Authors: (including presenting author): :
Lai KM(1), Ho CW(2), Chan PC(2), Chan TF(2), Wong WT(2), Lam SM (2), Chan OK(2), Mak PS(2), Liu CY(2), Fan HC(2), Hai MT(3), Pany I(3), Chan F(2), Tse G(3)
Affiliation: :
(1)Palliative Care, Hong Kong East Cluster (2)Palliative Care Unit, Department of Medicine and Geriatrics, Tang Shiu King and Ruttonjee Hospitals (3)Department of Medicine and Geriatrics, Tang Shiu King and Ruttonjee Hospitals
Keyword 1: :
Handheld ultrasound
Keyword 2: :
Palliative Care
Keyword 3: :
Home Care Team
Keyword 4: :
Pleural effusion
Introduction: :
Comfort care and medical treatment for patient in Palliative Care (PC) are highly standardized. The ultrasound helps to guide clinical decision-making, therefore, the wide range to apply in PC for malignant ascites and pleural effusion etc. In RTSKH PC team, the ultrasound performs at bedside in hospital, means that patient who presented symptoms may need to admit in ward. However, some of them were not urgency to admit for abdominal / pleural tapping, and unnecessary admission may be arranged. Otherwise, most of PC patients prefer to stay at home or institution. Hence Home Care Nurse (HCN) is the ideal health professional to utilize handheld ultrasound devices in home-base setting for assist early diagnosis and further clinical intervention. Nevertheless, perform ultrasound in nursing care is not included in tradition nursing training in Hong Kong. The project’s design would initiate the ultrasound application by nurse and empower nursing role in patient’s care. The objectives of project would be decreased unnecessary admission, assist early diagnosis with clinical decision-making and enhance home care nurse and supporting role in patient care.
Objectives: :
Enhance home care nurses in supporting role in patient care
Decreased unnecessary admission
Assist early diagnosis with clinical decision-making
Methodology: :
The project mainly consists of two parts and carry out in three phases:
Phase one: PC Associate Consultant advised and prepared 2 video demonstration clips (pleural effusion and ascites) for all HCNs; Phase two: PC Associate Consultant offered training lecture, demonstration, skill transfer and hand on practice for HCNs. Aimed at qualify their competency via quiz and re-demonstration in real patients. Finally, 8 HCNs qualified; Phase three: Perform handheld ultrasound for PC patients in community who have symptoms of dyspnea or abdominal distension with history of pleural effusion / ascites. Verbal consent obtained from patient or carer before examination. Screen captured the ultrasound image and preliminary diagnosis made by HCN. The follow up action will implement after discuss and confirmed by PC Doctor via the image. Otherwise, images would be sent to PC Dr via communication software “HA Chat” for analysis if urgent need.
Result & Outcome: :
The project started on Dec 2023, till Dec 2025, a total of 47 patients with mean of age 80.9 years were included. 1 patient presented pleural effusion and others were abdominal distension. Compared with doctors’ diagnosis on patient severity of pleural effusion / ascites, found high accuracy (94%) of HCNs on diagnosis made via ultrasound performed. The digital imaging help to treatment planning, as a result, 21 patients arranged admission for abdominal tapping, and 26 patients keep monitoring or titrate medication as planned. In this project, 55 % patient who presented symptoms, nonetheless, no urgent need to admit hospital for symptom management.
All 47 patients and their carers showed appreciation and satisfy to HCNs and PC team with advance investigation in home setting. The handheld ultrasound helped to avoid unnecessary admission as patients can stay at home as long as possible.
HCNs showed job satisfaction and agreed that the handheld ultrasound helped to plan and decision making on nursing interventions.
