Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Chan J(1), Yip CW(2), Tse WY(1), Tso S(1), Chung WM(1)
Affiliation :
(1)Siu Lam Hospital, (2)Tuen Mun Hospital
Introduction :
With the medical advancement, more learning-disabled persons with severe dysphagia have changed to gastrostomy feeding. The impact of nursing staff with limited experience of gastrostomy care was tremendous. Discharge to general hospital for tube dislodgement, gastrostomy site infection was common in the early years of gastrostomy care. Collaboration with medicine department of a general hospital had started since early of 2013. With the support of management level of both institutes, gastrostomy care workshop had been regularly organized.
Objectives :
The goals of the training program are to (1) increase staff competence in caring residents with gastrostomy feeding (2) enhance clinical safety and care delivery (3) reduce the discharge episodes to general hospital which could maintain continuity of care in infirmary service.
Methodology :
Gastrostomy care workshop for nursing staff of infirmary institute had been commenced since mid of 2013. Positive feedback and knowledge gain were revealed via pre- & post-test after the workshops. A working group for gastrostomy care was set up to reinforce the learned skills into clinical practice and assist unscheduled tube replacement when trained staff was not available in the involved unit. Apart from the classroom feedback, discharge episodes to general hospital because of gastrostomy problems were drawn from hospital data system with showing decreasing trend.
Result & Outcome :
From 1/1/2013 – 31/12/2017, there were 44 out of 2520 discharge episodes to general hospital because of gastrostomy problems, whilst only 10 out of 2508 discharge episodes were noted from 1/1/2018 – 31/12/2022 with significant reduction (X2=21.476 , p<0.001). Though discharge episodes due to tube dislodgement, site infection, leakage from gastrostomy decreased along time, the observed differences were not statistically significant (X2=0.098-0.261, p>0.05). In fact, the number of residents with gastrostomy feeding had increased from 35 to 77 between 2013 and 2022. Conclusion: In view of significant reduction of discharge episodes related to gastrostomy problems, the influence of training interventions towards the improvement of staff competence in advanced nursing skills of gastrostomy care was substantiated. Due to staff movement, regular training program on gastrostomy care workshop was necessary to maintain certain number of trained staff to cover the service demands. Currently, about 80% nursing staff had been trained for gastrostomy care.
