Authors: (including presenting author): :
Leung SLE (1), Tai CE (1), Wong WL (1), Law MW (1), Tse KB (1), Shum NY (1), Tse MW (1)
Affiliation: :
(1) Respiratory Nursing Team, Medicine & Geriatric, Tuen Mun Hospital
Keyword 1: :
Chest Drain Care
Keyword 2: :
Nursing Education Programme
Keyword 4: :
Chest Drain Management
Introduction: :
Chest drains manage pneumothorax, pleural effusion, empyema, and post-thoracic surgery etc. Aims to restore negative thoracic pressure for lung re-expansion. Patient with chest drains is commonly encountered in hospital settings, especially Medicine and Geriatrics (M&G) wards. Chest drains monitoring and management is an essential nursing procedure in acute medical and respiratory wards. Complications such as tube dislodgement, unrecognized blockage, or even infection may result in patient harm if not properly and immediately managed.
Objectives: :
The framework systematically enhances nursing proficiency in chest drain care through integrated interventions: MGNet training, Safety Café interactive sessions, daily respiratory nurse supervision, Quick Tips standardization, responsive consultations, and interprofessional workshops. It promotes uniform evidence-based practice adoption, boosts staff confidence and complication response, sustains Train-the-Trainer knowledge dissemination, and the most importantly—prioritizes patient safety.
Methodology: :
Six Tiers of Nursing Education were established. Tier 1 - Digital Knowledge Foundation through MGNet Platform: The training were given to the M&G nursing staff. Sessions covered chest drain physiology, insertion preparation, daily monitoring, complication management, and related protocols. Tier 2 - Interactive Safety Café Training: The training is organized by NSD of our cluster, NTWC. We were invited to craft the training curriculum, developing case-based scenarios reflecting the realistic chest drain challenges, designing the training material. We acted as the trainer in the Traini-the-trainer session, and be the facilitators in the training session as well. Tier 3 - Standardized Reference Tools: A One-page "Good Practices for Chest Drain Care" was developed, featuring the quick tips on the chest tube connection and security, daily monitoring, labelling & documentation. Tier 4 - Daily chest drain round A structured chest drain round was conducted daily by the respiratory nursing team in M&G ward. Each patient with an indwelling chest drain was systematically assessed using a checklist endorsed by the Respiratory team. Real‑time feedback will be provided to ward staff if any oversight was noticed, highlighting best practices and identifying areas for improvement, thus can reinforce the underdeveloped elements in future training. Tier 5 - Responsive Consultation Network: Apart from the daily ward round provided by our team, ah hoc telephone or on-site consultation service will also be provided upon requested. Tier 6 - Interprofessional Collaboration: Respiratory nurses co-facilitated Chest Drain Insertion Workshops for new graduate physicians, organized by the Respiratory team, emphasizing nursing care, monitoring, and multidisciplinary communication.
Result & Outcome: :
4 targeted MGNet sessions were delivered to 83 M&G nursing staff. The essential points of chest drain care with the promotion of the one-page “Good Practice of chest drain care” were delivered in the Safety Café to sustain nursing proficiency and patient safety. Since October 2024, chest drain rounds have been consistently conducted, delivering over 4,500 structured assessments. Oversight rates showed a significant decline, dropping from 32.1% in the initial phase to 8.7% during the maintenance phase. This reduction highlights a substantial improvement in nursing practice and patient management for chest drain cases. The structured approach has enhanced consistency, accountability, and quality of care, demonstrating the effectiveness of ongoing rounds in sustaining optimal nursing performance and patient care. This six-tier framework reduced chest drain oversights, boosting staff confidence and evidence-based care in M&G wards. Moving forward, scale to other units, monitor clinical outcomes, refine curriculum yearly according to HA guidelines, and formalize Train-the-Trainer refreshers for sustainability.
