NHS临床指南 The Introduction of Standardised Guidelines for Talc PleurodesisPPT.pptVIP

The Introduction of Standardised Guidelines for Talc Pleurodesis The Cardiothoracic Unit Claire Badger (ANP) and Mr J Asante-Siaw Talc Pleurodesis Direct visualisation b) CT Scan c) PET Scan INTRODUCTION ●Procedure has been traditionally undertaken by doctors, but is a role that can be carried out by Advanced Nurse Practitioners (ANP) with appropriate training ●Considerable practice inconsistencies with the technique of the procedure, and timing of chest drain removal OBJECTIVES ●Evidence-based protocol for the procedure to ensure consistency of practice by doctors and nurses ●High quality, timely, safe, effective care for all patients The Protocol ●Discussion with ward Pharmacist and Consultant Thoracic Surgeon ●Literature search ●Presentation of protocol at QIPP’s (Quality Innovation Productivity Prevention) ●Production of DOPS (Direct Observation Procedural Skills) assessment form DOPS Assessment Criteria ● Indications ● Anatomy ● Consent ● Technique, prep post procedure care ● Asepsis ● Communication ● Professionalism Timing of Drain Removal after Talc Pleurodesis ● n=22 ● Identified from pharmacy records 01/01/09 - 31/12/10 ● Retrospective review of CXR’s,discharge summaries and histology reports ● Effusion n=16 Pneumothorax n=6 Talc Pleurodesis performed for Pleural Effusion Pleural Effusion n=16 Malignant n=15 Non-Malignant n=1 No Success n=1 Success n=14 Success n=1 Talc Pleurodesis for Pneumothorax Pneumothorax n=6 Success n=5 No Success n=1 CONCLUSION ●Talc Pleurodesis is a procedure which can be competently and safely performed by appropriately trained ANP’s. - Audit patient satisfaction ●Evidence based protocol ●Guidelines disseminated for use Trust wide ●Apply similar process to other procedures as roles develop REFERENCES ● Braithwaite W (2008) Performing Talc Pleurodesis in Patients with Mesothelioma Nursing Times 29th April: 1-6. ● Groth, G; Gatzemeier, U; Halibingen, K et al (1991) Malignant Pleural E