The Implementation of a Revised Workflow to Improve Staff Competence & Confidence in Managing Patients with Tuberculosis in the Operating Theatre

By LIU, Wing Chi AMY, Nursing Officer I, RN, BN, MN

Background

Operating Theatre (OT) has specific workflows for some of the diseases (e.g., infectious diseases). If patients were suffering from unsuspected or undiagnosed airborne diseases, like tuberculosis (TB), patient need airborne precaution in OT. 

Purpose and Problem Statement

Airborne precaution had the specific workflow and which is out of the standard precaution. We did not emphasis the airborne precaution on the new staff training program, not all of our staff familiar with the airborne precaution guideline.

In OT, early detection and isolation of infected individuals are should be the core of our TB protocol. Nurses play an important role to protect and prevent our staff and patients from infection, also to control the spread of infection in OT. In order to provide a safe environment to all of our staff and patient, the promotion of the airborne precaution guideline is important. Staff must become familiar with the current TB guideline. The aim of my project is to increase the nurses’ competence and confidence to manage patient with TB in OT.

Implementation Plan

In my implementation plan, firstly, I setup a delicate file via computer to store the relevant protocol and workflow, in order to increase the accessibility rate, and announced to the staff about the setup of this file. I review and update the exciting guideline with the recommendation from ICN and my department head. I circulate the revised guideline to the staff, they were mandatory to read and signed after reading. Finally, training sessions for the use of HEPA filters were held in OT to consolidate their knowledge.

Results

Using the revised workflow can enhance and facilitate standard practice and increased staff competence and confidence. 30 nurses (n=30) were invited to join two interviews with asking same questions, which were pre and post intervention periods. 5 questions were asked during the interviews to evaluate their knowledge and 2 questions to evaluate their confidence on managing patients with TB. With the same questions asked, the correct rates for those questions have a significant increase in the post-intervention interview. The correct rate of the questions to evaluate their knowledge was increased from 34.7% to 81.3% in average. The interventions also increase their confidence level, from 31.7% to 98.3% in average. The nursing staff are now more confident to manage the TB patient.

Recommendations and Next Steps

Centralized the soft copy of the workflows in OT via computer is important. We need to review and update the guidelines if needed or practice changed. Regular audits should be conducted to ensure compliance and sustainability of the standardized workflow

For the next step, in order to ensure compliance and sustainability of the standardized workflow, we need to revise other workflows (e.g., management of needlestick injuries).