Implementing a nurse-led care bundle to reduce indwelling pleural catheter-related complications: a quality improvement project
5 affiliations
- 1Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
- 2Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
- 3Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- 4Department of Community Nursing, Changi General Hospital, Singapore
- 5Department of Health Services Research, Changi General Hospital, Singapore
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.
Related
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BibTeX
@article{tay2026implementing,
title = {{Implementing a nurse-led care bundle to reduce indwelling pleural catheter-related complications: a quality improvement project}},
author = {Tunn Ren Tay and Rayan Alsuwaigh and Sandra Hui and Kah Yee Tham and Wui Mei Chew and Jansen Meng Kwang Koh and Wai Kit Lee and Marnie Tamayo Gutierrez and Aza Abdulmawjood Taha and Imran Mohamed Noor and Bee Geok Low and Mon Hnin Tun},
journal = {BMJ Open Quality},
year = {2026},
month = nov,
doi = {10.1136/bmjoq-2026-004172},
url = {https://doi.org/10.1136/bmjoq-2026-004172},
note = {CC BY},
}
RIS
TY - JOUR
TI - Implementing a nurse-led care bundle to reduce indwelling pleural catheter-related complications: a quality improvement project
AU - Tunn Ren Tay
AU - Rayan Alsuwaigh
AU - Sandra Hui
AU - Kah Yee Tham
AU - Wui Mei Chew
AU - Jansen Meng Kwang Koh
AU - Wai Kit Lee
AU - Marnie Tamayo Gutierrez
AU - Aza Abdulmawjood Taha
AU - Imran Mohamed Noor
AU - Bee Geok Low
AU - Mon Hnin Tun
PY - 2026
DA - 2026/11/03
JO - BMJ Open Quality
DO - 10.1136/bmjoq-2026-004172
UR - https://doi.org/10.1136/bmjoq-2026-004172
AB - 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.
SN - 2399-6641
ER -