the royal national throat, nose and ear hospital the royal free hospital
TRANSCRIPT
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Implementation in practice
• Evaluation of a trial of two safety engineered iv cannulae
• Setting:– Acute London hospital theatres dept– May/June 2007
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Background
• MCEAG
• Finance
• Costs– it can be introduced at no extra cost – savings of about £5649 (rebate of £0.20 per
cannulae available) estimated
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Products evaluated
• Ported, winged cannula (20, 22 & 24G)
• Non-ported, non winged cannula (14,16,18, 20, 22 & 24G)
• incorporate self-activating clip technology, preventing needlestick injury
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Ported, winged cannula
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Non-ported, non winged cannula
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Evaluation Plan
• Two week trial• Evaluation form• Covering letter• Theatres
• Emergency• Neurosurgery• Liver• Urology
• Standard cannulae removed during trial
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Coordinated by:
• Supplies Clinical Nurse Advisor
• Consultant in Occupational Medicine
• Consultant Anaesthetist
• Principal ODA, Theatres
• Theatre Manager
• Infection Control Lead Nurse
• Practice Development Lead Nurse
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Evaluation criteria
• Ease of use/requirement for training
• Dexterity
• Sharpness
• Flashback visualisation
• Patient experience
• Reliable operation of safety mechanism
• Sharps injury risk reduction (perception)
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
This product requires to user to change cannulation technique
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1 (Agree) 2 3 4 (Disagree) n/a
Q1: This product requires the user to change cannulation technique?
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
The safety device is easy to use
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1 (Agree) 2 3 4 (Disagree) n/a
Q2: The safety feature is easy to use.
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
The safety feature requires more time to use than the standard non-safety device
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1 (Agree) 2 3 4 (Disagree) n/a
Q3: The safety feature requires more time to use than the standard non safety device?
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
This device required more manual dexterity than a standard device
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1 (Agree) 2 3 4 (Disagree) n/a
Q4: This device requires more manual dexterity than a standard device
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
This device was sharp and penetrated easily
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1 (Agree) 2 3 4 (Disagree) n/a
Q5: This device was sharp and penetrated easily
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
This device allowed rapid visualisation of flashback in the cannula or chamber
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1 (Agree) 2 3 4 (Disagree) n/a
Q6: This device allowed rapid visualisation of flashback in the cannula or chamber
Series1
Series2
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Use of this device does not increase the number of attempts to cannulate
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1 (Agree) 2 3 4 (Disagree) n/a
Q7: Use of this device does not increase the number of attempts to cannulate
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
The use of device does not increase pain and trauma for patients
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1 (Agree) 2 3 4 (Disagree) n/a
Q8: The use of this device does not increase pain and trauma for patients
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
It is easy to stop the flow of blood and attach connections with this device
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1 (Agree) 2 3 4 (Disagree) n/a
Q9: It is easy to stop the flow of blood and attach connections with this device
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
It is clear (audible or visual) when the safety device has been activated
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1 (Agree) 2 3 4 (Disagree) n/a
Q10: It is clear (audible or visual) when the safety device has been activated
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
The safety feature operates reliably
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1 (Agree) 2 3 4 (Disagree) n/a
Q11: The safety feature operates reliably
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
The product does not need extensive training to operate reliably
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1 (Agree) 2 3 4 (Disagree) n/a
Q12: The product does not need extensive training to operate reliably
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
The device is easily secured to the patient
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1 (Agree) 2 3 4 (Disagree) n/a
Q13: The device is easily secured to the patient
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Do you think this device will help prevent needlestick injuries?
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Yes No Don’t Know
Do you think this device will help prevent needlestick injuries?
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Have you sustained a needlestick injury while using the device?
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Yes No Don’t Know
Have you sustained a needle stick injury while using this device?
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
How many times did you use the device before you felt comfortable with it?
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Never felt comfortablewith it
<5 5-10 >10 Don't Know
How many uses before felt comfortable using cannula
How many times did you use the device before you felt comfortable with it
Introcan
Vasofix
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Conclusions
• the two devices were well received and acceptable to users on all parameters
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Recommendations
• Ported, winged cannula (20, 22, & 24G) to be implemented only in the Theatres
• Non-ported, non winged cannula (14, 16, 18, 20, 22, & 24G) to be implemented throughout the Trust
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Implementation
• August 2007
• Briefing letter for ward and departments
• Training sessions e.g. for new junior doctors
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
October 20076 week post implementation
• Majority of wards and departments had slowly started to use the smaller gauges of the non-ported, non-winged safety cannula
• Large amount of old stock, especially the larger gauge sizes (18, 16 & 14G)
• These sizes are infrequently used on the wards, so it will take considerable time for stock to be moved and replaced by the non-ported, non-winged safety cannula
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
October 2007, surgical ward
• Ward had a large amount of stock of old ported product– sizes 18 & 20G.
• When questioned they said that they “had been using this cannula for a while”.
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
October 2007, paediatric wards
• These wards had stock of a 24G IV cannulae and which were non-safety.
• They did not appear to have the non-ported, non-winged cannula yet.
• Codes needed changing
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
October 2007, ITU
• Had stock of old IV cannulae and non- safety cannulae
• They had 2 boxes of the non-ported, non-winged safety cannulae only.
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
October 2007, neonatal unit
• Would like to continue evaluating the non-ported, non-winged safety cannula.
• This is being coordinated by Matron
• They are currently successfully using the samples and Matron has said that the SHOs are now evaluating them.
• Evaluation is slow as they do not use many IV cannulae.
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
October 2007, main theatres
• Principal ODA said that the non-ported, non-winged cannulae were being ordered and slowly used, however old stock was being ordered incorrectly.
• Consultant Anaesthetist said that the anaesthetists are slowly getting used to the difference.
• A lunch meeting with the anaesthetists planned for 30th October to discuss the use of the non-ported, non-winged cannulae
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
October 2007, planned investigation and treatment unit and midwifery
• Matron and Practice Development Nurse to co-ordinate a cannulation training programme for nurses and midwives
The Royal National Throat, Nose and Ear Hospital
The Royal FreeHospital
Implementation planning
• Groundwork, stakeholders
• Business case
• Trial/pilot
• Training
• Evaluate
• Feedback, information
• Monitor, evaluate, review