Adopting Thopaz+ portable digital system for managing chest drains on the cardiothoracic ward at Oxford University Hospitals NHS Foundation Trust

• To enhance the quality of care for patients by adopting a device that facilitates more accurate measurement of the patient’s condition and the opportunity for early mobilisation following thoracic surgery
• Adopt the device consistently across all departments the patient's care pathway travels
• Provide thorough tailored training for all departments and staff who care for patients using this device.

The cardiothoracic ward originally used underwater drains for patients after thoracic surgery. The department recruited a consultant who had used Thopaz at another hospital and was able to share the benefits they had found of using Thopaz, including better management of air leaks and more accurate assessment of air and fluid loss. It offers portable suction so that patients can mobilise earlier following surgery. Thopaz was adopted in 2012. A change in funds available to the department meant that in March 2018 charitable funds from the trust were used to purchase 15 Thopaz+ devices for the cardiothoracic ward. The respiratory department were able to purchase 2 Thopaz+ devices for the respiratory ward. This shared learning examples will focus on adoption in the cardiothoracic ward.

When Thopaz was first adopted the business case was supported by the fact that although there was a cost to the Thopaz device, the consumables for Thopaz were cheaper than the underwater drain system which they were using at that time. The second business case, for adoption of Thopaz+ in 2018, was supported by the data and information gathered using Thopaz which showed reduced length of stay compared to the under water drains.

Adoption of Thopaz and Thopaz+ was focused on the cardiothoracic ward at John Radcliffe. It is used for all patients who have thoracic surgery and require a chest drain post-operatively. It is not used for people who have had pneumonectomy.

Patients in whom Thopaz+ is used following surgery commonly attend the admission ward, from there they are transferred to theatre, from theatre they are transferred to the cardiothoracic ward (the original care pathway was to transfer them to critical care instead of recovery).

Patients use Thopaz+ for 3 days with a range of 1-4 days.

Training of all the relevant staff was a large aspect of the adoption project for Thopaz and Thopaz+. Cardiothoracic patients who receive Thopaz + would have undergone a surgical procedure therefore the following healthcare professionals required training in how to use Thopaz+. Operating theatre staff, recovery staff, cardiothoracic doctors, cardiothoracic nurses, staff working on critical care including anaesthetists. When the care pathway was changed for patients to go from theatre to recovery (instead of to critical care) this meant there was a large group of healthcare professionals in recovery who had never cared for people with chest drains who required training in Thopaz.

Training was modified for the needs of each department for example theatres needed to know how to set it up and the cardiothoracic ward staff need to know how to make use of it for clinical decision making as highlighted by MTG 37.

The manufacturer provided support and training for staff and in the first 2 weeks of adoption a manufacturer representative was available 24 hours a day for trouble shooting.

Now that adoption is well established, new staff to the department receive training from more experienced staff and a representative from the manufacturer frequently visits to provide ongoing training and support.

Initially the department agreed a pricing approach for Thopaz with the manufacturer which involved paying a higher price for consumables but receiving the device for free. Updates to the manufacturer pricing structure meant that the trust then switched to renting the Thopaz devices from the manufacturer. A further change to the management structure and funds at Oxford University Hospital NHS foundation Trust meant that hospital charitable funds were available to apply for, to allow the purchase of the Thopaz+ devices. The second business case (for Thopaz + in 2018) was based on the benefits of Thopaz+ for patients in terms of being able to mobilise quickly following surgery, walk around, go to the toilet and benefits for the service in terms of enabling patients to attend X-ray without ward nurse escort, and reduced length of stay.

The department are keen to not lose any devices because this would impact on patient care. They therefore keep the devices in a locked cupboard on the cardiothoracic ward and each device is signed in and out on a named patient basis. A porter from theatre will come to the ward to collect a device when theatre is ready to set it up.

• The Thopaz and Thopaz+ devices provide better information for managing patients – 3 days’ worth of data on air leak and fluid loss
• Patients can mobilise earlier following surgery
• Patients can go to X-ray without a nurse escort because they do not have an underwater drain. This frees up nursing time for the ward
• Nurses find reading the result easier than counting bubbles
• Patients can see improvements in their condition from the readings

• Training of all relevant staff and ensuring they are aware of the benefits is essential for adoption. When staff are not trained or aware of the benefits they may revert back to the old type of drains because they feel more conformable with these.
• When considering training groups include all healthcare professionals who will care for the patient; including theatre staff, recovery staff, critical care staff including doctors etc.
• Directorate, divisional and finance managers supportive of adoption.
• When adopting Thopaz+ using a purchasing model where the devices are purchased out right, engage with the hospitals engineering department to secure support for when devices fail and require repair.