Authors (including presenting author) :
Ng NHY(1), Ko PS(2), Tang LM(3), Chan TY(3), Lam YF(3), Lau KC(3), Ma CM(3)
Affiliation :
(1) Nursing Services Division, (2) Department of Medicine and Geriatrics, United Christian Hospital, (3) Palliative Care Unit, Haven of Hope Hospital
Introduction :
As poor venous access is common in terminally ill patients, continuous subcutaneous infusion (CSCI) of medications is well-recognized to manage pain and other distressing symptoms when palliative care (PC) patients can no longer tolerate oral administration. Majority of PC patients admitted Tseung Kwan O Hospital (TKOH) required pain and symptom management, a program was launched to promote CSCI of medications via infusion/syringe pump beyond PC setting.
Objectives :
(1)To empower frontline nurses beyond PC setting with the knowledge and skills in handling CSCI; and (2) to implement CSCI of medications in acute care settings in TKOH.
Methodology :
A training program was devised with lecture (via onsite or video), train-the-trainer (TTT) hands-on skills workshop with demonstration and return demonstration on CSCI, audit of all frontline nurses on administration of SC medication via infusion/syringe pump, and pilot study before full implementation to all wards, along with ongoing support from PC consultative team throughout the process. All patients put on CSCI of medications were recorded by end-of-life (EOL) care link nurses of all wards for program review.
Result & Outcome :
Guidelines on “Subcutaneous infusion Nursing Management (Medication Administration)”, revision of subcutaneous infusion site assessment form, audit form and setting up of drug regimen in Inpatient Medication Order Entry (IPMOE) System were prepared prior to training of nurses. In August 2021 and May 2023, eight TTT workshops were conducted to frontline nurses of TKOH Medical, Surgical and Orthopaedics & Traumatology/Gynaecology (O&T/Gyn) Departments. Totally 15 wards with 145 nurses were trained as trainer who then helped to complete CSCI audit in respective wards. Pilot study was then conducted in one ward of each department, which ran smoothly without any adverse reaction observed or difficulty encountered by nurses. Implementation of CSCI with medications was then rolled out in phases from medical wards since October 2021, to surgical wards since May 2022 and to O&T/Gyn wards (currently in pilot study phase). By the end of November 2024, totally 115 patients were put on CSCI in three years with no adverse reactions or incidents reported. Safety in CSCI of medications via infusion/syringe pump in TKOH is ensured by training, skills transfer and auditing. Regular audit is recommended to ensure conformity of nursing practice.
