Clinicians

• In the event that any aspect of a pleural drain procedure starts to go wrong or not as expected, stop immediately and escalate for assistance.
• Thoracic ultrasound should be available and used where intercostal catheters are inserted for drainage of pleural fluid.
• Mandate a 'Time out'™ period prior to insertion to confirm the correct side and site both clinically and radiologically.
• Check coagulation profile prior to insertion or removal of a pleural drain. Insertion or removal of pleural drain should be avoided in anticoagulated patients until international normalized ratio (INR) 50 x10⁹/L is achieved.
• Ensure that a post insertion chest X-ray is performed within one hour of insertion and reviewed promptly by the Medical Officer (MO) who inserted the pleural drain.

Facilities

• Each facility should reduce to a minimum the number of designated clinical areas where a pleural drain can be inserted.
• Each facility and the relevant clinical location should have a designated 'stop person'™ whose role is to prevent an inexperienced operator from attempting or continuing to perform a pleural drain procedure without appropriate supervision. This designated 'stop person'™ should be either a senior or respiratory specialist nurse within the relevant ward or unit.
• Facilities should audit the range of pleural intercostal catheters, drainage systems and equipment that they stock for insertion and after care. There is a prima facie case that reducing the variety will reduce the risk of human error and incorrect equipment being used. 
• Facilities are encouraged to reduce to a minimum the numbers of non-critical care areas in which patients with a pleural drain in situ are cared for. It is better to move the patient to a ward where the pleural drain nursing expertise exists (exceptions if patients require care in specialised units e.g. oncology).