(精选)NHS临床指南 The Introduction of Standardised Guidelines for Talc Pleurodesis教学课件.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 ● Simple structured checklist ● Commonly used for medical trainees ● Practical skills essential to provision of good clinical care 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 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 Effusion with Mitoxantrane Placebo (Pleural Tube Alone) Annals Oncology (2): 213-5. ● Medicines Information (2004) Management of Malignant Pleural Effusions-Pleurodesis Calderdale and Huddersfield NHS Trust. ● Morriston Hospital Pharmacy Department (2003) Talc Pleurodesis Swansea NHS Trust. ● Munday H, Rintoul R, Laroche, C, Buttery R, Hunter C and La