Abstract

Poor communication following chest drain insertion can lead to problems with inadequate post-procedure follow-up and poor handover between teams resulting in non-adherence to clinical guidelines and sub-optimal patient care. NHS England recently recommended the introduction of national and local safety standards for all invasive procedures (NatSSIPs and LocSSIPs) to provide safer, standardised care and reduce patient safety incidents including never events.

Initial assessment involved conducting a retrospective audit of documentation standards in 45 chest drain insertions between February and July 2016. A local chest drain insertion sheet was then developed based on NHS England guidelines for LocSSIPs, British Thoracic Society (BTS) guidelines for chest drain insertion and the Academy of Medical Royal Colleges (AoMRC) guidelines on documentation standards.

This sheet was subsequently completed for all patients undergoing the procedure on the respiratory unit over a three month period. A prospective re-audit was completed and directly compared to the original data.

Initial results highlighted significant shortfalls in documentation and included one patient who had the side in which the drain was inserted incorrectly documented. Introduction of a chest drain insertion sheet significantly improved the communication issues with documentary compliance improving on average from 66.3% to 99.7%. Positive feedback was received from medical and nursing staff regarding ease of use, comprehensiveness and clarity of presentation resulting in this form becoming embedded in standard clinical practice in our department.

Significant improvement in documentation standards can be achieved by the introduction of a structured, systematic proforma provided that it is straightforward and not cumbersome. This is likely to improve patient safety, communication between professions, specialties and shifts as well as encourage adherence to recognised procedural standards and prevent never events.