There are many gains to be had by instituting a drain labelling system within any hospital. It is surprising that this simple and useful practice has not been naturally adopted with the frequency of errors in patient care related to drains alone. In fact, there may be room for industry involvement, writes Theresa Caridi, Georgetown, USA.
Shortly after settling into practice, it became apparent that of the three institutions where I did my residency, fellowship, and early career, not one had a formal drain labelling system. In fact, the vast majority of interventional radiology tubes went unlabelled – an interesting practice considering the large sector of drain/tube/line errors compromising safety. Also, labelling a drain takes mere seconds. A particular case of a retroperitoneal abscess drain that was identified in the medical chart as a chest tube, clearly requiring different management, was the final impetus to look more closely at the need for a drain labelling system.
It is no surprise that when nursing and house staff were anonymously surveyed, there was acknowledgment by both groups of the inaccuracy in drain charting leading to errors in patient care. Survey comments additionally suggested a lack of understanding of interventional radiology drain placement, termination points within the body, and subsequent management. It was clear based on these surveys that we could have a positive impact on errors and patient care by instituting a formalised method of drain labelling. We were fortunate that when this idea was presented to the Center for Patient Safety meeting at our institution, a committee made up of representatives from all medical staff, it was quickly adopted by surgery that then performed their own pilot project on the matter.
While repeat surveys since instituting our drain labels have shown mixed results, the comments have provided positive feedback and also suggestions for improvement that are now being addressed. The recurring theme in the comments from the follow-up surveys expressed concerns about communication regarding both dressings and drain management. A second area of concern was the perception that patients continue to return to the hospital wards without drain labels. Having been quite observant of the drains leaving interventional radiology myself, I know that it is rare for a drain placed by us to go unlabelled. We speculated that the perception may be coming from the lack of a uniform label between interventional radiology and surgery. As of recently, we were able to combine interventional radiology and surgical efforts to create a hospital-wide label which specifies type and location. This coloured label is also more likely to be identified than the prior white label.
Interventional radiology has taken our efforts a step further with the institution of a drain note on each patient to improve the communication with other services.
A secondary gain from this labelling system has been better hand-offs within interventional radiology. The staff taking care of the patient are often different from those at the first encounter and therefore labelling can be very helpful for the technicians in terms of prepping and also for the physicians inheriting a partner’s case.
There are many gains to be had by instituting a drain labelling system within any hospital. It is surprising that this simple and useful practice has not been naturally adopted with the frequency of errors in patient care related to drains alone. In fact, there may be room for industry involvement so that tube kits come packaged with a durable label. Perhaps it should also be integrated into the debriefing portion of a drainage procedure. At the very least, it seems intuitive that a drain labelling system can reduce errors in patient care at very little financial or time burden and should therefore become the standard of care.
Theresa Caridi is an assistant professor, Division of Vascular and Interventional Radiology, MedStar Georgetown University Hospital, Washington, DC, USA. She has reported no disclosures pertaining to this article.
