Authors (including presenting author) :
NG HW(1)
Affiliation :
Accident and Emergency Department, TKOH
Introduction :
Adverse events related to intoxication are well known to be a remarkable health care problem. It has been estimated that intoxication accounts for around 1-6% of hospital emergency department visits and 1-5% of all general hospital admissions.
Multidisciplinary approaches integrating different specialties within a hospital in the management of intoxicated patients have been strongly advocated. Studies had been done previously to confirm the contribution of the emergency department to its own hospital in the management of intoxicated patients.
In response to the demand on improvement in the effectiveness concerning the management of intoxicated patients in TKO and Sai Kung area, the Toxicology Team of the Emergency Department (ED) of TKOH was formed and began its operation in Aug 2022.
Traditionally, relationship between the physicians and the nurses is hierarchical and is characterized by doctors' dominance. Physicians view nurses as subordinate in which they receive orders for implementation. However, improper or poor communication can create a chronic state of conflict, increase in the medical errors and poor outcomes.
In contrast with other AED, we stress the importance of inter-professional collaboration and teamwork between nurses and physicians during the building of our Toxicology team. We believe the partnership approach can improve patient outcomes and lower healthcare cost, increase job satisfaction, and maintain patients' safety.
Objectives :
To evaluate the effect of the recently established Emergency Department (ED) Toxicology Team TKOH with close nurse-physician collaboration in the management of acute poisoning patients
Methodology :
Setting of the team
1. Toxicology team was formed and consisted of 4 medical, 10 nursing and clerical staffs.
a. 4 Medical members are experienced Emergency Medicine fellows with additional expertise in clinical toxicology
[HKCEM toxicology fellow or holders of Diploma in Clinical toxicology of the HKCEM].
b. 10 Nursing members are skilled registered nurse and APN with interest in poisoning.
2. A team was set up to provide 24 hours, 7 days per week service. Physicians are available to provide advice and
suggestion and assistance in clinical care.
3. A poison registry was also set up for collecting data for surveillance, audit and research purpose.
a. 3 parties contribute to the whole process of data entry
b. Clerks help to capture the demographic data via the AEIS
c. Nurses assist in input of the clinical data while browsing through the eAED and CMS
d. Doctors are responsible for the final data revision and rectification.
4. Regular monthly audit and training were conducted with participation from medical and nursing stream
a. Monthly Toxicology audit meeting by physician on toxicology cases statistics, audit, topic discussion, journal review
and departmental protocol
b. Monthly nursing toxicology meeting for poisoning training for nursing staffs.
i. Information and nursing skill on poisoning care was prepared by nursing team members, with input from
physician. The teaching is in the form of lecture, group discussion and workshop.
5. Follow up clinic was available weekly to take care of discharged poisoned patients.
We study the amount of work done during the four months period [ from 1st Aug, 2022 to 30th Nov, 2022]
Assessment on patient demographic and clinical outcome was done.
Result & Outcome :
Nine meetings were conducted in these four months. Better communication was found between nurses and physicians after the gathering. Different parties appreciate the role of each other better.
Brief statistics after a 4 month study.
1. A total of 192 intoxicated patients were included in the four months of study period [1st Aug, 2022 – 30th Nov, 2022]
2. Male/ Female ratio : 83/109; Age: 1-87
3. Type of poisoning:
a. Animal toxicology is the commonest culprits, followed by Industrial or household products, psychiatric
medications, medical pharmaceuticals: 63, 41, 33, 32 cases (33%, 21%, 17%, 17%, respectively)
4. Discharge destination:
a. Home / EMW admission / General wards admission / ICU admission: 43% / 23% / 20% / 2% respectively
5. No death in relation to poisoning
Modification of treatment or management guideline were made during the period
1. Snake bite guideline
2. Guideline on management of sea snake bite
3. Advice on management of stingray
4. Paracetamol treatment regimen
Conclusion
Our findings showed that the establishment of the ED Toxicology Team in TKOH achieved significant improvement in clinical care of poisoning patients.
Teamwork approach in the professional practice is crucial. Collaboration, between physicians and nurses, means cooperation in work, sharing responsibilities for solving problems, and making decisions to formulate and carry out plans for patient care. The partner-ship enhances patient care, increase job satisfaction, and maintain patients' safety.
Establishment of ED toxicology term with close nurse-physician collaboration provides a safe and efficient way in patient management. It is a cost-effective means of management of acute intoxication.
