{
  "abstract": "Introduction Caregiver-led care of the indwelling pleural catheter (IPC) has been associated with higher rates of infection compared with nurse-led care, potentially due to breaches in aseptic technique while accessing the drain. Increased infection rates can lead to increased healthcare utilisation. In our centre, patients are reliant on caregivers to care for the IPC after discharge. We observed higher rates of IPC-related infection (22.7%) than reported in the literature despite strict adherence to surgical scrub and sterile protocol. We conducted a quality improvement (QI) project consisting of the introduction of standardised nurse-led IPC education, combined with community nursing support, with the aim of reducing both infection rates and healthcare utilisation.Methods A multidisciplinary team was convened to identify the driving factors for IPC-related complications. Following their recommendations, the QI approach comprised two sequential Plan-Do-Study-Act (PDSA) cycles. PDSA cycle 1 consisted of standardising the trainer performing the IPC training for caregivers. PDSA cycle 2 consisted of standardising the training of community nurses in IPC care for them to carry out both home visits and provide phone calls to patients. 50 patients with IPC were analysed, with 22 in the pre-intervention cohort and 28 in the post-intervention cohort. Outcomes were assessed using a pre/post-comparison, assessing IPC-related all-cause infection, empyema rates, healthcare utilisation and cost-effectiveness.Results The bundled intervention resulted in clinically important reductions in both all-cause infections (7.1% vs 22.7%) and empyema (3.6% vs 22.7%) and a statistically significant reduction in IPC-related readmission length of stay. Cost-effectiveness analysis revealed that the costs of the intervention were largely offset by the savings from reduced IPC-related empyema-related readmissions.Conclusion In cohorts with high IPC-related infection rates, standardised nurse-led IPC education combined with on-demand community nursing support was associated with lower rates of IPC-related empyema and shorter total readmission length of stay.",
  "abstract_shown": true,
  "affiliations": [
    "Respiratory and Critical Care Medicine, Changi General Hospital, Singapore",
    "Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore",
    "Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
    "Department of Community Nursing, Changi General Hospital, Singapore",
    "Department of Health Services Research, Changi General Hospital, Singapore"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tunn Ren Tay"
    },
    {
      "affs": [
        1
      ],
      "name": "Rayan Alsuwaigh"
    },
    {
      "affs": [
        0
      ],
      "name": "Sandra Hui"
    },
    {
      "affs": [
        2
      ],
      "name": "Kah Yee Tham"
    },
    {
      "affs": [
        1
      ],
      "name": "Wui Mei Chew"
    },
    {
      "affs": [
        1
      ],
      "name": "Jansen Meng Kwang Koh"
    },
    {
      "affs": [
        0
      ],
      "name": "Wai Kit Lee"
    },
    {
      "affs": [
        0
      ],
      "name": "Marnie Tamayo Gutierrez"
    },
    {
      "affs": [
        0
      ],
      "name": "Aza Abdulmawjood Taha"
    },
    {
      "affs": [
        0
      ],
      "name": "Imran Mohamed Noor"
    },
    {
      "affs": [
        3
      ],
      "name": "Bee Geok Low"
    },
    {
      "affs": [
        4
      ],
      "name": "Mon Hnin Tun"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5ja3g8dddxvm5.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjoq-2026-004172",
  "fulltext_url": "https://bmjopenquality.bmj.com/content/15/4/e004172.full",
  "id": "5ja3g8dddxvm5",
  "issns": [
    "2399-6641"
  ],
  "landing_url": "https://doi.org/10.1136/bmjoq-2026-004172",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "R5-920"
    ],
    [
      "openalex",
      "2740|Pleural and Pulmonary Diseases"
    ]
  ],
  "openalex": "W7225164506",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-03",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/5ja3g8dddxvm5.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T14:20:39Z",
      "native_id": "08b7ac2fb2ef4ae0a326ca15df283ba4",
      "source": "doaj",
      "url": "https://doi.org/10.1136/bmjoq-2026-004172"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Pleural and Pulmonary Diseases",
      "subfield": "general"
    }
  ],
  "title": "Implementing a nurse-led care bundle to reduce indwelling pleural catheter-related complications: a quality improvement project",
  "title_text": "Implementing a nurse-led care bundle to reduce indwelling pleural catheter-related complications: a quality improvement project",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T14:20:36Z",
  "url": "https://research.draconitic.com/paper/5ja3g8dddxvm5",
  "venue": "BMJ Open Quality",
  "versions": []
}