Authors (including presenting author) :
Chan MC, Chan WF, Hau SS, Lai CH, Lau YW, Poon WS, Shum MN, So PL
Affiliation :
Accident and Emergecny Departments of New Territories East Cluster (NTEC) [including Alice Ho Miu Ling Nethersole Hospital (AHNH), North District Hospital (NDH) and Prince of Wales Hospital (PWH)]
Introduction :
In Hong Kong, emergency nurses were delegated to perform I&D for patient with simple cutaneous abscess. However, there is lack of a structural training on the skill and performance of it. The acquired skills is mainly by apprenticeship. However, the scope and degree of practice varies among different hospitals, such as locations of abscess or size of it. In the New Territories East Cluster (NTEC), there are 3 A&Es including Alice Ho Miu Ling Nethersole Hospital (AHNH), North District Hospital (NDH) and Prince of Wales Hospital (PWH), and two of them have such procedure performed by nurses. However, there is no standard training on it. A survey was conducted to explore the demand and the practice for I&D within the cluster last year and found that there was an impulse on developing a formalized training for it.
Objectives :
As there were variations in practice on I&D by emergency nurses within the cluster, a Continuous Quality Improvement (CQI) program was conducted. The aim of CQI was to ensure the quality and safety of simple uncomplicated I&D performed by emergency nurses in NTEC. The objectives of CQI were to improve the knowledge, skills, competence of nurses in performing simple, uncomplicated I&D and to standardize the I&D practice among nurses by adopting the same procedure outline.
Methodology :
A rapid Plan, Do, Study, Act (PDSA) cycle process, was applied in this program. It was used to verify the effects of changes and ultimately spread the effective changes through the practice. An education session was implemented, which included education PowerPoint, video, pre-test and post-test, hands-on practice and evaluation survey. A total of 23 RN were recruited in the education sessions from three hospitals. All of them had attended the Wound Management and Suturing Technique Course conducted by COC(A&E). A pilot education trial was conducted in PWH and two identical sessions were held in AHNH and NDH. Each session lasted for about 3 hours and were conducted by the consultant of PWH A&E and the Nurse Consultant (Emergency care) of NTEC. After one month of the education sessions, a post-education skill evaluation was done with a skill checklist.
Result & Outcome :
23 participants attended the education sessions. Participants with less than five years of experience in A&E accounted for 47% (11); and for those who had 5-10 years and more than 10 years of experiences were 35% (8) and 17% (4) respectively. The pre-tests and post-tests showed the knowledge in I&D of our participants had a significant increase with the education sessions. The overall mean scores rose from 4.39 to 7. For the perception of preparedness, Among 23 participants, 91.3% (21) of them either felt little or somehow prepared on performing I&D before the education, while only 8.7% (2) felt well prepared. However, after completing the education, the number of participants who felt little or somehow prepared reduced to 26.1% (6). For those who felt well or very well prepared on performing I&D increased to 73.9% (17). For confidence, around 90% of participants were not sure or not confident on knowledge and skills initially. In contrast, approximately 80% of participants experienced a significant increase in the level of confidence after receiving a standardized education. For participants’ satisfaction and program evaluation, all of the participants either agreed or strongly agreed that the education program was useful, applicable to clinical practice and satisfied with the education sessions. In 2020, a formal incision and drainage management course was organized by COC(A&E). It aimed at training nurses who are working in A&E Departments for better knowing the concepts and skills of incision and drainage management in daily practice. The half day course consisted of lectures, demonstrations, skill stations and written examination. Until December 2022, total 14 classes were held and more than 300 nurses were trained.
