Introduction Warrington is home to more patients with a history of alcohol excess and chronic liver disease than the national average. In Warrington hospital we have a cohort of patients dependent on regular therapeutic abdominal paracentesis who traditionally were admitted via A&E. In the trust paracentesis can only be performed on the gastroenterology ward, and so awaiting transfer led to increased length of stay. Once admitted, patients would wait for consultant review and for a junior doctor to finish their ward work before inserting their drain, causing further delay in treatment. Following this we developed a protocol and training scheme to allow band 6 nurses to safely perform the procedure and co-ordinate admissions directly. The aim of this service was to improve access for patients who require regular paracentesis and reduce length of stay, whilst maintaining patient safety.
Methods The nurses who volunteered for training began with tutorials, then with demonstration and direct supervision by three gastroenterology consultants. The nurses observed 3 drains inserted by a consultant or registrar, then assisted for 3 procedures, and finally inserted drains themselves under direct supervision. The nurses were assessed at 10, 15, 20 and 25 drains using an assessment tool based on the Paracentesis DOPS assessment form used for doctors. Following this they were deemed competent to perform the task independently. We carried out a prospective audit of all patients involved and analysed the data after 9 months of the service being established. Mean length of stay was calculated using inpatient discharge letters. Patients who had issues not directly related to the insertion of their drain were discounted from the results.
Results Since April 2015, a total of 114 drains have been performed in 25 patients. The majority of patients were male (76%). Interestingly we noticed two peaks in age distribution: the majority in the older age group 66–75 years (40%) which were more likely to have NAFLD aetiology; the younger group age 46–55 years (28%) and were shown to be majority ALD patients. We noted that in those elective patients admitted directly to the gastroenterology ward for nurse-led management, mean length of stay was less than 24 hours, compared with 4.5 days for the patients admitted via A&E. The latter was the path of all patients prior to April 2015. There have been no documented complications following any of the procedures performed by nurses.
Conclusion Therapeutic abdominal paracentesis in elective patients can be carried out safely by nurses, improves patient experience and drastically reduces length of stay. We feel this service has greatly improved the care of our outpatients with ascites and we would recommend implementation of this service in other trusts.
Disclosure of Interest None Declared
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