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

The safety device is easy to use

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

This device required more manual dexterity than a standard device

This device was sharp and penetrated easily

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

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

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

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

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

The safety feature operates reliably

The product does not need extensive training to operate reliably

The device is easily secured to the patient

Do you think this device will help prevent needlestick injuries?

Have you sustained a needlestick injury while using the device?

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

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 2007 6 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