Page 125 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP4.1 Clinical Safety and Quality Service II 16:15 Room 221

Enhancement of Patient Safety — Reduction of Unplanned Extubation in Neonatal Intensive Care Unit Monday, 18 May
Ho YWE, Shek CC, Fu YM, Wan HS, To MMA, Chan LW, Yau KY, Lee SY, Liu HL, Chan CT
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong

Introduction

Unplanned extubation (UE) is a significant patient safety issue in neonatal intensive care unit (NICU) as high risk infants
dependent on assisted mechanical ventilation are particularly at risk of severe complications as a result of hypoxia and
hypercarbia. Securing the endotracheal tube (ETT) in neonates is considered challenging due to their small face, fragile skin
condition and relatively short airway. UE rates ranging from 0.14 to 5.3 UEs per 100 intubation days (median 1.98) has been
reported in literature.

Objectives
To reduce incidence of unplanned extubation in NICU.

Methodology

A quality improvement programme was initiated in which the method for securing endotracheal tube was revised,
standardised and implemented since January 2013. The new method enabled nurses to timely revise loosened adhesive for
fixation of ETT. UE rate and trend data was collected. Case review on UE was done. Risks for UE and further improvement
actions were identified and implemented since January 2014. Reinforcement of new ETT securing method and improvement
actions was done through staff education activities, sharing of case review and trend data among doctors and nurses.

Results

Survey on nurses’ acceptance to the new ETT securing method and their extended role was done three months after
the implementation. Majority of nurses (87%) expressed confidence in performing the procedure. 47 nurses (78% of the
respondents) favoured their new role and increased nurse autonomy. Monitoring of UE rates was started since January
2013. There were seven UEs and a total of 663 intubation days in 2013, with UE rates of 1.05 per 100 intubation days. With
implementation of further improvement actions, UE rate in 2014 was decreased to 0.28 per 100 intubation days (two UEs and
697 intubation days). Our experiences demonstrated a success of reduction in UE through a continuous quality programme
without extra cost implication. It was the first reporting of UE rate in NICU in Hong Kong. We hoped that more doctors and
nurses would be aware of UE and the importance of the preventive strategies.

SPP4.2 Clinical Safety and Quality Service II 16:15 Room 221

Continuous Quality Improvement (CQI) Programme to Reduce Caesarean Section Wound Infection
Hui SK, Ho LF, Chow KM
Obstetrics and Gynaecology Department, Princess Margaret Hospital, Hong Kong

Introduction
Our Caesarean section wound infection rate of more than was considered high compared with international standard.

Objective HOSPITAL AUTHORITY CONVENTION 2015
To reduce Caesarean section wound infection.

Methodology

A continuous quality improvement (CQI) programme was carried out by the Obstetrics and Gynaecology (O&G) Department
of Princess Margaret Hospital and Infection Control Team. Multiple strategies were implemented in the O&G Department
to try to reduce the infection rate, including prophylactic antibiotic, brush-up of bedside hand hygiene and operation hand
scrubbing, advice to patients on wound care after discharge and additional pre-operation abdominal wall swabbing before
emergency Caesarean section. Infection Control Team followed-up the patients after delivery by phone and through ePR.
Quarterly outcome reports on infection rate were compiled with clinical information of both infected and non-infected cases.
Report of outcome of individual surgeon was also compiled and reported to surgeons and O&G Department.

Results

Caesarean section wound infection rate was reduced by more than 80% to below 1%. Graph was plotted with infection rate
against the time of various measures implementation to identify the effective measures. Comparisons of infection rate before
and after implementation of some of the measures were done to check their effectiveness. Apart from prophylactic antibiotic,
we could not confirm which of the other measures was effective. General measures, effort of surgeons and their increased
experience might have also contributed to the improved outcome.

123