The Royal National Throat, Nose and Ear Hospital The Royal Free Hospital

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



Background

• MCEAG

• Finance

• Costs– it can be introduced at no extra cost – savings of about £5649 (rebate of £0.20 per

cannulae available) estimated



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



Ported, winged cannula



Non-ported, non winged cannula



Evaluation Plan

• Two week trial• Evaluation form• Covering letter• Theatres

• Emergency• Neurosurgery• Liver• Urology

• Standard cannulae removed during trial



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



Evaluation criteria

• Ease of use/requirement for training

• Dexterity

• Sharpness

• Flashback visualisation

• Patient experience

• Reliable operation of safety mechanism

• Sharps injury risk reduction (perception)



This product requires to user to change cannulation technique

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Q1: This product requires the user to change cannulation technique?

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The safety device is easy to use

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Q2: The safety feature is easy to use.

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The safety feature requires more time to use than the standard non-safety device

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Q3: The safety feature requires more time to use than the standard non safety device?

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This device required more manual dexterity than a standard device

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Q4: This device requires more manual dexterity than a standard device

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This device was sharp and penetrated easily

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Q5: This device was sharp and penetrated easily

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This device allowed rapid visualisation of flashback in the cannula or chamber

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Q6: This device allowed rapid visualisation of flashback in the cannula or chamber

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Use of this device does not increase the number of attempts to cannulate

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Q7: Use of this device does not increase the number of attempts to cannulate

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The use of device does not increase pain and trauma for patients

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Q8: The use of this device does not increase pain and trauma for patients

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It is easy to stop the flow of blood and attach connections with this device

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Q9: It is easy to stop the flow of blood and attach connections with this device

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It is clear (audible or visual) when the safety device has been activated

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Q10: It is clear (audible or visual) when the safety device has been activated

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The safety feature operates reliably

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Q11: The safety feature operates reliably

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The product does not need extensive training to operate reliably

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Q12: The product does not need extensive training to operate reliably

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The device is easily secured to the patient

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Q13: The device is easily secured to the patient

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Do you think this device will help prevent needlestick injuries?

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Do you think this device will help prevent needlestick injuries?

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Have you sustained a needlestick injury while using the device?

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Have you sustained a needle stick injury while using this device?

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How many times did you use the device before you felt comfortable with it?

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<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

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Conclusions

• the two devices were well received and acceptable to users on all parameters



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



Implementation

• August 2007

• Briefing letter for ward and departments

• Training sessions e.g. for new junior doctors



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



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”.



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



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.



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.



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



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



Implementation planning

• Groundwork, stakeholders

• Business case

• Trial/pilot

• Training

• Evaluate

• Feedback, information

• Monitor, evaluate, review

Documents

The Royal National Throat, Nose and Ear Hospital The Royal Free Hospital