Proposed Topic (Most preferred): :
Staff Engagement and Empowerment (motivating staff / teamwork / work revamp tackling manpower issue / staff wellness / OSH / retention)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Lam KK(1), Mak CK(1), Yip CK(1), Mak KC(1), Ip MK(1), To C(1), Yeung YM(1)
Affiliation :
(1) Department of Rehabilitation and Extended Care, TWGHs Wong Tai Sin Hospital
Introduction :
Communication is essential element in the nursing care. Communication as a tools of information distribution, promote bound between staff members and allow each staff to share their concern about the patient. (Chapman et al., 2016). A systematic review suggested that poor communication contributed to 14% of missed nursing care and up to 85.3% of nurses reported that communication is important factor of missed nursing care. Effective communication plays a protective role in prevention of missed nursing care. (He M., et al., 2022) Several smart ward systems including, Clinical Dashboard (CDB), E-Vital Sign, E-bed Panel and IPMOE have been introduced in the Department of Rehabilitation and Extended Care (DREC), TWGHs Wong Tai Sin Hospital (WTSH) ward 4EF. In a survey within nursing staff of ward 4EF, >70% of nurses agree that smart ward system is effective in routine nursing care, but only 54% of staffs agree that it is effective in shift-to-shift hand overing. Situation, Background, Assessment, Recommendation (SBAR) communication tool is widely used in clinical area for clinical handover. A systemic review suggested SBAR brings positive patient safety outcomes. (Müller M, Jürgens J, Redaèlli M, et al, 2018) A common language with structured framework of communication can promote effective communication. This CQI was divided into two phases. Phase 1 was aimed at enhancing communication of nurses by developing a Communication Enhancement Package with make used of smart ward system to develop a common language, and then combined with SBAR communication tools as a communication framework, in order to make daily handover more effective. Phase 2 was aimed to increase the nursing care effectiveness by enhancing the empowerment of PCAs on the use of e-vital sign system, by helping nurses to perform the routine vital sign taking, which could preserve time for nurses to conduct nursing assessment and intervention by quick screening through the e-vital sign system under nursing manpower shortage situation.
Objectives :
1. Enhance nursing communication on daily shift handover and nursing assessment by use of E-vital, E-bed panel, Clinical dashboard and IPMOE. 2. PCAs have ability to record the vital sing in e-vital during patient routine vital sign round and administration procedure.
Methodology :
For phase 1, a “Communication Enhancement Package” and “Intergradation of Smart System with SBAR Communication Tools” are developed and introduced to nursing staffs. By satisfactory questionnaire, to elevate satisfactory rate of nurses on the “Communication Enhancement Package” and “Intergradation of Smart System with SBAR Communication Tools”. Besides, self-reported satisfactory rate on daily shift hand over improvement is elevated by pre and post questionnaires. Moreover, pre- and post- intervention fall rate and new pressure injuries developed rate were measured. For phase 2, “E-vital sign user guide for PCA” is developed for education purpose and nursing audit form was developed to assess PCAs on the skills ability of the vital sign taking and accuracy of e-vital sign system recording. A designated PCA1 was assigned for education of other supporting staffs after completion of nursing audit. All PCAs required to pass the nursing audit before they are allowed to perform e-vital sign recoding independently.
Result & Outcome :
In phase 1, both satisfactory rate of the Communication Enhancement Package and SBAR Communication Tools reported effective or more are 100%. The satisfactory rate of CQI project on the use of E-system during daily-shift hand over increased from 54% to 100%. The phase 1 project is still in progress, and the fall rate and new pressure injures developed rate are await results. In phase 2, the accuracy of e-vital sign recording and the skills ability of vital sign taking of PCAs are 100%. All PCAs have ability to perform accurate e-vital sign taking and recording independently.
