Authors (including presenting author) :
Lai SK, Li CY, Hon CY, Chan WY, Koo YL, Yung WY
Affiliation :
Ward A6, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Home non-invasive ventilation (NIV) has been shown to improve patient outcomes resulted from chronic respiratory failure, such as improving alveolar hypoventilation, reducing associated symptoms and improving patient’s overall quality of life, sleep quality and survival. In the current nursing service, education on home NIV is provided before installation of home NIV, along with subsequent post-discharge phone consultations to monitor patient’s condition.
Objectives :
1. To empower home NIV patients and their caregivers by equipping them with home NIV-related knowledge and skills and providing them with psycho-social support and reassurance. 2. To enhance patient’s compliance to home NIV by providing different types of educational materials.
Methodology :
FADE model is used in this CQI project. In the step of ‘Focus’, home NIV patient journey is reviewed. In recent years, there is an increasing trend in the application of NIV in home setting. One of the determinants of home NIV success is patient’s compliance to home NIV therapy which is greatly affected by patient intolerance. In the step of ‘Analyze’, current home NIV education program is reviewed. It is found that patients and caregivers knowledge deficit related to home NIV therapy, improper operation of home ventilator machine and complications are some of the contributing factors of poor compliance and increased healthcare utilization in patients with home NIV. Besides, patients with home NIV may be cared by foreign domestic helpers who cannot read education booklet written in Chinese. In the step of ‘Develop’, a CQI team is formed by inviting both junior and senior nurses from A6 ward. Based on the collected data, an action plan is developed. It is planned that home NIV education booklet is updated with QR codes to educational videos inserted after comprehensive literature review. This helps to facilitate knowledge acquisition as standardized education content of video is delivered to patient and caregivers on-demand. Furthermore, it is planned that the home NIV education is available in three languages (i.e. Chinese, English and Bahasa Indonesia). In the step of ‘Execute/ Evaluate’, the action plan is implemented. Patient’s compliance is evaluated through the home NIV compliance report. Moreover, demonstration of home NIV operation and system set-up by patient and caregivers is pre-video recorded at home, which is evaluated by nurse during clinic follow-up.
Result & Outcome :
In 2022, five patients were recruited into this CQI project. The patients are with the following diagnosis- bronchiectasis, type two respiratory failure, pneumoconiosis and aortic stenosis. After the selection of home NIV machine, education was given to those patients’ caregivers. Scores of pre- and post- home NIV knowledge questionnaire are then evaluated. It is found that there is on average 32.16% of improvement in the scores. Due to COVID-19 pandemic, those patients are reluctant to come to hospital for follow up. Hence, the home video recorded demonstration of home NIV operation and system set-up by patient and caregivers cannot be assessed. The previously mentioned is the preliminary result of this CQI project and data collection is still in progress.
