Objectives
In May 2008,
a National Patient Safety Alert (NPSA) was issued,
warning of the risks associated with inserting chest drains (Fig 2).
In the preceeding 3 year period,
12 deaths and 15 serious incidents were reported as a consequence of chest drain insertion.
The NPSA strongly recommended that all pleural procedures should be done under ultrasound guidance due to the risk of major organ puncture.
King's College Hospital is a busy tertiary referral centre.
Historically,
pleural procedures have been carried out by the radiology department....
Materials and Methods
The need for the service was established by auditing current practice.
A business plan was submitted and the budget agreed.
The location was identified; the bronchoscopy suite in the Chest Unit.
An inventory was drawn up and items ordered.
Staffing included a lead clinician (Dr G Warwick),
respiratory specialist registrars and assistants.
Service times were confirmed.
An arterial blood gas machine was already available in the department.
Electronic Patient Record (EPR) was set up so that pleural ultrasound and procedures could be requested by clinicians....
Results
Audit 1.
This looked at the existing practice (i.e.
procedures done in the Radiology Department) prior to setting up the new pleural ultrasound service.
The audit took place over a 2 month period and looked at 33 patients of which 29 (88%) were chest drain insertion for pleural fluid,
2 for pneumothorax and one for drainage of a chest wall collection.
The audit showed that chest drains were being inserted outside of the NPSA and BTS recommended guidelines.
One drain was inserted five days after...
Conclusions
We are now compliant with the NPSA guidelines;
procedures are done under consultant supervision by competent staff
all procedures are done under ultrasound guidance
clinical guidelines are followed and staff are aware of the risks
patients give written consent before the procedure
all incidents are audited
The setting up of a new pleural ultrasound service has resulted in the following additional service improvements;
Expanded capacity.
Shorter waits (and therefore reduced length of stay).
We no longer 'mark the spot' for later aspiration/drainage and anticipate a...