Resuscitation 85 (2014) 1523–1526

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A simple solution for improving reliability of cardiac arrest equipment provision in hospital夽 Michelle Davies a , Keith Couper b,c , Julie Bradley a , Annalie Baker a , Natalie Husselbee a , Sarah Woolley d , Robin P. Davies a,c , Gavin D. Perkins b,c,∗ a

Resuscitation Service, Heart of England NHS Foundation Trust, Birmingham, UK Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK c Warwick Medical School, University of Warwick, Coventry, UK d Patient Safety Team, Heart of England NHS Foundation Trust, Birmingham, UK b

a r t i c l e

i n f o

Article history: Received 13 June 2014 Received in revised form 23 July 2014 Accepted 26 July 2014 Keywords: Patient safety Cardiopulmonary resuscitation Emergencies Hospital equipment Quality improvement

a b s t r a c t Introduction: Effective and safe cardiac arrest care in the hospital setting is reliant on the immediate availability of emergency equipment. The patient safety literature highlights deficiencies in current approaches to resuscitation equipment provision, highlighting the need for innovative solutions to this problem. Methods: We conducted a before–after study at a large NHS trust to evaluate the effect of a sealed tray system and database on resuscitation equipment provision. The system was evaluated by a series of unannounced inspections to assess resuscitation trolley compliance with local policy prior to and following system implementation. The time taken to check trolleys was assessed by timing clinicians checking both types of trolley in a simulation setting. Results: The sealed tray system was implemented in 2010, and led to a significant increase in the number of resuscitation trolleys without missing, surplus, or expired items (2009: n = 1 (4.76%) vs 2011: n = 37 (100%), p < 0.001). It also significantly reduced the time required to check each resuscitation trolley in the simulation setting (12.86 (95% CI: 10.02–15.71) vs 3.15 (95% CI: 1.19–4.51) min, p < 0.001), but had no effect on the number of resuscitation trolleys checked every day over the previous month (2009: n = 8 (38.10%) vs 2011: n = 11 (29.73%), p = 0.514). Conclusion: The implementation of a sealed tray system led to a significant and sustained improvement in resuscitation equipment provision, but had no effect on resuscitation trolley checking frequency. © 2014 Elsevier Ireland Ltd. All rights reserved.

1. Introduction In-hospital advanced life support requires the immediate availability of key equipment.1 Resuscitation trolleys were developed to store key equipment, and enable it to be quickly wheeled to an emergency when required.2 Today, they are a common sight on hospital wards, and form an essential part of every ward’s safety equipment. In recent years, issues surrounding resuscitation equipment have been a recurring theme in the patient safety literature.3–5

In 2007, the National Patient Safety Agency (NPSA) identified a series of deaths where there were reported issues with missing or non-functional resuscitation equipment.3 These findings highlight deficiencies in current systems for resuscitation equipment provision, and suggest a need to develop innovative solutions. The aim of this before/after study was to evaluate the impact of an intervention on resuscitation equipment provision. 2. Methods 2.1. Setting

夽 A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.07.021. ∗ Corresponding author at: Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, MIDRU Building, Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK. E-mail address: [email protected] (G.D. Perkins). http://dx.doi.org/10.1016/j.resuscitation.2014.07.021 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.

The study was undertaken in a large NHS trust, with 1405 beds and 153 resuscitation trolleys located across three hospital sites. Resuscitation equipment provision is based on national guidelines.6,7 Clinical areas are responsible for checking and documenting daily that this equipment is present, functioning and

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M. Davies et al. / Resuscitation 85 (2014) 1523–1526

Fig. 1. Picture of cardiac arrest trolley with 2009 and 2011/2012 advanced airway drawer.

within date on each trolley. Prior to the implementation of the intervention, resuscitation trolleys contained 108 items and equipment was stored loose in drawers (Fig. 1). 2.2. New design Our new approach was the combination of a sealed tray system and a bespoke equipment tracking database. Three trays (basic airway, advanced airway, intravenous (IV) access/circulation equipment) were developed to fit drawers in existing resuscitation trolleys (Fig. 1). Trays are created by resuscitation service staff. Each piece of equipment is scanned by the database system, and then placed in the tray. The system logs the equipment present in the tray, and only allows the tray label to be printed once all items are present. The tray label seals the tray, and lists the tray’s unique identification number, the trays contents, and the shortest expiry date of tray equipment. Equipment is bulk purchased and packaged centrally to facilitate standardisation and minimise costs. The database system tracks trays in and out of a central point on each hospital site and records item batch numbers and expiry dates. Clinical staff now only confirm trays and large equipment (e.g. suction, oxygen) are present and in-date, rather than check individual items. A pictorial equipment list is provided to educate staff about the types and purpose of emergency equipment stored in the trays. The set-up of the system cost £30,000, which covered: database development; purchase of plastic trays, bags, heat sealer, labels and label printer; and the initial purchase of equipment. Ongoing costs relate to staff time to produce trays, although these costs are

mitigated by bulk equipment purchase and a reduction in the time taken by ward staff to check equipment on a daily basis. 2.3. Evaluation For each speciality at each hospital site, a different random sample of trolleys was chosen for un-announced inspections prior to and following the implementation of the intervention. Items located in the basic airway, advanced airway and IV access/circulation drawers were recorded on a standardised assessment template as present and in-date, present and out of date, absent or duplicate. For post-implementation reviews, equipment was deemed to be present and in-date if a sealed and in-date tray was present. Evidence of daily trolley inspections over the past month was also checked. In addition, we compared the time taken by a convenience sample of staff to undertake a simulated trolley inspection with and without the sealed tray system. 2.4. Statistical analysis Data were analysed using SPSS statistical software (SPSS Version 21, IBM, Chicago, Illinois, USA). Categorical variables are reported as percentages and counts, and compared using the chi-squared test. Continuous variables were normally distributed data and reported as mean (95% confidence interval (CI)), and compared using a T-test. A p-value of 0.05 was considered statistically significant. In accordance with NHS Research Governance Framework, this work met the criteria for a quality improvement project and was therefore exempt from ethics review.

M. Davies et al. / Resuscitation 85 (2014) 1523–1526

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Table 1 Results of unannounced trolley inspections. 2009 (n = 21) Trolleys with no missing, expired or surplus equipment

2009 vs 2011 p-value

2011 (n = 37)

2009 vs 2012 p-value

2012 (n = 37)

1 (4.76%)

A simple solution for improving reliability of cardiac arrest equipment provision in hospital.

Effective and safe cardiac arrest care in the hospital setting is reliant on the immediate availability of emergency equipment. The patient safety lit...
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