Authors (including presenting author) :
Chan KY (1), Lok HT (1), Lee KF (1), Salim A (1), So MH (1), Wong SL (1), Chui ST (1)
Affiliation :
(1) Department of Surgery, Prince of Wales Hospital
Introduction :
According to the Hong Kong Cancer Registry in 2019, hepatocellular carcinoma (HCC) is the fifth commonest cancer and the third leading cancer death in Hong Kong. Intervention radiological procedures including trans-arterial chemoembolization (TACE), radiofrequency ablation (RFA) and microwave ablation (MWA) are important treatment modalities which have proven therapeutic values in terms of prolonged survival and hope of cure for HCC patients. These patients contribute to considerable workload to the hepatobiliary-pancreatic (HBP) ward. However, there is no standardized clinical pathway with regard to peri-procedural management, resulting in variable treatment orders among different clinicians. Inconsistent peri-procedural management may predispose to medication error. Therefore, a quality improvement program is designed to standardize clinical pathway for those IR procedures.
Objectives :
1. To enhance patient safety by minimizing variation of clinical practice 2. To promote clinical competence and job satisfaction for nursing staff 3. To improve quality and consistency of clinical care 4. To shorten hospital stay
Methodology :
Discussion was held among HBP medical and nursing teams to develop a clinical pathway of TACE. A sharing session with regard to the adoption of new clinical pathway was held for nursing and medical staff before implementation. An audit form including blood taking, medication, puncture site checking and follow up arrangement was designed to check compliance before and after TACE procedure. Pre and post treatment questionnaires were distributed to nurses for evaluating clinical competence and job satisfaction. The clinical pathway was implemented from March to October 2021 in HBP ward.
Result & Outcome :
A total of 42 patients underwent TACE procedure were recruited. The overall compliance rate increased significantly from 68.60% to 95.59% while staff competence and job satisfaction increased from 44.89% to 92.00%. The results were very encouraging. In view of the above satisfactory initial results, a standardized clinical pathway of percutaneous RFA and MWA was commenced in December 2021. The team spirit was greatly enhanced after the program. The implementation of clinical pathway was highly valued among both medical and nursing staff to enhance patient safety and clinical efficiency.
