Mapping Greener HealthcareMapping Greener Healthcare

Goal: To reduce unnecessary cannulation in the emergency department (ED).

Background: before the project was carried out, inserting a cannula for a patient arriving in the emergency department was considered ‘routine’ care. Once a cannula is inserted the policy was for all cannula to be fitted with a Bionector, for infection control purposes. However, staff noticed when reviewing patients that many cannulae were inserted and not used or were used inappropriately (e.g. intravenous fluids or drugs used when the patient was able to drink and take oral medications). It was suspected that practice of inserting a cannula ‘routinely’ led to significant waste in terms of clinician time, waste of equipment required for cannulation, inappropriate use of intravenous fluids and medicines and unnecessary discomfort for patients. It was also noted that, where cannulae were likely to be short term, such as in theatres or the resus section of ED then Bionectors were not mandated, but in the main ED it was still expected that patients should have Bionectors attached to cannulae even though cannulation is often only required short term in ED.

Approach: The ED team planned to carry out an audit to test the hypothesis that a significant number of cannulations were unnecessary. ED consultants raised awareness of the audit prior and during the audit at the thrice-daily team handovers and with a poster campaign (posters put up around the department and on equipment trolleys where the cannulainsertion kit was kept). For 1 week doctors and nurses inserting cannulae recorded information on the patient’s main clinical problem on admission, the intended indication for insertion, number of attempts at insertion (i.e. number of cannulae used), whether the cannula was used in ED and what the cannula was used for. The 6 proforma for recording data was handed out at handover and was available on equipment trolleys. A collection tray for completed proformas was placed in ED. After the initial audit the results were presented. Informal (at handover) and formal (presentation) education was carried out on correct use of cannulae including raising awareness of a revised policy for ED, agreed with the infection control team, that if a cannula is likely only to be required short term then a Bionector did not need to be attached.

After a round of education the consultants stopped mentioning the changes and the audit was then repeated 1 month later, again over 1 week, to see if the project and education had been effective and if any changes had been embedded.