Context This project was based in a busy district general’s Paediatric resuscitation bay. Doctors, nurses and the resuscitation team were involved.
Problem The Resuscitation Council states: ‘Healthcare organisations have an obligation to provide a high-quality resuscitation service’ and ‘staff have immediate access to appropriate resuscitation equipment and drugs’ with ‘A reliable system of equipment checks and replacement in place’. It states that appropriate airway equipment should be immediately available and circulation equipment accessible within minutes.
The current Paediatric resuscitation bay was felt to not fully meet the above criteria. The resus bay was not an intuitive area and had no clear restocking guidelines with trust incident forms being logged for missing equipment during resuscitations.
Assessment of problem and analysis of its causes Two lists of equipment were devised: one of simple airway equipment and one of equipment required to gain IV access and give a dextrose bolus. We timed one SHO trying to find specific equipment in our current resuscitation bay. The results were discussed in departmental meeting to consolidate the opinion of the Paediatric team, the Anaesthetic team, the Resuscitation officers and the Paediatric nurses, an action plan was devised to address the failings noted by staff in the department.
Intervention The main instigated changes involved creating uniform circulation trolleys containing all the required equipment for paediatric cannulation and giving a bolus of rescue fluid. The bay had 3 grab trolleys and all were identical. To aid restocking, a label was placed below each piece of equipment to state what should be there and photographic checklists were created. The same principle was used for the airway trolley which, while being organised for weight, had an identical layout in each drawer and the same labelling system and checklist.
Study design This was an observational study based on the time taken for SHO’s to find emergency equipment pre and post changes.
Strategy for change The changes were implemented by a Paediatric SHO and F1 who redesigned, labelled and restocked the trolleys. This was organised prior to the new rotational doctors starting who were then inducted around the department by one of the study organisers.
Measurement of improvement We timed SHO’s finding equipment pre and post changes.
ResultsPrior to the changes SHO 1 took a protracted amount of time to find a paediatric non-rebreath mask and during the circulation speed test searched multiple drawers, could only find half a culture kit and used the last bag of 10% dextrose in the paediatric resuscitation bay. After our implementation, SHO 2 found all of the airway adjuncts in the airway trolley and only required one grab trolley to successfully collate all the circulation equipment with a decrease in time.
Effects of changes Although two SHO’s were used, both were of a similar grade and had had a similar amount of exposure and experience within the resuscitation bay. Simple measures, requiring no additional equipment or money, were taken to standardise the area. Substantial improvements in time were noted in both tests. Nursing staff and doctors reported finding the area easier to use, more logical and clearer to restock.
Lessons learnt Simple changes can make a demonstrable difference and improve patient safety.
Message for others We showed with no money or extra resources you can ensure a safer environment for patients by ensuring uniformity and clear labelling.
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