Authors (including presenting author) :
Mak HN(1), Lam YC(1), Leung WK(1), Shit KYF(1), Tong SY(1), Lam MY(1), Yu HY(1), Leung YY(1), Cheung KWA(1), Li SY(1), Chui ST(1)
Affiliation :
(1)Department of Surgery, Prince of Wales Hospital
Introduction :
Wound packing is a very common nursing care procedure in surgical wards, in which the checking step of previously packed items is utmost importance. The NTEC Wound Packing Record provides a comprehensive documentation of wound packing material, numbers and length/size throughout the continuity of patients' wound care. With the use of the wound packing record, the achievement of zero retained wound packing also relies on multidisciplinary cooperation.
Miscommunication can cause staff's wrong assumption or doubt in the completeness of packing removal. Such ambiguous handover of packing removal can eventually result in retained packing materials, which endanger patient's safety. With the aim to avoid any retained wound packing materials, an improvement project is implemented in 11 surgical wards of PWH to promote accurate counting during packing removal.
Objectives :
1. To enhance communication of wound packing removal between multidisciplinary staff.
2. To promote accuracy in counting removed packing materials in clinical settings.
3. To prevent any retaining of wound packing materials due to staff miscommunication.
4. To increase staff alertness in handling removed wound packing materials from patients.
Methodology :
The workgroup has been developed with members from Surgical wards and Wound Team. Action plan was discussed with all ward managers and approved by DOM in Surgery. To collaborate with surgeons, the project was introduced in the Department's M&M Meeting on 29-7-2021, comments and support were obtained from surgeons. "Packing Safe+ Bag", an initially disposable plastic bag with packing removal instruction label, was designed for collecting removed wound packing materials during doctor's rounds or dressing procedure in 11 surgical wards of PWH. In order to increase the usage of the bags, they were placed in easily accessible clinical area, even on bedside tables of patients with wound packing. Doctors used the bag to collect the packing items after they removed from patients' wounds for nurses to check before dressing. In case of any packing number discrepancy or fragmented materials, nurses must inform doctor in-charge immediately and investigations have to be conducted. With the aim to enhance nursing and supporting staff's awareness of checking removed packing materials, the project members visited the wards to share the use of "Packing Safe+ Bag". Poster and Instruction Sheet with smart tips were designed to further promote the use of "Packing Safe+ Bag" to ensure correct counting of wound packing materials.
Result & Outcome :
The evaluation period of "Packing Safe+ Bag" project was 16-25/5/2022, in which e-questionnaire was disseminated to nurses and doctors via poster QR code. Totally, 107 replies from 5 doctors, 2 NCs, 8 WMs, 21 APNs, 64 RNs and 7 ENs were received. More than 90% respondents agreed that the "Packing Safe+ Bag" was always used to collect removed packing for counting and checking in their workplaces; the use of the "Packing Safe+ Bag" could: enhance communication of wound packing removal between nurses and doctors, increase staff alertness when handling removed packing materials, prevent retained packing materials in patient's wound, was practical in their workplaces; the location of "Packing Safe+ Bag" was obvious and easy to take in their workplaces; there were always enough "Packing Safe+ Bag" to use in their workplaces; the training materials of the project (poster and instruction sheet) could enhance their knowledge in wound packing.
There was no retained wound packing related AED attendance or admission during the project period. In view of good and positive feedback of the application of the "Packing Safe+ Bag", the bag's design has been further enhanced to become a well-printed zip-bag. Overall, the "Packing Safe+ Bag" project is proved to be successful in preventing retained packing materials in patient's wound.
