Authors (including presenting author) :
CHAN WLF(1), WONG CW(1), TANG MKC(1), TANG MKC(1), Yik WMJ(1), Ng CW(1),
LI MPM(1), Ng PK(1)
Affiliation :
(1) Medical & Geriatric, Princess Margaret Hospital
Introduction :
Prevention of retained tourniquet program has been installed in PMH in many years. Retained tourniquet was defined as tourniquet intended to temporarily promote venous distention for peripheral venous access devices (PVAD), but tourniquet was inadvertently left applied for an extended time. The longer a tourniquet being left in place, the greater the chance of significant injury. Transient pain, edema, and/or paresthesia of involved extremity, and/or leaking at puncture or catheter insertion site, infusion may infiltrate or flow slowly are the common signs of retained tourniquet.
In current practice, the responsibility on preventing retained tourniquet is mainly relied on phlebotomists and doctors. They used to insert PVAD and remove the tourniquets themselves after procedure only by their experience and there was no monitoring or checking. A journal stated that the expertise of nurses in inserting, managing, and removing these devices may reduce the likelihood of complications, and increased recognition of complications associated with use of the devices which was important to ensure the continued improvements in safety, quality, and efficiency of health care.
In 2019-2020, there were two episodes for retaining tourniquet in Heamatology unit. In case analysis, those cases would be preventable if prevention of retained tourniquet program installed systematically. After analysis, checklist, teaching material, annual audit and self-evaluation form should add on the revised prevention of retained tourniquet program.
Objectives :
I. Establish a prevention of retained tourniquet program workflow in systematic approach
II. Develop a regular yearly audit for staff
Methodology :
How to achieve this outcome
At the beginning, the project leader search journals and make a literature review on prevention of retained tourniquet. They summarizes the suggestion in literature review and select some suitable methods in PMH the haematology unit. New template of haematology unit prevention of retained tourniquet program have been designed.
Besides that, project leader designed a new chop for chop the blood job sheet to verify tourniquet removal after blood taking. Project leader develop the new IV cannulation record to verify tourniquet removal after IV insertion.
In the haematology unit prevention of retained tourniquet program, The nursing staff should
I. Double checking that tourniquet has been removed in each shift by shift IC and a nurse
II. Having a nurse’s signature on the IV cannulation record to verify tourniquet removal after IV insertion.
III. Having a nurse’s signature on the blood taking job sheet to verify tourniquet removal after blood taking
IV. Having documentation in CMS after the IV insertion
Measure of success
Checklist, teaching materials, annual audit and self-evaluation form were designed for reviewing the program periodically.
Result & Outcome :
This ongoing program was started from April 2020. There were no incidents of retained tourniquet since program installed. Heamatolgy unit nurses agreed that the program could effectively increase the awareness of retained tourniquet and minimize the risk of retained tourniquet. The nursing staff also mentioned that the program is not time consuming and does not increase the workload.
