Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Staff Engagement and Empowerment (motivating staff / teamwork / work revamp tackling manpower issue / staff wellness / OSH / retention)
Authors (including presenting author) :
CHAN PS (1) , LEE OY (1), CHU MWC (1), WONG YK (1), LI KY( 1)
Affiliation :
Department of Rehabilitation and Extended Care, TWGHs Wong Tai Sin Hospital
Introduction :
Tracheostomy is a surgical procedure which creates an opening in the anterior wall of the trachea. It is one of the most commonly conducted procedures in critically ill patients. For instance, as many as one-third of the patients admitted to Intensive Care Unit (ICU) & Ear, Nose and Throat Unit( ENT) (Gratrix, Graves & Murphy, 2008) require a tracheostomy to facilitate mechanical ventilation (Casserly , Lang , Fenton & Walsh, 2007).
In recent years, there are an increasing number of patients receiving tracheostomy due to improvement of technological support, leading to more tracheostomized patients being discharged to non-specialized areas( i.e. rehabilitation hospitals for extended care). Hence, whether experienced or junior, capable and confident nurses equipped with appropriate nursing knowledge and skills are needed so as to provide safe tracheostomy care and prevent undesirable complications.
Objectives :
This program aims to enhance the knowledge and skills of the nursing staff who are working in the infirmary ward for caring of patients with tracheostomy in TWGHs Wong Tai Sin Hospital.
Methodology :
-Pre -test questionnaires of nursing staff
-To investigate the knowledge and skills among nursing staff
-Pre- test skill audit in tracheostomy dressing and change of inner tube
-To understand the nursing skill performance among nursing staff
-Education talk
-Post- test questionnaires of nursing staff
-To evaluate the knowledge and skills among nursing staff
-Post- test skill audit in tracheostomy dressing and change of inner tube
-To evaluate the nursing skill performance among nursing staff
-Evaluation of the project
-To obtain the feedback from nursing staff for better improvement of the program
Result & Outcome :
The data collection time of the Pre-test questionnaire and Pre-skill audit was between October and December 2022. The data collection time of the Post-test questionnaire and Post- skill audit was between January and March 2023.
Total participants were 15 which included registered nurse(RN) and enrolled nurse(EN) with 100% response rate.
-Questionnaire
Regarding demographic data, the junior EN and RN with working experience less than 2 years accounted for 60% and 20% respectively. The majority of nursing staff answered incorrectly about clinical knowledge and emergency care management. It might be due to lack of clinical experience on handling emergency situations in the ward among the nurses. The average score of the Pre-test and Post-test questionnaire significantly increased from 8.3 to 14.4 after the participants attended the education talk.
-Skill Audit
The passing rate of Pre-skill audits and Post-skill audits were 100%. The learning points were investigated as follows:
i) 50% Nursing staff always forgot to bring along with the tracheal dilator during tracheostomy tube dressing
ii) 33% Nursing staff was unable to state the correct range of suction pressure
iii) 33% Nursing staff seldomly gave hyperoxygenation before suctioning
iv) 20% Nursing staff was not good enough to secure the tracheostomy tube correctly
After the education talk, the results of the skill audit showed that 56% of nursing staff scored greater than 80 and 44% of them scored between 60 and 79.
Great improvement was shown after the participants attended the education talk with 100% of them scoring over 80 and no participants scoring between 60 and 79.
-Outcome
Positive feedback was obtained from the evaluation among nursing staff. Over 90% of them agreed and strongly agreed that the program enhanced the knowledge in providing tracheostomy care and the clinical skills(e.g. emergency care of tracheostomy tube)are useful to be applied in the clinical workplace
