Post-operative care of total laryngectomy patients in the ward: a best practice implementation project

Abstract

Executive Summary Objectives The aim of this project was to improve the local practice of nursing care for total laryngectomy patients in Shanghai Eye & Ear Nose and Throat (ENT) hospital, thereby making a contribution towards improving patient outcomes. Methods A baseline audit, change strategy and implementation, then follow-up audit cycle were conducted. Six evidence based criteria identified by the Joanna Briggs Institute were audited in the ENT ward of Eye & ENT Hospital of Fudan University in Shanghai. Fifteen patients and twenty nurses were involved in the baseline audit, and ten patients and twenty nurses in the post implementation audit. Results The baseline audit was poor across four of the six criteria. The assessment of patient humidification, hydration, nutrition, and drainage sites was not carried out. Following the implementation of interventions, the post audit cycle achieved a considerable improvement in 5 out of the 6 criteria, with assessment of drainage sites remaining unchanged. Conclusion This project assisted in improving evidence-based practices for total laryngectomy patient's post-operative care. Attempts to implement drainage site assessment were unsuccessful. Strategies in sustaining the momentum of compliance are required.

Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review

“…First, 22 studies (20%) reported that implementation was inhibited by the absence of formal reinforcement by management to integrate the innovation with organizational policy/protocols (57,(60)(61)(62)(63)(64), or with other innovation-related elements (15,24,39,(65)(66)(67)(68)(69)(70)(71)(72)(73)(75)(76)(77). Those elements include tools (e.g., communication tools to guide nursing handover) (65), checklists (e.g., Chinese HF discharge checklist) (65), indicators (e.g., referral indicators) (12), systems (e.g., information management system) (72), and forms (e.g., ETT: endotracheal tube assessment form) (66).…”

“…Insufficient knowledge and skills regarding the innovation of health professionals (12,60,62,63,65,67,68,70,71,78,82,93,(95)(96)(97)(98) and patients (21,30,60,77,94) was raised as an inhibitor of implementing the innovation. For example, in one study (60) nurses' lack of knowledge and skills of stoma management was identified by the project team as one of the barriers.…”

“…Second, existing workload was raised as a barrier for implementing innovations in 8 studies (7%) when the existing workload was perceived to leave no time for implementation of innovations (21,41,61,63,69,71,74,78). A related barrier is when health professionals perceive that the innovation would result in an increase of workload (14,41,58,62,63,69,70,77,100,102,103). Finally, the lack of organizational capability; represented by the number of skilled health professionals (often skilled nurses) within health facilities and abilities of qualified health service provision (e.g., emergency departments' capacity to implement thrombolysis) formed a barrier for implementing the innovation in ten studies (9%) (12,22,23,27,28,38,61,75,77,128).…”

“…First, many of these studies identified adaptation as an important factor to facilitate implementation; both the adaptation of the innovation (n = 10, 9%) (41,48,79,89,102,105,109,(116)(117)(118) and that of the implementation approach. (n = 17, 15.5%) (13,14,21,22,28,30,35,36,39,40,56,62,79,93,(119)(120)(121). Four studies (4%) (102,105,109,117), for example focussed on Chinese adaptations of integrated care approaches (e.g., clinical pathways).…”

Investigación bibliográfica sobre la atención de enfermería en la laringectomía total

“…Formación del personal de enfermería [12][13][14][15][16][17] Educación para la salud [17][18][19][20][21] Cuidados de la herida quirúrgica y del estoma [22][23][24][25] Comunicación y rehabilitación de la voz [22,26,27] Nutrición enteral y alimentación oral [22,[28][29][30][31] Humidificación [32,33] Formación del personal de enfermería En general, cuando no es habitual tratar a pacientes laringectomizados, los conocimientos sobre los cuidados apropiados son pobres [12]. Para que la asistencia ofrecida por el personal de enfermería sea la más adecuada, la literatura describe que las formas más eficaces de mejorarla son mediante la estandarización de estos cuidados [13] y la valoración continua y la individualización de los planes de cuidados [14]. Otro método eficaz es realizar un entrenamiento mediante auditorías y materiales de educación basados en la evidencia, demostrando una mejora considerable tanto en la práctica asistencial como en la educación sobre los autocuidados que se debe realizar al alta del paciente [15].…”