/Hong_Kong)
20190514T1615 20190514T1730 Asia/Hong_Kong Service Enhancement Presentation 4 - Clinical Safety and Quality Service II

Clinical Safety and Quality Service II

Room 421 HA Convention 2019 hac.convention@gmail.com

Clinical Safety and Quality Service II

5S-Strategy to Reduce Fall Rate for High-Risk GroupsView Abstract
HA Staff 04:15 PM - 04:25 PM (Asia/Hong_Kong) 2019/05/14 08:15:00 UTC - 2019/05/14 08:25:00 UTC

Introduction

Falls are serious cause of morbidity and costs, especially in Cancer Palliative Care. Most patients with these incurable diseases were aged, terminally-ill and highly stressful. Patients with bone metastasis or brain metastasis were extremely high risk. Cancer patients could suffer from more immense consequences of physical injuries, fractures, post-fall syndrome and functional decline. It was also followed by prolonged hospital stays, follow-up investigations and treatments; consequently, it increased the costs and risks significantly in health care system. To take comprehensive preventive measures, 5S-Strategy was launched.

Objectives

To reduce fall rate To minimize prolong hospital stay due to fall To enhance staff engagement To foster safety culture

Methodology

Systems Universal screening was performed for all patients upon admissions. The individual needs of screened patients would be addressed, such as assisted toileting round, morning warm water round, providing non-skid slippers, alarm pad and yellow vest, keeping bed at low level, and providing anti-slippery spray. All these rounds aimed at improving the observation level and preventing high risk activities for example toileting and filling warm water. Strategy Post-fall incident investigation of each fall is a necessary component and must indicate how a client was assessed and the specific strategies implemented for that patient to prevent further falls. The results for every new operation would be documented and announced. Shared Values High-risk patients and their relatives would be engaged through face-to-face discussions or phone call. Education would be given and consensus would be gained to achieve mutual understanding. When patients, relatives and clinicians had the same shared values and goals, patients would comply with instructions from the ward. Staff Multidisciplinary approaches, including physicians, nurses, physiotherapists, occupational therapists, were involved in the fall program. Repeated assessments would be conducted as conditions of cancer patients would deteriorate suddenly. Multidisciplinary approaches with repeated assessments can provide a quick response to change of conditions and timely prevention can be taken in advance. Skills Supporting staff was trained as the eyes of clinicians. Two workshops were provided by nurses annually. In each shift, supporting staff would be informed of the patients with high risks. As supporting staff had a high intensity of interaction with patients, they were able to enhance the observation level and provide assistance.

Results & Outcome

The fall rate decreased from 10.04 cases per 1000 episodes in 2012/13 to 4.89 cases per 1000 episodes in 2017/18. Causes of falls are multiple and hard to prevent all of them. The preventive measures should be from different angles and implemented by different people.

 

 

Presenters
KC
K L CHAN
Standardized computerized printing of use-before date and auxiliary label for reconstituted medications during drug dispensing process in pharmacy settingView Abstract
HA Staff 04:26 PM - 04:35 PM (Asia/Hong_Kong) 2019/05/14 08:26:00 UTC - 2019/05/14 08:35:00 UTC

Introduction

Certain types of syrup medications, especially antibiotics, are freshly reconstituted in pharmacy upon receipt of prescriptions from physicians. Under previous practice, the use-before dates are manually calculated and filled on drug labels by dispensers after reconstitution. Auxiliary labels of “Refrigerate” are also stuck accordingly if appropriate. Information is thus checked by another dispenser and then pharmacist before issuing. Although there are information charts assisting colleagues in checking shelf life and storage condition of individual medications, the following challenges exist: 1. There is a range of medications that require fresh reconstitution. Effort is needed for colleague to check and calculate each time for the use-before dates and storage conditions. 2. Manual error may occur during calculation process. 3. Poor handwriting and/or diffusion of ink may lead to difficulty in reading information from the labels.

Objectives

This project aims to: 1. Improve medication safety through replacing manual written labels by automatic printing 2. Ensure patients will not be using an expired product due to incorrect use-before date 3. Optimize dispensing process and improve efficiency 4. Improve tidiness and neatness of dispensing labels for better readability by patients/carers or nursing staff when administering the drug

Methodology

To improve the current practice and quality of dispensing, a computerized program is designed to calculate and print use-before date and auxiliary label automatically from label printer after scanning barcodes which is originally printed on dispensing labels.

