Authors (including presenting author) :
Shit KYF(1),Mak HN(1), Tong SY(1),Lam MY(1), Yu HY (1),Leung YY(1), Cheung KWA(1), Lam YC (1), Cheung KN(1), Ng MKM(1), Lee LN(1), Tam ML(1), Li SY(1), Lee SW(1), Yeung WK(1), Lo KL(1), Yan CK(1), Mak WH(1), Chui ST(1).
Affiliation :
(1) Department of Surgery, Prince of Wales Hospital.
Introduction :
Wound packing is often integral to surgical gap wound’s healing and should be carefully handled throughout the patient journey, from hospitalization to discharged aftercare. Any retained wound packing item however can be detrimental to patient safety and lengthen the period of wound healing. Apart from the development of standardized NTEC Wound Packing Record and electronic template, NTEC Wound Services Team has collaborated with the Department of Surgery, PWH beginning from July 2021 to develop four special CQi Projects: i) Development of “Difficult Wound Packing Management Pathway” for discharged patients; ii) Use of “Packing Safe + Bag” for removed packing items inspection; iii) Use of “Peri-operative Nursing Record-Wound Packing Chop” for patients back from OT; and iv) Introduction of “Wound Packing Q-card and Reminder” in patient folder and clinical dashboard. Altogether these projects aimed at reaching zero wound packing related incidents and enhancing wound care continuity.
Objectives :
(1) To safeguard proper wound packing insertion and removal practice; (2) To facilitate accurate and comprehensive documentation on NTEC Wound Packing Record; (3) To support patients being discharged with difficult wound packing by NTEC Wound Services Team’s involvement; (4) To foster interprofessional collaboration between nursing staff and surgeons in wound packing management.
Methodology :
The CQi projects were implemented in all 11 surgical wards and EWNC (Enterostomal and Wound Nurse Clinic) in PWH. Action plan was presented to nursing staff and surgeons prior to implementation. Data collection and post staff satisfaction survey were conducted at the end of the projects. Major outcome measures included: incidence of retained wound packing; related A&E attendance; staff satisfaction and feedbacks; statistics on extended periods of specialty-wound care after discharge; statistics on packing alternatives applied for reduction of wound packing etc.
Result & Outcome :
The project aimed at reaching zero wound packing related incidents, promoting wound healing and enhancing wound care continuity. From July 2021 to March, 2023, all nursing staff and surgeons from Department of Surgery, PWH and NTEC Wound Services Team have participated in the projects. 97% nursing staff and surgeons agreed that the interventions of the CQi projects effectively reduce the risk of retained wound packing in the evaluation survey. 42 patients (49 wounds;2 paediatric & 40 adults) were discharged with difficult wound packing. 11 (26%) with narrow wound opening or deep wound +/- undermining required daily intensive wound irrigation and packing; or negative pressure wound therapy by Wound Services Team with total 101 visits (mean=9.2 visits for each patient; treatment time~2-51 days (mean=21.7 days) prior to GOPC care. 31 (74%) patients with wound packing in GOPC and monitored by Wound Services Team with total 104 visits (mean=3.35 visits for each patient). Packing alternatives such as Medihoney, Alginate Silver Paste and wound irrigation were applied successfully to reduce wound packing and promote wound healing. No wound packing related incident or A&E attendance was recorded. All CQI practices are effective and successful to promote patients' safety in wound packing.
