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Small changes, big differences

A new approach to catheter care

Nottingham University Hospitals NHS Trust

Amy Cartwright, Clinical Procurement Specialist at Nottingham University Hospitals NHS Trust, took inspiration from the USA to reduce catheter-related infections in her Trust.

Catheter care is a real passion of mine dating back to when I was an infection prevention and control nurse and then a urology nurse. During that time, I led on initiatives to reduce catheter-related infections, including creating an e-learning package for colleagues in my Trust.

I was awarded a Winston Churchill Memorial Fellowship Trust to develop this work, and spent a month in the USA to see what American health care providers did to reduce infection. The trip opened my eyes to what was possible in catheter-related care.

In America there is a catheter pack for every patient, which contains everything needed to perform the procedure. The catheter and drainage system are pre-connected, and the system remains in place for 14 days until the drainage bag needs replacing.

Finding a solution

Only one such product existed in the United Kingdom - Bard’s Comprehensive Care Foley Tray - so I worked with a company rep, and with my Clinical Procurement Matron, to find a solution for our Trust.

We began a four week trial of the pack in high-risk areas including on the wards and in A&E. As with any new product or initiative, there was some resistance, but the majority of my colleagues saw the benefits straight away.

For staff who do not catheterise on a regular basis, it can be difficult to remember what is needed, because there are many items involved.

Before the new pack was available, staff would go to various different store rooms, or even, in some cases, break off from a procedure because they had forgotten an item. But now, everything is in one place. This saves time and promotes better practice for what is a very intimate procedure.

Methodical process

In January 2015, following the trial, we rolled out the packs to the whole Trust. We’re a large organisation across two sites with more than 1,700 beds, so this had to be a methodical process, working one corridor at a time.

I spent many hours on the wards, with the company rep, talking to people about the pack, before and after their shifts. This helped to increase product recognition, and meant that staff were prepared when the time came to change.

I monitor the impact of the packs closely, and each catheter-related infection is recorded on the safety thermometer, which is how we record patient safety data across the Trust.

In 2014, before the packs were introduced, there were 132 catheter-related infections in the Trust.

In 2015, following its introduction, this decreased 45% to 54, and our most recent data, from 2016, recorded 21 infections - a reduction of 80% in just two years.

Each catheter-related infection costs the NHS £1,760 to treat, so, in just two years, this change has avoided patient costs of more than £130,000, and reduced the number of people staying longer in hospital.

Introducing the packs saved £40,000 on a product for product basis too, meaning the overall saving was £170,000.

Communicating with staff

We have communicated these results with colleagues via the patient safety newsletter, and new staff are told about this work during their induction.

I still get queries about the packs, and it’s great to be able to show staff the evidence I have gathered. Having the confidence to positively challenge colleagues is an important part of working in procurement.

I use every opportunity to share best practice, and have taken my learnings to other Trusts across the East Midlands, as well as via the Clinical Procurement Specialist Network.

Now more Trusts are getting in touch, and I am looking forward to working with them to improve their approach to catheter care.