Authors (including presenting author) :
Li WY (1), Chu CK(1), Cheung KFM(1), Chui WS(1), Ng MK(1), Tsang PY(1), Tsui TT(1), Liu LC(1)
Affiliation :
(1) Medicine & Geriatrics Isolation Ward, Department of Medicine & Geriatrics, Kwong Wah Hospital
Introduction :
Nurses always navigate challenges to implement interventions on patients under isolation setting with identifiable constraints. The double-door suite, aiming at minimizing infection risk, features environmental constraints to direct observation of the patients. Barely audible alarms signaled from life-sustaining device, e.g., mechanical ventilators, may hinder the responsiveness on alarms of nurses. To overcome the barrier and further enhance patient observation, nurses in the isolation ward were educated and empowered to utilize Central Physiological Monitoring System with revised workflow, and Ventilator Nurse Call Alarm System with advanced technology embedded.
Objectives :
To enhance patient safety and instant nursing care of patients on mechanical ventilators by revised workflow in utilization of Central Physiological Monitoring System, and raising alertness and prompt response of nurses with newly introduced Ventilator Nurse Call Alarm System
Methodology :
Hospital management and Q&S department rendered support to liase other departments for installation of Ventilator Nurse Call Alarm System in the isolation ward: Interfacing nursing call alarm system with ventilator alarms by connection of a 3mm-cable from the mechanical ventilators to the wall unit. The alarm signal was then conveyed to the nurse call panel, prompting message on the panel with nurse call alarm activated in the ward. Structured training was delivered by nursing supervisors with revised workflow and graphic flowchart. Alignment in format of data entry was done to aid physiological monitors in differentiable use in accordance with the needs. Reminders affixed on the monitors and mechanical ventilators to remind steps of set-up. Nurses then return demonstration with performance evaluated. Clinical supervision to foster the culture of change with established shared goals, and discussion on concerns regarding to the project. Supervisors acted as role models and render support. Records of the central physiological monitors by case nurse handover at each shift to raise the awareness. Ward round by nursing supervisors safeguard proper utilization of the systems. Evaluation tools include assessment on training performance and direct observation on the compliance of utilization; 5-point Likert Scale Surveys was also utilized to review feedback from nurses.
Result & Outcome :
Total 27 nurses participated: All passed the clinical assessment of utilization and fully compliant to the utilization with 100% response rate to the ventilator alarms prompted. All of them accepted the change and were confident to utilize the systems. Most of them agreed that it maintained high quality standard of nursing practice, enhanced patient safety and efficiency in nursing care on IMV patients. Culture of enhancing safety and instant care was fostered since the systems introduced to the isolation ward. Moreover, support rendered from hospital management was crucial to elicit change in current practice for enhancing patient safety and quality of care. Handover and countercheck of the systems by case nurse at each shift could cultivate a habit of enhanced awareness on patient observations. Ward round by nursing supervisors as gatekeepers to sustain cultures of patient safety and reduce clinical incidents led by delayed response to alarms emitted from life-sustaining or monitoring device. The aforesaid systems may further be established in other general wards with isolation facilities to aid patient safety and quality of care, attributed by raised awareness and prompt response from nurses to implement interventions accordingly in the isolation ward.
