Proposed Topic (Most preferred): :
Staff Engagement and Empowerment (motivating staff / teamwork / work revamp tackling manpower issue / staff wellness / OSH / retention)
Authors (including presenting author) :
MAN WY(1), KWONG CLJ(2),LUI CKV(2), CHEUNG CCC(3), CHAN WK(4)
Affiliation :
(1)Acute Stroke Unit, Department of Medicine, Yan Chai Hospital, Kowloon West Cluster (2)Acute Stroke Unit, Department of Medicine & Geriatrics, Caritas Medical Centre, Kowloon West Cluster (3)Integrated Neurosurgery and Neurology Ward, Department of Neurosurgery, Princess Margaret Hospital, Kowloon West Cluster (4)Accident and Emergency Department, North Lantau Hospital, Kowloon West Cluster
Introduction :
Thrombolytic therapy is time dependent for eligible acute ischemic stroke patients within narrow treatment window. According to ECASS III study in 2008, eligible patients without contraindication should be administered intravenous thrombolytic agent within 4.5 hours. The shorter the onset-to-needle time, the better the neurological outcome. The DEFUSE 3 and DAWN trials have shown that with longer therapeutic window, more patients can benefit from intra-arterial mechanical thrombectomy (IAMT) if criteria are fulfilled. In Kowloon West Cluster (KWC) of Hospital Authority, 24-hour thrombolytic therapy has been in place from July 2019 onwards. With the further expansion of 24-hour IAMT service from Aug 2023, it implies demand on reperfusion therapy will be increasing. To prepare for the change, PMH was accredited as PRCC stroke care nursing clinical practicum site in 2016, followed by YCH & CMC in 2018 for nursing staff training.
Objectives :
1. Maintain adequate qualified stroke nurses for on-site reperfusion therapy service 2. Ensure qualified nurses are capable to deliver hyperacute nursing care according to prevailing workflow
Methodology :
What did you change: a. Revised clinical workflow in accordance with latest reperfusion treatment b. Guidance from mentor and trainee experienced at least 10 real cases before formal assessment c. Ensure trained nursing staff to familiar with HA Chat as smart communication tool Methodology: All potential nurses were offered reperfusion training through theoretical input and clinical coaching by mentors. Once received TPA (Tissue Plasminogen Activator) call from AED (Accident and Emergency Department) or clinical wards, trainee is required to assess the patient as soon as possible under supervision. After that, the trainee should call duty neurologist for reporting followed by sending referral form via HA Chat. Then formal reply from neurologist would be obtained via email. Upon completion of training, formal assessment by neurologist would be arranged. The nurse would be qualified to handle all potential reperfusion therapy patients independently after passing the assessment.
Result & Outcome :
Outcome: In the past decade, 126 nurses have been trained according to standardized training curriculum in KWC. Due to the staff turnover, we continue regular training to maintain around 12-17 trained nursing staff in each hospital in KWC to maintain safe and efficient stroke reperfusion service. Conclusion: Ensure adequate and qualified nursing staff is very crucial to sustain the 24-hour stroke reperfusion therapy service.
