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Implementing NPSA guideline A DGH Perspective

Implementing NPSA guideline A DGH Perspective. Dr Diane Laws Consultant Respiratory Physician Royal Bournemouth Hospital BTS Winter Meeting 3 rd December 2008. Bournemouth . Medium sized DGH Staff in Thoracic Department 4 Consultants, 3 Respiratory SpR 56 respiratory in patient beds

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Implementing NPSA guideline A DGH Perspective

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  1. Implementing NPSA guidelineA DGH Perspective Dr Diane Laws Consultant Respiratory Physician Royal Bournemouth Hospital BTS Winter Meeting 3rd December 2008

  2. Bournemouth

  3. Medium sized DGH • Staff in Thoracic Department • 4 Consultants, 3 Respiratory SpR • 56 respiratory in patient beds • Specialist triage • No on site thoracoscopy • “Non-Trauma” Emergency Department

  4. NPSA report • Deaths and complications • Seldinger drains • Training Lead: formal training • Ultrasound for all pleural effusions • Written consent

  5. Initial thoughts… • How many doctors need to be trained • How to train • Am I still competent??? • Should a specialist service be offered • But what happens in emergency • Is ultrasound necessary for all and how • But we haven’t had any complications….

  6. Complications

  7. To plan – we need the data • How many drains do we insert • Who's doing it • Where • Can they do it • How many would need ultrasound

  8. Indication for Drain Insertion

  9. Location at time of insertion

  10. Speciality of doctor inserting drain

  11. Time of Insertion • 74% within working hours • Of the out of hours drains Complication rate = 57% More serious complications

  12. Use of ultrasound at RBH • 16% radiology inserted • But pleural effusions account for >50% • Portable ultrasound available • 1 consultant (nearly) level 1 trained

  13. Have doctors been Trained? • All surgical doctors ATLS trained • Senior doctors most experience, but none recent • Most obtained verbal consent • Complications explained to patients • Pain, bleeding, pneumothorax

  14. Have doctors been Trained? • 65% never been assessed as competent • 53% no formal training • “see one, do one, teach one”

  15. Training Content • Theoretical component • Indications and risks • Asepsis, analgesia, insertion technique • Securing drain and subsequent care • Practical demonstration on manikin • Awareness of kit used in local trust • Supervised practice • Assessment of competence

  16. Moving Forward at RBH • Database of doctors able to insert drains or supervise • Observe Respiratory SpR’s on joining • Familiarity with local kit used • Chest drain insertion form • Drains for pleural effusion can wait • Offer respiratory supervision for drains • Explore “aseptic” area for procedures

  17. Thanks to • Dr Tom Brown, Respiratory SpR • Dr Tom Havelock, Respiratory SpR • Dr Roger Patel, Radiology consultant • Clinical Audit Department RBH

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