Authors (including presenting author) :
Lee MH, Chan SC, Lee PC, Lau MK, Leung WY, Chan MK, Ng LK
Affiliation :
Department of Surgery, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Introduction
In our hospital, about 90% of our patients who has undergone major breast surgery will have a drain inserted to their wound postoperatively. It is a usual practice for them to be discharged with axillary drain in situ. Although pre-operative counselling and post- operative education were given to patients / significant others, unexpected complications were happened including leakage, pain and pressure injuries due to drain pressure. Patient satisfaction declines and additional clinic visits may be resulted. In addition, early discharge after surgery involves a major change of mindset especially for elderly patients. Therefore, nurses should reassure patients/significant others to increase their confidence to manage a surgical drain at home.
Objectives :
Objectives
1. Patients / significant others show understanding on drain care education provided by nurse
2. Patients / significant others able to manage drainage and maintain closed system at all time
3. Patients are free from complications due to wound drain.
4. Nurses are confident in providing care and health education to patients / significant others.
Methodology :
Methodology
1. Set up a workgroup with Breast Care Nurse and representatives of different ranks (Apr 2019)
2. Review existing measures and explore further improvement. (May 2019)
3. Develop education tool with procedure guide and photos for wound drain education (May 2019)
4. Develop questionnaires for nurse and patient opinion survey (May 2019)
5. Implement the program. (June 2019)
6. Conduct nurse and patient opinion survey to evaluate the program. (Dec 2019)
Result & Outcome :
Results 1. For patient opinion survey, the response rate was 90%. In total, 20 patients with mean age of 60 years old (range 33-86) were included and all of them have undergone major breast surgery including mastectomy with sentinel lymph node biopsy (SLNB)/ axillary node dissection, breast-conserving surgery with sentinel lymph node biopsy (SLNB). All our patients agreed that nurses’ guidance and explanations upon drain care was detailed and their worries were being relieved. All of them feel confident in handling the wound drain and tackling the problem 2 For staff opinion survey, 17 nurses were interviewed. All staff agreed that they received sufficient training regarding wound drain care. They also feel confident in providing care and giving education to patients with wound drain 3 Before the program, total 5 cases were developed stage 1 pressure injury (Dec-May/2019) After the program, no more problem when patients bring wound drain to home Conclusion Our findings shown that patients appreciated drainage care guidance was clear, and comprehensive. They feel confident to handle the drainage by themselves. Besides, they know how to check and solve the problem, also seek advice when necessary. Their worries being relieved after receiving the guidance from nurses. On the other hand, this program was effective in standardizing our nursing practices on giving patient health education. Our nurses agreed that they were more confident in giving education after program training. Overall, the program is welcomed by patients and nurses as well as patients’ comfort and safety are enhanced. Nevertheless, we notice that there are still rooms for improvement such as our elderly patients should be more clearly informed of the early discharge plan before and after surgery.
