Authors (including presenting author) :
Shit FKY (1), Tong SY (1), Ng WY (1), Mak HN (1), Lam WY (1), Tong CM (2), Liu YW (2), Chan SP (2), Ho BPY (2)
Affiliation :
(1)NTEC Wound Services Team, Department of Surgery, PWH, (2)Central Nursing Division, NTEC
Introduction :
Several sentinel events have been occurred in NTEC related to retained packing material in patients after dressing procedures. The development of standardized NTEC Wound Packing Record with essential elements is key concern. Besides, the establishment of effective communication system for clinical handover of wound packing issues in all settings is crucial.
Objectives :
To develop tool to align the documentation of wound dressing and its related management and, to develop strategies for updating and maintaining the continuity of wound care across specialties / departments / hospitals within NTEC.
Methodology :
Existing gaps in non-standardized documentation tools and failure in information retrieve in different settings were identified. 4-steps action plan was developed on April., 2020 to prevent further incident occurred. Step 1:Essential elements in wound dressing and packing were defined. Step 2:NTEC Wound Packing Record was developed for use in all in-patient areas. Step 3:CMS templates in Nursing Discharge Summary and Nursing Note for documentation of all essential elements were implemented in all 7 hospitals. Phase 1 and 2 pilot studies were performed in the Cluster. Ward-based and hospital-based dissemination seminars have been arranged to all AEDs, OTs, wards and community settings. Step 4: Standardized guideline on wound dressing and packing will be developed.
Result & Outcome :
Phase 1 pilot study (2 weeks) of NTEC Wound Packing Record was performed from 6-7-2020 to 26-7-2020. Phase 2 pilot study (2 weeks) with the involvement of the use CMS documentation was performed from 7-9-2020 to 6-11-2020. Total 86 patients (127 wound record with 823 packing entries) were recruited in Phase 1 study; and total 164 patients (199 wound record with 1169 packing entries) were recruited in Phase 2 study. 100% Overall compliance rate was 63% in Phase 1 study and increased to 88.5% in Phase 2 study. Compliance of 80 or above was 98% in Phase 2 study. Cluster mean compliance rate has increased to 98 in Phase 2 study compared with 93.3 in Phase 1 study. Besides, key parameters have significant improvement in Phase 2 study such as: 100% compliance on “one wound one record”; no error found in daily “in & out entry” of “material” and “number” of packing material in all records; documentation of the length of newly packed material has increased from 58.6% to 94.8%; and 100% correct documentation of “completely removal” of packing material. The use of template with essential elements with uploading to ePR in Nursing Discharge Summary or Nursing Note was 84.7% and 100% in wards and community respectively. 17 Operation Records have been checked with correct packing information after operations. In additions, total 36 wards/units with 100% compliance were granted as “Model Wards” in the Cluster. Modifications of Packing Record and CMS templates were performed according to staff feedback in order to prevent duplication of entries and increased in staff workload. To enhance the smoothing running of the cluster’s roll-out plan, total 9 seminars with 1 CNE point (5 Zoom classes) were organized for all NTEC staff in different hospitals from 4-1-2021 to 19-1-2021. Apart from lecture sharing, video on “Ribbon Gor’s Tour in NTEC” and slogan were developed to promote staff understanding. Over 600 staff in NTEC (Zoom class: 280) had attended the training with positive evaluation results. With the collaboration of Central Nursing Department, NTEC Wound Packing Record and essential elements in CMS have been successfully roll-out as official document on 12-1-2021. Post implementation audit will be arranged 6 months afterward to evaluate the compliance. To conclude, patients’ safety can be promoted with the implementation of wound dressing and packing essential elements in every hand over process from all in-patient to out-patient settings.
