Kazmi S.M.H.; Chandramouli S.; Trafford R.; Murthy M.; Babores M; American Journal of Respiratory and Critical Care Medicine, May 2010,


Impact of structured teaching programme in chest drain insertion in a district general hospital

Introduction: Chest drain insertion is an invasive procedure that can lead to complications. British Thoracic Society guidelines1 recommend that all members of staff involved in insertion of chest drain should be adequately trained, and patients should be managed in specialist wards in order to optimise care. The National Patient Safety Agency UK issued a rapid response report2 in May 2008 highlighting the above issues and recommending
written consent in all patients requiring chest drain. A training programme was introduced in our hospital comprising of awareness lectures, workshops highlighting the importance of specialist wards and practical demonstrations in order to improve medical and nursing staff knowledge in chest drain insertion and management.

Rationale: To assess the impact of focused teaching programme in documentation and management of chest drains especially clinical area at the time of insertion.

Methods:  We retrospectively audited chest drain procedures undertaken from October 2008 to March 2009. Case note analysis was done to assess quality of documentation and clinical area at the time of insertion. The variables defined for adequate documentation were consent, aseptic technique, site of insertion and size of drain. Chest drain teaching programme was then rolled out trust  wide in March 2009. Further retrospective data were collected from April to August 2009. Complications were also assessed in both groups.

Results:  Data was divided into two groups reflecting data before and after teaching programme. The table shows comparison results: (Table Presented) No major complications were seen in either group. Minor complications included: surgical emphysema (5 patients in first group vs 3 in second group), entry site infections (2 in first group and 3 in second group) and 2 accidental fall-outs in second group.

Conclusions: The results show statistically significant improvement in consent documentation after teaching programme and in the number of chest drains being undertaken in specialised areas. Some improvement was also seen in
aseptic technique and site of insertion documentation. We can conclude that simple measures like effective and targeted teaching programme can significantly improve management of chest drain insertion. We suggest that these teaching programmes should be run on regular basis to ensure continuous promotion of safe practice.

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