Authors (including presenting author) :
Chan WK (1), Ho CW (1), Aboo Gloria (2), Lau KY Kara (1), Lai CH Eric (1)
Affiliation :
(1) Department of Surgery, Pamela Youde Nethersole Eastern Hospital (2) Quality and Safety Office, HKEC
Introduction :
Retained gauze in wound is a sentinel event in nursing. Despite of structured and evidence based guidelines, the incidence seemed to be occasionally reported in the cluster incident report panel. This paper describes a new nursing model which can enhance the competency in wound packing, and hence it can eliminate the risk of retained gauze in wound.
Objectives :
1. Improve the nursing quality and risk to prevent retained gauze in wound 2. Enhance communication among nurses on wound management
Methodology :
We implemented the new model in 3 phases. In phase 1, we tried to explore different improvement strategies and plans to demonstrate wound packing skills among nursing staff in Surgery. After survey, 24% nurses preferred digital pictures, 67% preferred videos and 9% reported not necessary. In next phase, we recruited patients who needed wound packing in Surgery and Medicine. By protocol, digital pictures were captured for simple wounds with craters. For complicated wounds with semi-opened undermining craters, deep pockets or tunnels, video were recorded. All pictures and videos were saved in the hospital tablets with verbal consents. Nurses needed to review the videos or pictures before dressing. In phase 3, nurses were required to be interviewed individually by wound nurse specialist.
Result & Outcome :
During December 2021, we recruited 10 patients (6 surgical wounds and 4 chronic wounds) and 40 nurses (38 RNs, 1 APN and 1 Student). All nurses agreed that digital images and videos greatly enhance a clear communication on wound care, including the cleansing method and packing skills among nurses in different shifts. And we noted 23 nurses (58%) could well comprehend and achieved on wound packing therapeutically. Besides of the present nursing protocols, they all commented the new model could effectively and practically eliminate the risk of retained gauze in wound. However, 27 nurses (67%) reflected the optimal video length could be limited to 60 seconds, whereas 23 nurses (58%) reported the video needed to be periodically updated for wound condition change. In coming days, continuous skill transfer on wound assessment, wound cleansing and packing, and instrument handling are major roles in nursing advances.
