Reducing Time Taken to Gather Equipment for Venepuncture and Cannulation

1) Understanding the Problem & Setting our Aim​

• Timely and efficient gathering of equipment for basic procedures including venepuncture and cannulation is critical for doctors and other healthcare professionals, particularly when on - call, during emergencies and on unfamiliar wards.

• At our hospital, the Royal Devon & Exeter (RD&E), we have had frustrating experiences trying to find equipment in a timely manner (figure 1).

• We performed a root cause analysis to understand the reasons for the excessive time taken and hoped to rectify the situation (figure 2).

• We aimed to reduce the time taken to gather equipment for venepuncture or cannulation to twenty seconds by June 2023.

(1) You go to the blood trolley:

SCENARIO:

You are the overnight F1 on call at a cardiac arrest. You need to urgently get bloods.

(2) You open the blood trolley:

(3) You go to the storeroom:

4) Learning points

• Implementing changes can be challenging due to human factors; such as resistance of staff to change. This highlighted to us the importance of stakeholder involvement and ensuring recruitment of the "early adopters."

• Starting with a small change and assessing its effectiveness before expanding on a larger scale ensures sustainability and high motivation by valuing "small wins" (Weick, 1984).

5) Next Steps

• Establish sustainable method of stocking trollies by involving stakeholders and early adopters on the ward, including the clinical matron.

• Educate staff on presence of trollies and encourage engagement and maintenance.

• Put up clear signage to try and encourage visitors to the ward to use the trolley.

• Expand to acute wards hospital - wide

(5) And blood bags are in the sluice!

(4) To get more butterflies:

2) Setting up measurements

• A suitable ward was identified – a surgical ward which has a preexisting stock trolley to provide a good base for improvement.

• Across several days, medical students and other volunteers were observed and timed collecting equipment for both venepuncture and cannulation using the existing set - up.

• Photos of current stock were taken and subjective feedback gathered.

"This is rubbish"

"I can't find anything – it is useless!"

Two quotes from a surgical F1 doctor.

3) Implementing Changes

• We created a driver diagram to try and understand what factors may lead to an improvement (figure 3).

• This informed each part of the Plan - Do- Study- Act (PDSA) cycles (figure 4) and implementation of a new trolley layout (figure 6).

• Results showed median time for equipment collection was reduced from 141 seconds pre - intervention to 18 seconds post - intervention for venepuncture (figure 5) and 137.5 seconds to 18 seconds for cannulation.