Creative Labelling for Chest Tube Care

By Amy Weng

Chest tubes drain excess air or fluids from the chest cavity following an open-heart surgery. It is common for patients to have multiple chest tubes attached depending on the type of surgery they underwent.

However, the existing identification system has created workflow challenges for staff. They have to trace tubes from patients’ bedside to collection bottles placed two metres away.  Both the chest drainage bottle with its attached tubing and the chest tube inserted into the patient are long. When connected, they form a lengthy tube system. This adds to the complexity in caring for post-operative patients as it can potentially cause confusion and may lead to accidental removal of tubes during patient’s care.

“Improper chest tube removal can pose serious risks, including respiratory distress, and in severe cases, the need for surgical reinsertion. This can lead to prolonged hospitalisation. There is an urgent need to address this issue and ensure the highest standard of care for our patients,” explained Assistant Nurse Clinician (ANC) Stella Kwek from Ward 56 who is also the team leader of Creative Thinking Squad.

Recognising the severity of the problem, the team came together to identify ways to enhance chest tube management in the ward. Their goals were to make the workflow more efficient and to improve patient safety.

Unlabelled chest tubes and drainage containers, which collected excess fluids drained from the chest tubes, previously required staff to spend valuable time tracing.

Tackling the Tracing Challenge

The team developed a double-labelling system using waterproof, durable labels placed directly on both chest tubes and collection bottles. This provides clear visual identification at the patient's bedside, eliminating time-consuming tube tracing.

"We worked closely with surgeons to decide on the label size and collaborated with vendors to find labels that were waterproof and smudge-resistant," said ANC Stella. When they later noticed issues with adhesiveness, the team continued working with suppliers to source higher-quality materials that were compatible with the chest tube materials.

The new double labels are stuck onto both the chest tube and container.

Communication to Engage the Team

Getting staff buy-in for the new process was challenging because it involved additional verification steps to the existing workflows for staff. With the new chest tube labels, surgeons must label each chest tube before closing the wound, and nurses must then verify that the labelled chest tube position matches the corresponding bottle to ensure correct placement.

"Staff shared that this new step was tedious and time-consuming," acknowledged NC Yang Ruiqin. "To overcome this, we conducted a PDCA (Plan-Do-Check-Act) cycle and explained our zero-harm objectives as well as the importance of their participation in ensuring patient safety."

This open communication helped staff understand the value of the initiative, which increased their engagement. When staff noticed their feedback was incorporated to improvements such as better label adhesiveness and size, their acceptance of the new process grew significantly.

New Labelling System with Outstanding Results

Since the implementation of the labelling system, there have been no cases of incidental removal of chest tubes, successfully meeting the team’s Target Zero Harm goal. The system also reduced the time required for chest tube removal from 20 minutes to 10 minutes. This 50% improvement translates to 18,250 minutes of time saved each year, allowing healthcare professionals to focus more on direct patient care.

Creative Thinking Squad team members (Front row, L-R): Nurse Clinician (NC) Yang Ruiqin, Ward 56; Deputy Director Foo Lee Lian, Nursing Administration; Senior Nurse Manager, Belinda Wong, Ward 56, Assistant Nurse Clinician Stella Kwek, Ward 56; and Senior Staff Nurse (SSN) Olivia Zhuang, Cardiothoracic Intensive Care Unit; (Back row, L-R): SSN Paw Sheau Fang, Ward 56; Dr Chua Yang Chong, Senior Consultant, Cardiothoracic Surgery; and SSN Luther Lin, Operating Theatres, SGH.

The impact goes beyond improving efficiency. "Seeing both staff and patients benefit from the implementation has been the most rewarding part of this initiative," shared ANC Stella. "With the new labels pasted directly on the chest tubes, we can verify tube placement more quickly and accurately to ensure patient safety. Our work has also become more streamlined and meaningful," beamed ANC Stella.

For departments considering similar initiatives, the team offers this advice: Improvement starts with each one of us. Embrace innovation and feel confident to explore new ideas. You never know how a small idea can lead to positive outcomes!