Aims: This study aims to evaluate the documentation quality of chest drain insertions in a pulmonology department and assess improvements after implementing a standardized pro forma. Methods: This audit was conducted in the pulmonology department of HMC, Peshawar. Documentation quality was assessed over three months, after which a structured pro forma based on NHS guidelines was introduced to improve the documentation process. Results: This audit showed substantial gaps in documentation, with essential information often missing. Implementing NHS-based proforma significantly improved the quality of clinical documentation. Conclusion: Standardizing documentation with a structured pro forma improves the quality and completeness of chest drain insertion records, which is essential for patient safety and interprofessional communication.
Chest drain insertions are essential but potentially risky procedures that require enough training and expertise to guarantee patient safety and effectiveness. Chest drain insertions and their aftercare require appropriate training and experience to improve the overall safety and efficacy of the procedure. A UK-wide audit identified significant complication rates associated with chest drains, prompting recommendations for enhancing safety (1). The recommendations were further elaborated recently. These recommendations include important pre-procedural safety checks, avoidance of chest drain insertion out-of-hours, and optimal documentation (2).
National Patient Safety Agency (NPSA) reported in 2018, 45 deaths related to chest drain risks. The reason behind these risks was unsatisfactory practice (3). A recent study found that using a checklist during endoscopic procedures helped improve how well doctors documented the procedures in patients' records. The checklist ensured that all the important information was written down accurately. This not only made things safer for patients but also made it easier for doctors (4). We conducted an initial review of how chest drain insertion procedures were documented over four months.
Afterward, we introduced a chest drain proforma in Pulmonology ward and give recommendations to improve the documentation quality.
In 2016, Hasan and Barnes conducted an audit focusing on the documentation of pleural procedures. They examined six general parameters, including consent, operator details, indication, type of procedure, complications, and risk assessment related to INR and platelet levels. Additionally, they assessed six pleural-specific parameters, such as the site of abnormality, ultrasound findings, medications administered, aspirate amount and character, tests requested, and post-procedure management.
Their audit involved a small sample size of 30 procedures both before and after the introduction of a new documentation pro forma. Initially, they found poor documentation, with none of the 30 procedures having complete documentation of all 12 parameters. However, after implementing the new pro forma, 66% of the procedures achieved full documentation, indicating a significant improvement in documentation quality. (5)
Setting and Duration:
The audit was conducted in the pulmonology department of HMC, Peshawar, from February to May 2024.
Sample and Exclusion Criteria:
A random sample of 70 patients was selected, excluding those with indwelling pleural catheters.
Data Collection and Analysis:
Documentation was reviewed against NHS standards, assessing 15 parameters. Data was analyzed using SPSS version 20.0.
Initial Audit Findings:
Sample Distribution: Male (55.7%) and Female (44.3%) patients.
Primary indications for chest drain included pneumothorax, pleural effusion, malignant effusion, hydropneumothorax, and empyema.
Documentation Quality:
Significant omissions in initial documentation, with only 34.3% including a coagulation profile and 37.1% having a chest drain chart.
Radiological Confirmation:
Ultrasound was performed in 85.7% of cases.
Analgesia and Post-Procedure Imaging: Post-procedure analgesia was given in 94.3%, and chest X-rays were documented in 87.1% of cases.
After the phase 1 audit, recommendations were given to improve the documentation process.
The audit highlights key procedural gaps, particularly in consent, coagulation profile assessment, and post-procedural documentation. Implementation of a structured pro forma showed clear benefits, aligning with findings from similar studies that emphasize the impact of standardized documentation on patient safety. Remaining gaps suggest further training and reinforcement of checklist protocols to minimize the risks.
The purpose of this audit is to improve the quality of documentation.
Standardizing documentation via a structured pro forma significantly improves record accuracy in chest drain procedures, and contributes to better patient outcomes. Continuous audits, training, and protocol updates are recommended to maintain and improve documentation standards in clinical practice.
Recommendations:
Introduction of a standardized chest drain proforma.
Establish, a protocol to check Routine Coagulation profiles pre-procedure to minimize the bleeding risks.
Complete Chest drain chart documentation.
Mandatory Radiological Confirmation via ultrasound before procedure.
Training and Feedback sessions.
Conducting workshops to reinforce and give awareness among trainees for the importance of coagulation profile assessment, patient communication, and procedural adherence.
This Clinical audit emphasizes the critical need for quality improvement measures to enhance compliance with evidence-based practices and optimize patient care in chest drain procedures
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