Recommendations for assessing competency in nurses
Patients with a pleural drain should be managed in a clinical environment where nurses deemed competent to manage chest/pleural drains are available at all times.
Each facility is responsible for accrediting designated nurses for pleural/chest drain management in line with their scope of practice. The competency recommendations aim to ensure that a consistent process is undertaken for nursing education, training and attaining competency in management of pleural drains within NSW.
Registered nurse/endorsed enrolled nurse pleural drain competency
Assessment of competency will entail specific consideration of all aspects required for the management of patients with a pleural drain and drainage devices.
Demonstrates an understanding of the fundamental principles of normal breathing and pleural drainage, including:
- intrathoracic pressures
- egulatory mechanisms
- indications for insertion and removal of a pleural drain
- principles of chest/pleural drainage systems.
Competently assesses patient and drainage system, including:
- drainage type and amount
- air leak
- patent tube and secure connections
- dressing correct and intact
- appropriate use of suction
- need for bottle change.
Identifies cardinal signs of pleural drain complications and emergencies, including:
- tension pneumothorax
- surgical emphysema
- blocked chest drain
- dislodgement of chest drain
Demonstrates ability to set up equipment, prepare and appropriately manage a patient undergoing a pleural procedure, including:
- understanding the role of an RN assisting the procedure
- obtaining valid consent
- maintaining Clinical Procedure Level 2 Safety Checklist Aseptic techniques and hand hygiene
- pain assessment and ensuring adequate analgesia is ordered
- educating patient and family
- selecting appropriate equipment and assembling it correctly
- recognising and managing complications
- taking pre-, peri- and post-procedural observations
- requirements for transfer and handover.
Displays knowledge of equipment required, current guidelines and procedure for:
- correct dressing
- changing bottles
- performing observations according to risk and/or the patient’s condition
- managing a dislodged pleural drain
- unblocking a blocked drain
- removing a pleural drain.
Maintains effective communication with patient, staff and others, including:
- explaining procedures and interventions to patient and family
- discussing and reporting adverse findings to the medical officer or senior nurses
- appropriately documenting assessment findings on a chest drain chart and within progress notes
- sharing information related to interventions and management of drainage system with colleagues at handover and when clinically relevant.