Queen Mary Hospital
Improvement Measures
Taken Before and After the Recent Clinical Incidents

 Trauma Team

 Adult Intensive Care Unit

 Blood Bank

 Operation Theratre Services

 Central Nursing Department

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Trauma Team

Supervision	* Involve senior doctor in resuscitation of trauma patients
Training	* Organise Advance Trauma Life Support Courses for first line doctors & nurses * Organise training courses for ICU nurses in care of trauma patients * Organise drills for doctors & nurses
System, Equipment & Facilities	Restructured trauma team (July 97) - introduce the two tiers response, appoint designated team leader & Trauma Director Held Strategic Planning Meeting on 4 Aug 97 * Open a new resuscitation room in A&E
Guidelines	Compiled guidelines on activation criteria, code call response system & ICU admission policy for patients with polytrauma & severe head injuries
Communication	Set up Trauma Service Executive Committee
Audit & Analysis	Held bi-monthly audit meeting Conducted pilot study on polytrauma ( Apr to Jun 97)

* denotes that the improvement measure is implemented after the clinical incidents

Adult Intensive Care Unit

Manpower	Deployed Intensive Care Unit trained nurse to work in Intensive care UnitPriority for Intensive Care Unit nurse recruitment * Strengthen back up nursing support by non-Intensive Care Unit based nurses * Create 2 Nursing Officer positions for 24 hour coverage
Supervision	*Increase Ward Manager & Nurse Specialist time in supervision *Intensive Care Unit based night Nursing Officer * Full time preceptor
Training	Orientated new staff on all ICU protocols & guidelines Organised briefing on blood transfusion procedure Organised in-service training for newly recruited Intensive Care Unit nurses Nominated nurses to attend Intensive Care Unit course * Revise training with paired preceptorship for 4 weeks * Organise regular tutorials for both doctors & nurses on blood transfusion
System, Equipment & Facilities	Compiled job assignment & equipment preparation list * Remove Group A & B blood for emergency use from mini-blood bank * Relabel blood compartments in blood fridge
Guidelines	Compiled guidelines on Intensive Care Unit routine care, blood transfusion, medication administration, trauma call, resuscitation & patient transport
Communication	Set up Intensive Care Unit Executive Committee
Audit & Analysis	* Conduct audit on major nursing activities daily & blood transfusion

* denotes that the improvement measure is implemented after the clinical incidents

Blood Bank

Training	* Organise 2 open seminars and debriefing on the HAHO blood transfusion guidelines * Orgainse talks & Blood bank visits for student nurse * Stress on transfusion safety for medical students during lecture and visits to the regional blood transfusion service
System, Equipment & Facilities	* Reappraise the satellite mini-blood bank system
Guidelines	Revised guidelines for new doctors * Review existing Standard Operation Procedures and transfusion practice * Update guidelines on satellite mini-blood bank system
Audit & Analysis	* Conduct audit

* denotes that the improvement measure is implemented after the clinical incidents

Operation Theatre Services

Manpower	* Review nursing manpower & utilisation in Operation Theatre Services Department
Training	Organised Operation Theatre Assistant training & implement Senior Support Worker Pilot Scheme (Apr 97) Nurse Specialist direct supervised the training of Operation Theatre Assistant * Organise recovery room nurses' course
System, Equipment & Facilities	* Discontinued the use of inflatable neck support & search for better substitute * Clear labelling of all access lines attached to patient * Scrutiny of all devices * Establish Equipment & Drug Committees
Communication	* Form Working Groups on Resuscitation Team, Blood Transfusion & Support Staff Training

* denotes that the improvement measure is implemented after the clinical incidents

Central Nursing Department

Manpower	Refined Continuous Night Duty Scheme Employed part-time & agency nurses Liaised with HAHO for more Registered Nurse Initiated instant walk-in recruitment exercise * Plan to organise staff buses for nurse
Supervision	* Appoint acting Nursing Officer.
Training	* Re-organise training program for all staff working in Intensive Care Unit & Operation Theatre Services Department * Update nursing knowledge on high-risk clinical practice
System, Equipment & Facilities	Formed Working Groups to study safe utilisation of infusion pumps & ventilators
Communication	Held meeting with Nurse Unions Organised open forums * Organise programs to improve communication & relationship between doctors & nurses, seniors & juniors and hospital staff & clients
Audit & Analysis	Planned to audit on high risk nursing practices

* denotes that the improvement measure is implemented after the clinical incidents