Background Hospice pleural aspiration has been undertaken for the last 27 years, following training by a local chest physician. When the requirement for ultrasound (US) guided aspiration was introduced, an ultrasound machine was purchased and staff training undertaken. The British Thoracic Society issued guidance for pleural drainage in 2003 and standards were adapted for use in respect of pleural aspiration in hospice. An audit undertaken in 2015 showed 36 procedures undertaken over a period of three years. 14 of 19 standards were 100% met; two met in 97% and two in 94%. Following this there were changes to the documentation template, patient information leaflet and consent form to ensure the capture of missing items.
Method Retrospective review of all pleural aspirations undertaken since the last audit, drawn from electronic clinical record. Documentation of the procedure was audited against 19 standards identified.
Results 16 procedures for eight patients identified. 18 of 19 standards were 100% met compared to 14 at last audit. In two procedures, aspiration of fluid at the end of instilling local anaesthetic was not confirmed by documentation. One procedure failed to obtain more than 10 ml of fluid despite initial aspiration of fluid via syringe and needle prior to procedure. There were no complications of pneumothorax, pain during procedure, haemorrhage or visceral injury during any of the procedures.
Conclusions Almost all the standards are now comfortably met. Further documentation changes and reminders to clinicians undertaking procedure should ensure thorough documentation. Out of hours procedures should continue to take place when essential for symptom management, but undertaken by most experienced clinician.
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