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Abstract

Introduction: Hospitalizations for pleural infections are increasing, with an estimated 10–20% mortality rate. Standard treatment strategies, including antibiotics, are often ineffective, requiring surgical intervention, leading to lengthy hospitalizations and increasing health care costs. Recent evidence has shown intrapleural tissue plasminogen activator (t-PA) and deoxyribonuclease (DNase) as a novel therapeutic strategy for management of empyema that has been shown to reduce the need for surgical intervention. The pulmonary practice at this large, academic medical center incorporated this treatment into the management of individuals with empyema. The 2010 Institute of Medicine (IOM) report states that “care teams need to make the best use of each member’s education, skill, and expertise, and all health professionals need to practice to the full extent of their license and education”. With this in mind, we set out to explore translating this new evidence into nursing practice. Methods: After verifying that intrapleural medication administration is within the scope of nursing practice and obtaining nursing leadership approval we collaborated with pharmacy and pulmonary physicians to develop a nursing procedural guideline for t-PA/DNase administration for empyema. The guideline outlines the process for administration of t-PA/DNase into a chest tube or pigtail catheter. To prevent intravenous administration, the medications are dispensed in a catheter tipped syringe. Through simulated trial and pilot testing, we determined the appropriate equipment needed to administer the intrapleural fibrinolytic medications and developed an educational video demonstrating proper technique. Results: A guideline for the administration t-PA/DNase was successfully developed and since implementing this novel process, nurses have administered t-PA/DNase to 15 patients. Conclusions: This project demonstrates how nurses can utilize their expertise and work to their full scope in the management of complex patient care processes. Nurse leaders should continue to look for ways to leverage the role of the registered nurse.