Changing the culture of the “just in case” Cannula in the Emergency Department

Ms Tracey  Hawkins1, Prof Louise Cullen1,2, Ms Sara Berndt1, Ms Caitlin Lock1, A/Prof Jaimi Greenslade1,2
1Royal Brisbane And Women’s Hospital, Herston, Australia, 2University of Queensland, St Lucia, Australia

Background: Reducing the number of unnecessary peripheral intravenous cannula (PIVCs) is important. Insertion can be painful for patients, consumes staff time, costs resources and poses a risk of healthcare acquired infection. An innovation was developed to reduce the number of PIVCs inserted and the number of unused PIVCs in the emergency department (ED). Using implementation science, the focus is now on sustaining the innovation.
Method: A single-centre, observational study, assessed PIVC usage in the Royal Brisbane and Women’s Hospital ED. Data from 4611 patients were collected before, after, and 12 months following the three-month implementation period. The innovation is a novel “strength-based” multi-modal method that draws upon clinician strengths and knowledge, empowering staff to critically appraise the requirement for cannula placement. The innovation centres on the key message to clinicians “Are you 80% sure this cannula will be used in your hemodynamically stable patient in the next 24 hours?” Sustaining the innovation utilises behaviour change strategies to address barriers to change, such as changing the layout of the PIVC trolleys. Clinical “change champions” continue to wear “80%” branded scrubs and badges to promote our core message.
Results: Following the campaign, PIVC placement decreased by 10% and PIVC utilisation increased by 12.9%. The reduction in PIVC insertion post-intervention equated to a $4718 saving over two weeks.  Follow-up audit results are pending; however, we expect to see sustained improvements.
Conclusions: This simple cost-saving intervention exemplifies high-value care as it uses minimal additional resources to achieve benefits to our patients and resource utilisation savings. Reproduction of the program in other sites and other clinical scenarios is feasible because the project plan and educational materials developed as a part of the project are simple to understand and easy to disseminate.

Tracey Hawkins is an experienced Clinical Nurse in the Emergency and Trauma Centre at the Royal Brisbane and Women’s Hospital, Queensland, Australia.  Since 2008, she has been undertaking research into innovative models of cardiovascular care, peripheral intravenous cannulation and emergency care. Tracey completed her nursing degree at the Central Queensland University and completed further training in emergency nursing in the United Kingdom and Australia. She is currently enrolled at Queensland University of Technology undertaking a Graduate Certificate in Health Science Health Services Innovation in collaboration with Metro North and AusHSI.