Report of the announced monitoring assessment at Bantry ... - hiqa.ie

Report of the announced monitoring assessment at Bantry General Hospital, CorkHealth Information and Quality AuthorityThere are daily checklists as part of all care bundles, which are included in thepatient’s end-of-bed documentation. These are completed by the assigned nurse onduty. Items to be completed on PVC care bundles are: date and time of insertion,reason for insertion, type/gauge, daily inspection signature, removal date, reason forremoval and signature of staff removing device. Date of insertion of PVCs isdocumented on the dressing. PVC devices are checked daily. The Authority revieweddocumentation of inpatients with PVC care bundles, which was comprehensive.Some of the patients were admitted via the ED and documentation revieweddemonstatrated that care bundle records started there, as is appropriate. The WardManager discussed care bundle documentation and outlined that as part of newdoctors’ induction programme, care bundle rationale is outlined to ensurecompliance with both care and documentation.Urinary catheter (UC) care bundles were assessed. Daily checks in place for UCincluded: daily patient hygiene, UC continually connected, empty bag often, handhygiene, request removal or leave UC in situ. While this documentation wascomprehensively completed for some care bundles, it was not accurately completedfor one. The indication for insertion of one urinary catheter was for urinary outputmonitoring. However, when the Authority reviewed the associated fluid balancechart, frequent emptying of the catheter bag to enable monitoring was notundertaken. This could pose a risk of HCAI to patients, and was highlighted to theWard Manager.CVC care bundles in ICU were reviewed by the Authority. While there was no patientrecieving care for a CVC, the Ward Manager outlined the documentation to supporteffective CVC management. In conjunction with Bantry General Hospital’s CVC carebundle policy, there is the ‘mandatory transfer policy’ which indicates factors forinitiation. Placement of a CVC in a patient is one of those factors that indicates thatpatients should be transfered to Cork University Hospital.The Authority observed records of weekly reporting of all care bundle compliancesubmitted from each ward to the Infection Control Nurse (ICN). Overall, compliancehas improved and staff on each ward outlined positive outcomes for patientsincluding a decrease of insertion of IV lines in the ED and timely removal of devices,which should decrease risk to patients of HCAIs in Bantry General Hospital.In conclusion, ward managers on both the Medical ward and the ICU who werespoken with by the Authority were knowledgable about the principles and use ofcare bundles. Daily checklists were in place; patient care bundle documentationreviewed and the results of the audit would indicate that care bundles are embeddedinto the management of invasive devices at operational level.11