1. The Introduction of Standardised Guidelines for Talc Pleurodesis The Cardiothoracic Unit Claire Badger (ANP) and Mr J Asante-Siaw

2. Talc Pleurodesis a)Direct visualisation b) CT Scan c) PET Scan

3. INTRODUCTION ●Procedure has been traditionally undertaken by doctors, but is a role that can be carried out by Advanced Nurse Practitioners (ANP) with appropriate training ●Considerable practice inconsistencies with the technique of the procedure, and timing of chest drain removal

4. OBJECTIVES ●Evidence-based protocol for the procedure to ensure consistency of practice by doctors and nurses ●High quality, timely, safe, effective care for all patients

5. The Protocol ●Discussion with ward Pharmacist and Consultant Thoracic Surgeon ●Literature search ●Presentation of protocol at QIPP’s (Quality Innovation Productivity Prevention) ●Production of DOPS (Direct Observation Procedural Skills) assessment form

6. DOPS ● Simple structured checklist ● Commonly used for medical trainees ● Practical skills essential to provision of good clinical care

7. DOPS Assessment Criteria ● Indications ● Anatomy ● Consent ● Technique, prep & post procedure care ● Asepsis ● Communication ● Professionalism

8. Timing of Drain Removal after Talc Pleurodesis ● n=22 ● Identified from pharmacy records 01/01/09 - 31/12/10 ● Retrospective review of CXR’s,discharge summaries and histology reports ● Effusion n=16 Pneumothorax n=6

9. Talc Pleurodesis performed for Pleural Effusion Pleural Effusion n=16 Malignant n=15 No Success n=1 Success n=14 Non- Malignant n=1 Success n=1

10. Talc Pleurodesis for Pneumothorax Pneumothorax n=6 Success n=5 No Success n=1

11. CONCLUSION ●Talc Pleurodesis is a procedure which can be competently and safely performed by appropriately trained ANP’s. - Audit patient satisfaction ●Evidence based protocol ●Guidelines disseminated for use Trust wide ●Apply similar process to other procedures as roles develop

12. REFERENCES ● Braithwaite W (2008) Performing Talc Pleurodesis in Patients with Mesothelioma Nursing Times 29 th April: 1-6. ● Groth, G; Gatzemeier, U; Halibingen, K et al (1991) Malignant Pleural Effusion with Mitoxantrane Placebo (Pleural Tube Alone) Annals Oncology (2): 213-5. ● Medicines Information (2004) Management of Malignant Pleural Effusions-Pleurodesis Calderdale and Huddersfield NHS Trust. ● Morriston Hospital Pharmacy Department (2003) Talc Pleurodesis Swansea NHS Trust.

13. ● Munday H, Rintoul R, Laroche, C, Buttery R, Hunter C and Lau-Walker, M (2007) Talc Pleurodesis:Doctor Versus Nurse Led Procedure. A Prospective, Randomised, Non- Inferiority, Multi-Centre Pilot Study J International Assoc Study Lung Canc 57(1):16. ● Nursing Practice Guidelines (2005) Guidelines for Pleurodesis via a Chest Drain Nottingham City Hospital/Queens Medical Centre/Rushcliffe PCT p1-6. ● Pharmacy Department and Respiratory Unit (2009) Protocol for Pleurodesis with Sterile Talc Lothian University Hospitals Division. ● Roberts M, Ali N, Neville E and Antunes G (2009) British Thoracic Society Guideline for the Management of Malignant Pleural Effusions British Thoracic Society 5 th August:1-44.

14. ● Tan, C; Swift, S (2006) The Evidence on the Effectiveness of Management for Malignant Pleural Effusion: a Systematic Review EJCTS (29): 829-838. ● Webb, WR; Ozmen, V; Moulder, PV et al (1992) Iodized Talc Pleurodesis for the Treatment of Pleural Effusions J Thorac Cardiovasc Surg 103:881-5. ● Weissberg, D; Ben-Zeev, I (1993) Talc Pleurodesis Experience with 360 patients J Thorac Cardiovasc Surg 106: 689-95.

15. Acknowledgements Mr Mohammed Hawari Cardiothoracic Registrar for his help with this project