Page 183 - Hospital Authority Convention 2018

Parallel Sessions

PS9.1 Innovative Nursing 13:15 Room 221

Transition Care for Paediatric Patients with Chronic Illnesses to Adulthood
Lau SL
Department of Paediatric and Adolescent Medicine, United Christian Hospital, Hong Kong
Adolescents with chronic illness face challenges in social adjustment, changes in life styles and disease self-management HOSPITAL AUTHORITY CONVENTION 2018
etc. Transition care is an important process to address their bio-psycho-social needs from child-centred to adult-oriented
healthcare system. Poor transition results in suboptimal health outcomes. A Transition Care Programme has been in place
since 2011 for patients with diabetes, Beta Thalassemia Major and is extended to patients with epilepsy in 2018.

Programme content includes ongoing assessment, counselling, peer group therapy and a post-transition phone evaluation. A
Transition Assessment Booklet is used in individual interviews to evaluate skills in disease management and self-awareness of
independence. The booklet is part of the patient record for continuity of care in adult service. An educational tool ‘’My Health
Passport’’ is tailored made for different diseases to facilitate patient’s understanding of the disease through discussion with
adolescent nurse. Patients and caregivers’ perception of the usefulness of the individual counselling part were reflected by a
questionnaire-based survey from 2011 till 2018.

A monthly peer support group was introduced as part of the Diabetes Outpatient Clinic to equip adolescents with skills and
knowledge in negotiating the path from paediatrics to adult service. This support group led by nurse and actively participated
by adolescents covers life skill issues such as stress handling, friendship etc. with reference to disease proper. A post group
questionnaire-based evaluates the group effectiveness. A post-transition phone survey is conducted six months to one year
after transition to explore their confidence in managing illness, treatment adherence etc.

Results of the questionnaire-based and phone follow up evaluation show positive feedbacks from adolescents and
caregivers. This programme bridges the gap between paediatrics and adult service for patients with chronic illnesses.

PS9.2 Innovative Nursing 13:15 Room 221

Use of a Locally Developed Novel Silicone Cannulation Model to Enhance Patient Safety in Extracorporeal
Membrane Oxygenation
Lai PCK
Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong
Introduction
Extracorporeal Membrane Oxygenation (ECMO) is a high risk life-saving technology. Physicians must be competent in
ultrasonography-guided ECMO cannulation but the required skill is more advanced than that for usual insertion of central
venous catheter. Any procedural error may result in fatal complications.

Methodology Tuesday, 8 May 2018
We designed a prototype model for ECMO cannulation training in 2015. The cannulation model was made of platinum-
catalyzed silicones. In 2017, an ECMO cannulation simulation system was created to enhance the simulated blood vessel
anatomy, venous compressibility and product durability.

Results
Our model is the first and the only cannulation model in the world designed particularly for training of ultrasonography-guided
ECMO cannulation. The model had been on trial in physician training courses in Hong Kong, Qatar, Japan and Singapore in
these two years. 78 clinicians were trained in the courses in Hong Kong. Mean product evaluation rating among clinicians
was 4.53±0.60 on a 5-point scale (high rate implied high realism). Mean perceived confidence score of participants before
and after cannulation workshops were 4.3±2.4 and 7.1±2.1 on a 10-point scale (p<0.01). Mean perceived competency score of
participants before and after cannulation workshops were 4.6±2.9 and 6.8±2.3 on a 10-point scale (p<0.01). For the intensive
care units in Hong Kong which adopted its use in the training programme, major incident related to ECMO cannulation was
reduced to zero. Based on unpublished ECMO data, we estimated that the relative risk reduction is 88.8% and the number
needed to treat is 12.5 per year. The cost for each cannulation model was USD$100 and it could withstand multiple punctures
with large bore ECMO cannulas.

Conclusion
Ultrasonography-compatible silicone ECMO cannulation model can replace animal model for physician training, skill
enhancement and competency assessment. It can simulate various body sites and incorporate into different ECMO
cannulation situations according to training needs. This technology is replicable, cost-effective and can significantly enhance
patient safety.
181