Results & Outcome

This project targets to achieve the following outcomes: 1. Elimination of wrong calculation or writing of use-before date and wrong labelling of “refrigerate” after medication reconstitution 2. Elimination of poor readability of manual writing of use-before date, so as to safeguard correct medication administration and patient safety 3.Reduction of pharmacy staff workload and optimization of dispensing process. Zero near miss of incorrect use-before date and refrigerate instruction was recorded since implementation in AHNH main pharmacy and TPH main pharmacy. Improvement of dispensing efficiency is evaluated by interviewing dispensing staff (pharmacists and dispensers) after implementation. All staff interviewed agreed new measure can reduce workload for manual calculation, reduce frontline stress and increase dispensing accuracy and efficiency. ​ Questionnaires were distributed to patient/carers and nursing staff. 100% of respondents are satisfied with the new measure. Most respondents agreed that new measure can improve tidiness of instruction, reduce mistakes and misunderstanding of information, and hence improve medication safety.

 

 

A three steps “SAFE model: Screening, Checking and Monitoring”, to prevent change of patient’s condition during training in physiotherapy department in Shatin HospitalView Abstract
HA Staff 04:36 PM - 04:45 PM (Asia/Hong_Kong) 2019/05/14 08:36:00 UTC - 2019/05/14 08:45:00 UTC

Introduction

There has been an increase in frequency of changes in patient conditions during training in physiotherapy department due to frailty, multiple comorbidities and more acute status of patients that may endanger patients’ safety. Patients’ safety is always first priority in delivering treatment to patients.

Objectives

To derive a systematic, practical and sustainable system to minimize the occurrence of change of patient condition in physiotherapy department

Methodology

Root cause analysis was conducted for the “change of patient condition” data (10 cases happened for 15148 patient attendances) in first 10 months in 2017. It included patient’s medical record review and staff interview. Major information reviewed including screening of patients’ medical history, any checking and monitoring of vital signs for those patients. Major causes were postural hypotension (60 %) and poor blood pressure (BP) control (10%). Practice of monitoring of vital signs was inconsistent amongst different therapists. In addition, focus group was formed with physiotherapist team in-charge in different specialties, to gather opinions on safety measures. A three steps “SAFE” model: Screening, Checking and Monitoring” was implemented in January 2018. Step 1 “Screening” was a procedure that using standardized screening checklist, which included contra-indications and precautions for screening of medical conditions and unstable vital signs. All physiotherapists needed to conduct this procedure. Step 2 “Checking” was checking patients’ vital signs (using reference range from screening checklist) before training in physiotherapy department. Staff needed to sign a checking record, with regular audit by senior staff. Step 3 “Monitoring” was monitoring of vital signs during training if the patients’ vital signs was within borderline range (regarded as precautions in screening checklist).

Results & Outcome

After implementing the procedures of “Screening” and “Checking”, percentage of patients cancelled due to unstable vital signs was 2.2% (482 out of 21909 patients booking) in 2018. Unstable vital signs included fever (58.5%), unstable BP (27.8%) and unstable pulse rate (3.7%). Together with the measures of “Monitoring”, the occurrence rate of change of patient condition in physiotherapy department showed a marked decreasing trend (decrease 64.1%) from 0.92 incidents per month in 2017 (out of 18178 yearly attendances) to 0.33 incidents per month in 2018 (out of 21424 yearly attendances). Staff evaluation questionnaire showed that all staff agreed that the 3 steps “SAFE model” could increase staff awareness on patients’ safety and decrease occurrence of change of patient condition in physiotherapy department. Continuous data collection and evaluation, and regular safety measures review are necessary to enhance patients’ safety in future.

 

 

M&G Nurse Coordinator e-Handover SystemView Abstract
HA Staff 04:46 PM - 04:55 PM (Asia/Hong_Kong) 2019/05/14 08:46:00 UTC - 2019/05/14 08:55:00 UTC

Introduction

Effective communication is a driver of performance for clinical team and helps the timely and relevant information is provided to Nursing Management Team. SharePoint is typically associated with web content management and document management systems, it is actually a much broader platform of web technologies, capable of being configured into a wide range of solution areas. By using SharePoint to create an electronic platform – “Nurse Coordinator e-Handover System”, this platform provides DOM/WMs/NOs/APNs to easy access for monitoring daily Medicines & Geriatrics ward operation, quality and safety via workstations and home computers, also this platform helps the Nursing Management team get information and give response effectively.

