Authors: (including presenting author): :
Lit MPK, Lee KH, Mak FT, Chow PS, Wong YH, Chan YH, Chan WMJ
Affiliation: :
Respiratory Division, Department of Medicine, Queen Elizabeth Hospital
Keyword 2: :
clinical guidelines
Keyword 3: :
education materials
Keyword 4: :
nurse competency
Keyword 6: :
assessment checklist
Introduction: :
The increasing use of Indwelling Pleural Catheters (IPCs) for managing malignant pleural effusions within the Kowloon Central Cluster (KCC) revealed significant clinical challenges. Input from consultations across different hospitals and specialties, coupled with reported clinical incidents, highlighted substantial knowledge gaps and inconsistent nursing practices. Many ward nurses lacked formal IPC training, while community nursing services were often unable to provide home care support. This variability led to reliance on patient families for guidance, incidents of device malfunction, and compromised patient safety, underscoring an urgent need for a standardized, cluster-wide approach to IPC care.
Objectives: :
This initiative aimed to: 1) Develop and implement evidence-based KCC IPC Nursing Practice Guidelines to ensure care standardization across all clinical settings. 2) Create comprehensive patient education materials and a nurse competency framework. 3) Deliver targeted, simulation-based training to a multidisciplinary nursing workforce to enhance knowledge, practical skills, and confidence in IPC management.
Methodology: :
Spearheaded by the Respiratory Nurse Consultant, a comprehensive program was launched from 2020-2023. The methodology included the development of detailed clinical guidelines, pre-insertion assessment checklists (evaluating psychological, functional, and environmental factors), and patient education resources. A structured training curriculum comprising didactic lectures and hands-on simulation workshops was delivered across nine identical sessions. The workshops featured three rotating stations focusing on drainage procedures, patient assessment/education, and complication troubleshooting. A total of 548 nurses from diverse specialties (Medicine, Surgery, ICU, Oncology, Community, etc.) participated. Program effectiveness was evaluated using pre- and post-training assessments of knowledge, confidence, and observed practical competency.
Result & Outcome: :
The program yielded significant improvements. Critical knowledge gaps were addressed: post-training, understanding of IPC purpose increased substantially, and confusion with chest drain management was reduced from 44% to below 10%. Clinical competency metrics improved markedly, with aseptic technique compliance rising from 48% to 89% and accurate complication identification increasing from 52% to 86%. All participants demonstrated correct home drainage technique post-training. Nurse confidence in IPC management surged from 50% to 80%, with similar gains in patient education (40% to 80%) and troubleshooting skills (45% to 80%). Standardized practices eliminated reliance on family guidance and prevented valve malfunction incidents. Enhanced documentation and better-prepared carers led to improved patient outcomes and care continuity. The initiative successfully standardized IPC care across KCC, enhancing patient safety, nursing competency, and job satisfaction, thereby serving as a model for procedure-specific quality improvement.
