Abstract
BackgroundIntravenous cannulation is undertaken in a high proportion of hospitalised patients. Much international attention has been given to the use of care bundles to reduce the incidence of infection in these patients. However, less attention has been given to the systems required to ensure availability of the equipment needed to support these care bundles. Our objectives were to assess how reliably the equipment recommended for a peripheral intravenous care bundle was available for use, and to explore factors which contributed to its non-availability.MethodsWe studied 350 peripheral cannula insertions in three NHS hospital organisations across the UK. Staff inserting cannulae were asked to report details of all equipment problems. Key staff were then interviewed to identify the causes of problems with equipment availability, using semi-structured qualitative interviews and a standard coding frame.Results47 equipment problems were recorded during 46 of 350 cannulations, corresponding to a reliability of 87%, or 94% if problems with sharps disposal were excluded. Overall reliability was similar in all three organisations, but the types of problem varied. Interviews revealed a variety of causes including issues associated with purchasing policies, storage facilities, and lack of teamwork and communication in relation to reordering. The many human factors related to the supply chain were highlighted. Often staff had adopted work-arounds to deal with these problems.ConclusionsOverall, 87% of cannulations had the correct and functional equipment available. Different problems were identified in different organisations, suggesting that each had resolved some issues. Supply chain management principles may be useful to support best practice in care bundle delivery.
Highlights
Intravenous cannulation is undertaken in a high proportion of hospitalised patients
A study of the effectiveness of implementing a central venous catheter care bundle showed that provision of adequate equipment at the point of need was essential in supporting frontline staff in complying with evidence-based care bundle guidelines [8]
A total of 47 incidents of non-availability or non-functional equipment occurred in 46 cannulation operations, representing a prevalence of 13.1%
Summary
Much international attention has been given to the use of care bundles to reduce the incidence of infection in these patients. Less attention has been given to the systems required to ensure availability of the equipment needed to support these care bundles. The availability of the right equipment when needed is critical to ensure that frontline staff perform their tasks consistently, achieving the aim of the care bundle. A study of the effectiveness of implementing a central venous catheter care bundle showed that provision of adequate equipment at the point of need was essential in supporting frontline staff in complying with evidence-based care bundle guidelines [8]. No studies have examined equipment availability for the more frequently undertaken insertion of peripheral intravenous cannulae
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