Objectives

The objectives of the project are: (a) To enhance efficiency in clinical management (b) To enhance communication between DOMs/WMs/NOs/APNs even working area or home (c) Provide update, timely and relevant information to Nursing Management team (d) Data can be retrieved for evaluation and statistics

Methodology

The I2E2 (i.e. Inspiration, Infrastructure, Education and Evidence) strategies are adopted for facilitating the implementation of the project: (a) Review the existing workflow of Nursing Coordinator handover method (b) Develop an electronic platform (c) Conduct training and competency assessment (d) Prepare for the rollout of the project to meet operational need (e) Collect staff feedback (f) Assess the readiness for implementation and provide timely feedback (g) Monitor the utilization

Results & Outcome

With the collaboration from DOMs/WMs/NOs/APNs, the project was successfully rollout on 4Q2018, at least 200 records are documented. The concept of M&G Nurse Coordinator e-Handover System was supported by Nursing Management Team. This platform facilitated communication and improve work efficiency. Positive feedback and suggestions from Nursing Management Team on enhancing the system are followed up for further improvement. In conclusions, an innovative and good quality information could provide staff Timely, Relevant and Efficiency clinical area.

 

 

Presenters
WL
Wa Sing LAM
Hospital-wide Evidence-based Practice Change to Ventrogluteal Intramuscular Injection by NursesView Abstract
HA Staff 04:56 PM - 05:05 PM (Asia/Hong_Kong) 2019/05/14 08:56:00 UTC - 2019/05/14 09:05:00 UTC

Introduction

Dorsogluteal (DG) region, the upper outer quadrant, of buttock is a common site for intramuscular injection by nurses. In December 2016, the Medical Council of Hong Kong recommended changing to the ventrogluteal (VG) site. Therefore, an evidence-based project group was established under our Nursing Services Division to follow up this issue.

Objectives

The group aimed at (i) examining the evidence for the VG site; (ii) formulating the evidence-based strategies for promoting the practice change among our nurses; and (iii) implementing the action plan of change and evaluating its effectiveness.

Methodology

The Johns Hopkins Nursing Evidence-based Practice Model was adopted. Apart from reviewing the evidence for VG site, the project also covered the: (a) optimal locating method of VG site; (b) occupational and health issues concerned; and (c) optimal method for facilitating the change. Hospital-wide nurses training was conducted, especially for senior nurses who had never learned the VG injection skill before. As informed by the evidence, simulated practice was incorporated, a new poster was designed for work places, and a video clip was produced for on-going education. Participants were required to pass the skill assessment in simulation setting. Their knowledge gain, attitude change and performance would be evaluated. Incidence of patient injury and staff needle stick injury would also be captured.

Results & Outcome

Thirty identical training sessions were conducted from December 2017 to October 2018 for nearly 860 nurses. No incidence of patient injury and staff needle stick injury was reported so far. After training, the nurses’ mean knowledge score increased from 2.98 to 5.58/6 (p< 0.001, paired t-test). Proportion of nurses willing to use VG rose from 19.3% to 95.6% (p< 0.001, McNemar's test). Among the 691 nurses who used to choose DG site, 654 of them (94.6%) were willing to change to VG. The strongest motivator was the knowledge of the benefits of VG over DG. Conversely, difficulty of the VG skill perceived was the most common barrier for change. Analysis by the logistic model also revealed that more experienced the nurses, less likely they would choose VG. But they tended to be more willing to change after training in our cohort. These results are promising. Clinical audit will be conducted later to verify the actual clinical behaviour.

 

 

Presenters
WL
W M LING
Fall prevention enhancement through fall prevention training program in Occupational TherapyView Abstract
HA Staff 05:06 PM - 05:15 PM (Asia/Hong_Kong) 2019/05/14 09:06:00 UTC - 2019/05/14 09:15:00 UTC

Introduction

Patient fall incidents remain the first priority in the risk registry of Occupational Therapy Department in Kowloon Hospital in the pass years. In order to improve the patient safety and quality of services, interventions to prevent patient fall incidents while receiving treatment are required. Currently different specialty team have their own way to orientate new staff and train up their professional and supporting staff to help them to be more competence in serving their unit. However, the training is not comprehensive and lack of focuses on fall prevention as well as suitable for all level of our colleague.

Objectives

A comprehensive Fall Prevention Training package was developed for all level of staff which covered the content of general fall information and patient’s condition, proper use of wheelchair, wheelchair transfer, plinth activities, standing frame activities and use of hoist. The training was implemented and Questionnaire survey was performed to evaluate change in the Level of knowledge and confidence before and after the training as well as the evaluation of the usefulness and satisfactory of the training.

