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• W4387265718 abstract "SESSION TITLE: Education, Research, and Quality Improvement Posters 7 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Chest tubes are commonly used to manage patients with pneumothorax and complicated pleural effusions. At the Salt Lake City VA (SLC VA), ward patients requiring chest tubes are cared for by the internal medicine team with consultation from the pulmonary service. When urgent issues arise, the pulmonary team is generally available to assist internal medicine housestaff in troubleshooting problems. However, we have had instances where problems occur at night when housestaff function independently. Comfort level and knowledge gaps with chest tube management can potentially lead to patient safety issues. We set out to examine the knowledge and skill gaps present among nursing and housestaff at the SLC VA. METHODS: We surveyed University of Utah internal medicine housestaff and chief residents, VA medicine attending physicians, and VA medicine floor nurses. We examined several domains including communication between providers (nurses, housestaff, and pulmonary consult service), prior formal instruction on chest tube management, comfort level caring for patients with chest tubes, and common problems encountered. After the data was analyzed, we designed an intervention which included education targeting reported deficiencies, creation of additional troubleshooting resources, and changes in workflow to improve clarity regarding plan of care. RESULTS: We received data from 7 attendings, 19 housestaff and 10 nurses. Overall, communication was reported as good from both physicians and nurses, although some commented on lack of clarity on desired tube setting (i.e. suction, water seal, clamped). Regarding knowledge, attendings tended to express comfort with chest tube management and troubleshooting. However, both housestaff and nurses reported significant knowledge gaps across several domains. Housestaff reported some comfort with troubleshooting chest tube issues but noted discomfort with many basic aspects of chest tube care. Nurses reported a lack of formal education on chest tube function, with several areas of discomfort with bedside care and assessment. All three groups had congruence on several commonly encountered chest tube issues, many of which matched with reported housestaff and nurse knowledge deficits. This resulted in a targeted multimodal intervention. Resources were created that focused on improving education in areas of deficit. We additionally created a new workflow that would improve clarity regarding the plan of care so that housestaff functioning independently would more immediately be aware of the chest tube status, while also streamlining nursing tasks. CONCLUSIONS: In general, internal medicine housestaff and nurses reported a lack of education on chest tube function and management along with some degree of discomfort with caring for patients with chest tubes and troubleshooting problems. Reported deficits were congruent with issues commonly reported (specifically malpositioning/kinking of the tube). This data allows for a targeted quality improvement initiative with ongoing follow-up data collection to ensure improvement in patient safety. CLINICAL IMPLICATIONS: Our project exposed knowledge gaps and poor comfort level in care team members in regard to chest tube management and troubleshooting and identified areas for improvement. As a result, we have instituted educational initiatives and standardized management of chest tubes with the goal of improving provider comfort in independently managing chest tubes and improving patient safety. DISCLOSURES: No relevant relationships by Emily Beck No relevant relationships by Alex Ryden" @default.
• W4387265718 created "2023-10-03" @default.
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• W4387265718 date "2023-10-01" @default.
• W4387265718 modified "2023-10-03" @default.
• W4387265718 title "AN ANALYSIS AND INTERVENTION OF PHYSICIAN AND NURSING KNOWLEDGE GAPS TO IMPROVE CHEST TUBE SAFETY" @default.
• W4387265718 doi "https://doi.org/10.1016/j.chest.2023.07.2510" @default.
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