Authors (including presenting author) :
HKL Yau (1), EKF Shek (1), J Wun (2), M Yu (3), KN Yu (1), C Yeung (1)
Affiliation :
(1)Department of Surgery, Caritas Medical Centre, Hong Kong; (2)Department of Community Nurse, Caritas Medical Centre; (3)Department of Eye, Caritas Medical Centre.
Introduction :
Percutaneous Nephrostomy (PCN) is one of the methods to relieve upper urinary tract obstruction. As patients may have a PCN drain after discharge from Hospital (Caritas Medical Centre), some problems regarding PCN drain care encountered including kinking, twisting, dislodgement of PCN catheter and soiling of PCN wound. These problems might lead to outlet obstruction, affected patients’ hygiene, increased risk of infection, deterioration of renal function and discomfort experience to patients. Readmissions are needed for subsequent management and thus increase staff workload and medical expenses. Proper PCN drain care from hospital to community is crucial to maintain effective drainage functioning without altering patients’ quality of life.
Objectives :
(1) To improve patient’s level of comfort.
(2) To increase both patients and staff’s satisfaction towards PCN drain care.
(3) To unify PCN dressing method between inpatient and outpatient setting.
(4) To decrease change of PCN dressing frequency.
(5) To compare the cost-effectiveness between commercial kit and traditional method on dressing for PCN.
Methodology :
3 Briefing sessions for the nurses from Department of Surgery and Community Nurse in October, 2017 and 4 identical PCN drain care workshops for all the nurses from the hospital July, 2018. 109 nurses had attended the workshop. Specific dressing review PCN drain care dressing pamphlet had been distributed to different departments of the hospital after the briefing sessions workshop. Communication from Department of Surgery to Community Nurse Service (CNS) and Out Patient Department (OPD) to adopt the revised dressing method. The transparent hydrophobic dressing was used as outer dressing and “Ω” anchoring method was applied to secure PCN catheter. Continuity of care for patient with PCN from hospital to community.
Result & Outcome :
The review period with data collection started on 1st November,2017 to 31st December, 2018. A total of 68 satisfaction questionnaires were sent with 61 responses (55 staff and 6 patients). The response rate was 89.7% while 78% showed their keen on undergoing the revised method. Additionally, despite the decrement in the frequency of dressings, no dislodgement or signs of infection were reported till 30th June, 2019. Moreover, revised dressing method also showed more cost effective in terms of time (from 3-5 days to 5-7 days) and money (from HK$61.5 to HK$9.2) when comparable to traditional dressing and commercial kit.
