Authors (including presenting author) :
Wu CMT(1), Chan CSS(2), Chin SC(2), Cheung CM(1), Ngai HY(1), Sze HY(1), Wong YP(2), Lo WP(1), Li SC(1), Lee PO(2), Lee CH(1), Lee OK(2), Kwan YF(1), So HM(1)(3)
Affiliation :
(1)Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, (2)Deparment of Cardiac and Intensive Care Unit, Ruttonjee and Tang Siu Kin Hospital, (3)Department of Intensive Care, Hong Kong East Cluster
Introduction :
Inappropriate care of TPN administration can contribute to catheter associated bloodstream infection (CABSI), which extends length of hospital stay, increases medical cost and jeopardizes critically ill patients. Currently, covering the TPN administration set with Pethidine soaked gauze remains controversial. There is no standardized protocol on taking care of patients requiring TPN within the same cluster. With the aim to enhance care of patients receiving TPN, a continuous quality improvement (CQI) project was initiated in Hong Kong East Cluster (HKEC).
Objectives :
The objectives of this project were to identify the best practice in caring patients receiving TPN, to streamline and standardize TPN care in HKEC ICUs, and to empower nurses in HKEC ICUs the necessary skills and knowledge on providing appropriate and safe TPN care.
Methodology :
This project was divided into four phases. In phase I, the project team conducted extensive literature review to identify best TPN practice. In phase II, a comprehensive training programme was developed. An interactive mode of teaching including mini-lecture, video demonstration, bedside coaching and cue cards was adopted. In phase III, eight updated practices such as adopting 2% Chlorhexidine gluconate in 70% isopropyl alcohol as disinfectant, using 3M CHG Tegaderm continuously, abolishing wrapping junction ports were fully implemented. In phase IV, staff’ knowledge, psychomotor skills and attitude were evaluated. A 10-question pre-and post-tests and a 27-item compliance checklist were developed. Semi-structured interviews were conducted. CABSI rate was retrospectively monitored for half year.
Result & Outcome :
This CQI project has commenced since April 2019. A total of 122 HKEC ICU nurses were recruited to the training programme, of which 90 from PYNEH and 32 from RHTSKH. Eight updated practices of TPN administration were adopted. There was a statistical difference between the scores for ICU nurses’ knowledge at the pre-test (M=5.678, SD=1.490) and at the post test (M=8.222, SD=1.571) with t=-11.149 and p=< 0.001. Majority of staff demonstrated good compliance and competency of new TPN practice. Out of 27 items of compliance check, there were 25 items achieved 100% compliance rate. Qualitative feedback from front line colleagues was supportive and encouraging. There were total 39 patients requiring TPN admitted to HKEC ICUs from April to December 2019. The CABSI rate remained zero in both ICUs. The clinical guidelines of TPN administration in both ICUs were revised and disseminated. The project successfully streamlined the current practice to facilitate daily operation and provide a basis to other specialties for full implementation to enhance quality of care and improve patient safety.