Methodology

Training package was developed in power point presentation, sound recording and video clip for present the Fall prevention strategy, knowledge and skill for staff training. The training package was presented to staff in various ranking including Occupational Therapist, Personal care assistant (PCA) and Operation Assistant (OPA). A self-report questionnaire was designed in four point ordinal scale from strongly agree to strongly disagree to investigate degree of knowledge gain and level of confidence of the colleagues was filled by the colleagues before and after the training session. The usefulness and satisfactory of the training content were also evaluated. The characteristics of the response was analyzed, compared and reported.

Results & Outcome

Two training sessions was implemented. The distribution of response was classified by staff groups (OT, PCA and OPA) and rating of knowledge gain and confidence gain before and after the training was compare to evaluate for any significant change. For the training of fall prevention part 1: 31OT, 22PCA and 11OPA attended, the result found that rating of significant knowledge gain increased from 91% to100% in OT group, increase from 32% to 96% in PCA group and increased from 25% to 80% in OPA group. Rating of significant confidence gain increased from 89% to 99% in OT group, increased from 45% to 96% in PCA group and increased from 19% to 87% in OPA group. Overall usefulness of daily practice of the training was for OT, PCA and OPA were 94%, 91% and 91% respectively and satisfactory rate of the training for OT, PCA and OPA were 94%, 100% and 100% respectively. For the training of part 2 (hoist using): 24OT, 10PCA and 7OPA attended, the result found that rating of significant knowledge gain increased from 39% to 86% in OT group, increase from 20% to 86% in PCA group and increased from 0% to 100% in OPA group. Rating of significant confidence gain increased from 93% to 96% in OT group, increased from 56% to 94% in PCA group and increased from 0% to 100% in OPA group. Overall usefulness of daily practice of the training was for OT, PCA and OPA were 96%, 90% and 100% respectively and satisfactory rate of the training for OT, PCA and OPA were 96%, 90% and 100% respectively. Average severity of patient fall incident captured from the data of AIRS after training on June 2018 was only 1.7 while the data of last five years were 2(2013-14), 2(2014-15), 2.3(2015-16, 1.7(2016-17) and 2.3(2017-18).

 

 

Presenters
JT
Jess TO
Leg Ulcer Management & Empowerment Program at Department of Surgery, RTSKHView Abstract
HA Staff 05:16 PM - 05:25 PM (Asia/Hong_Kong) 2019/05/14 09:16:00 UTC - 2019/05/14 09:25:00 UTC

Introduction

Leg ulcers affects ~1% of population (Sarkar PK, 2000). Frontline Nursing staffs often encounter patients' with leg ulcers. However, frontline nurses may not recognize those potential illness like the underlying vascular diseases which lead to those leg ulcers. Different types of leg ulcers (arterial, venous or mixed types) wounds may not be accurately identified & classified & therefore they may be improperly treated. By implementing the Leg Ulcer Management & Empowerment Program, nursing staff would be taught to gain more knowledge on leg ulcers. They would be more competent to identify and classify leg ulcers. They are encouraged to refer the leg ulcers to wound nurses and other healthcare professionals like podiatrist for assistance. They are also encouraged to inform Doctor for prompt, advance and expertise assessment and management. Thurs, the leg ulcers wounds healing prognosis, staff communication and management could be promoted and enhanced.

Objectives

- To enhance Nursing staffs' awareness & knowledge on caring patients' with leg ulcer - To promote the nursing care on leg ulcers - To promote the multidisciplinary approach on patients' with leg ulcer - To enhance frontline Nursing staffs' communication with the wound nurses

Methodology

Target participants: - Nursing Staff from Dept. of Surgery 1. Review (Feb-April 2018) 2. Process and Planning (Aug - Sept 2018) 3. Implementation (Oct - Nov 2018) - organize workshops for the designated frontline staff on leg ulcer management 4. Evaluation (Dec 2018 - Jan 2019) - evaluating effectiveness of the workshop by implementing post-test and survey (same as pre-test) - review whether the objectives of the workshop are accomplished and achieved - generate overall report of the workshop and discuss with designated WMs - determine the future direction of the program.

Results & Outcome

12 individual workshops were organized with total 50 Nursing staffs participated. After the workshops, a survey was conducted to compare the pre-test and post-test results. It was showed that there is significant improvement from the staffs in dealing patients' with leg ulcers, especially in: 1. The knowledge on ABI (improved by 30%) 2. The service and role of Occupational Therapist and Podiatrist (improved by 40%) 3. The confidence in caring patients with leg ulcers (improved by 28%) 4. The understanding of management with leg ulcers (improved by 15%) 5. The communication and cooperation between Nursing staffs and Wound Nurse (improved by 12%)

 

 

Presenters
LW
L M WONG
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