Chest drains are indicated for pleural effusions and pneumothoraces. Documentation of chest drain insertion in patients' notes can vary and may be sub-standard. We did a retrospective audit of documentation of chest drain insertions and repeated it after the introduction of a chest drain pro forma. Patients and Methods: All chest drain insertions over a two-year period (2017-2019) in our hospital were audited. Indwelling pleural catheter insertions were excluded. We re-audited chest drains inserted in the respiratory ward for 3 months (January-March 2020) after the introduction of a chest drain pro forma to assess improvements in documentation. Results: In the first audit, 134 patients had chest drains [85(63%) male; age 18-91 years]; 16 of these were emergency procedures. Documentation of chest drain insertion procedures was poor. In 12(9%), the procedure was not recorded at all. One or more preprocedural safety checks (indication, review of radiology, coagulation parameters) were documented in 23(17.2%) procedures. In 11 (8.2%) the department/unit where the procedure was performed was not documented. In 30(22.4%) the time of the procedure was not entered. The grade and speciality of doctor performing the procedure was missing in 18(13.4%) and 13(9.7%) entries, respectively. Patient consent was available for 90(67.2%) procedures (61 verbal, 29 written). Adherence to aseptic technique was mentioned in 66 (49.2%), and the dose of local anaesthetic was included in 82(46.3%) entries. Re-audit following the introduction of a pro forma in respiratory ward (n=29) showed improvements in documentation. There was a significant improvement in the documentation of preprocedural checks (59.8% vs 19.4%), and a positive trend in documentation of consent and the use of local anaesthetic. Conclusion: Documentation of chest drain insertion procedures can vary and may be incomplete. Routine use of a pro forma improves documentation of chest drain insertion procedures and should enhance overall patient safety.

Neutrophils are the most abundant leukocyte in humans and the principal effectors of the innate immue response. Genetic modification of human neutrophils is challenging due to their short lifespan and tendency to activate in response to even minor perturbation. However, genetic manipulation of haematopoietic progenitor cells and subsequent directed differentation into neutrophils represents a potential avenue to study the contributions of individual genes and pathways to human neutrophil function. Here we present a method of directed granulocytic CD34+ progenitor differentiation into neutrophils capable of key functions such as priming and neutrophil extracellular trap (NET) formation. We further show that differentiating progenitors can be efficiently and stably modified by lentiviral gene delivery and Cas9-gRNP nucleofection to produce potent and activation-free gene knockdown in mature neutrophils, thereby providing new tools for understanding the contribution of neutrophils to health and disease. Using this model we have shown that, contrary to previous reports, CD11b is not required for phagocytosis of serum-opsonised bacterial particles.