Improving the insertion of chest drains in the Emergency Department

Quality Improvement Poster Download

Background & Problem

Chest drain insertion is an invasive procedure performed in the ED. All patients should have a drain inserted in line with WHO checklist standards and as described by the BTS. A trust wide chest drain checklist was available but was not used consistently in the ED as identified by M and M cases and audit. This puts the patients and staff at risk through risk of harm and scrutiny if not following local and national guidance.

Aim

80% of patients receiving a chest drain in the ED should have a pre-procedure checklist undertaken by the end of July 2017.

Method

Prior to the start of this QIP equipment had been changed and E learning videos were made to demonstrate the use of the equipment. Process mapping and driver diagrams helped identify barriers, generate change ideas and process, balancing and outcome measures:

• PDSA 1 – Improve availability of insertion record
• PDSA 2 - Increase staff awareness
• PDSA 3 - Focussed situational training

Outcome measure - % of chest drains inserted in the ED that had an accompanying insertion record.

Process measures - spot checks of equipment, questionnaires of staff awareness and number of educational initiatives undertaken

Balancing measures – time taken to use the tool

Results

Outcome measure: baseline = 30%, November 2016 = 100% with an overall trend of improvement seen on a run chart.

Process measures: Staff awareness – sustained improvement in awareness of Drs, baseline = 0%, Nov 16 = 67% with overall improved trend. Continued poor awareness of nursing staff

Equipment checks, was the insertion record present? – baseline = 0%, Nov 16 = 100%. There was no change in trend however for the number of missing essential items.

Balancing measures: Users feel it actually take less time to complete than writing free hand.

Implications

Through a series of PDSA cycles initial trends show an improvement in compliance with WHO and BTS standards for chest drain insertion. The sustainability of this without the high level of educational interactions is yet to be seen.