Nottingham University Hospitals NHS Trust is one of the largest employers in the East Midlands. With over 80 wards and 1,700 beds, the Trust provides a range of services including heart, cancer, stroke, renal neurosurgery and major trauma to over 2.5 million residents of Nottingham and its surrounding communities.
While the provision of high quality care is at the heart of the Trust, it needs to be achieved in a financially sustainable way. In 2014-15 the Trust’s cost improvement target was increased by 10% from the previous year to £44m – £5.5m of which was expected to come from savings in the procurement of clinical supplies.
The emphasis for the Trust’s procurement team was on delivering safer products for staff and patients.
‘The project was about doing things better and delivering patient and staff safety first, above anything else,’ says David Newton, Matron and member of the Trust’s Clinical Procurement Team.
Other key objectives identified by the Trust were to improve value for money through better technology and lower cost products; to reduce risk for nurses through less variation in clinical supplies; and to increase the Trust’s share of spend with small and medium sized enterprises.
Their efforts focussed on three products with a combined spend of over £1.8 million: infusion pumps and administration sets, film dressings for intravenous cannulas, and syringes and needles.
Of the three items, the most significant outlay (£1 million per year) was on infusion pumps and administration sets. Existing stock was ageing and needed replacing, meaning the same levels of control were not in place compared to more modern machines. Each pump had four possible administration sets which increased the chance of error and took up valuable storage space.
The team saw an opportunity to improve both value for money and patient safety by adopting more advanced technology.
David worked with NHS Supply Chain’s National Framework to find a new supplier. The tendering process took three months to complete and resulted in a saving of over £350,000. The Trust secured 1,000 pumps – 300 more than it had previously – so equipment was more readily available, converting time spent searching for pumps to time spent caring for patients.
The number of administration sets required for the new machines was reduced from four to two, which has simplified the process further and freed up more space on the ward.
David did experience a delay in securing Board sponsorship. The Chief Executive, Medical Director and Director of Nursing had to agree on a drugs library for the pumps, something that he had not foreseen at the start of the project.
When this was agreed, the Trust implemented the changes from ward to ward, ensuring that training and stock administration, most of which was delivered by the supplier, was managed in a controlled way.
Evaluating the Trust’s use of film dressings for intravenous cannulas was a much shorter process. Comparable film dressings were available at a lower cost, presenting a potential saving of up to £70,000 over 12 months.
Having agreed, in principle, to a potential switch, David tested the durability of a number of products, replicating activities that patients would typically undertake while wearing intravenous cannula dressings. It was vital that any new product could remain in position for 72 hours, and in some cases, 96 hours where patients reacted badly to the insertion of cannulas.
David tested the new product over a two week period within high usage departments such as critical and emergency care. He developed a new approach to evaluation which incorporated over 600 separate observations from teams in the pilot areas, as well as asking them a range of qualitative questions.
While time consuming, this new approach gave a more realistic picture of the clinical experience, and one-to-one consultation with nurses significantly reduced the number of issues and queries after implementation.
The project also tackled the delicate issue of needle stick injuries. Injuries caused by hypodermic needles were having a traumatic effect on staff and a significant impact on the Trust’s productivity, with over 20 incidents being reported each month, at a cost of £3,000 per injury, plus four working days lost.
David worked with key stakeholders to introduce blunt fill needles for the drawing up and mixing of IV medicines. Where this wasn’t a feasible option, hypodermic safety needles were used. This flexible approach, incorporating two different products, has improved staff and patient safety, and saved £180,000.
Both product suppliers ran a series of activities to support implementation, including a roadshow which gave practical demonstrations to nursing staff. Training was delivered ward by ward, to minimise disruption, and the suppliers worked in partnership with materials management and NHS Supply Chain to monitor stock levels.
Adopting blunt safety needles has reduced needle wastage by almost 10% across the Trust and raised awareness of needle stick injuries. As a result, reporting levels have increased. The Trust’s work on safer sharps has been extended to improve safety for diabetes patients too.
The project has also led to additional savings of £213,998 on a contract spend of £4.1 million. There has been price reductions on a range of items including polymer aprons and waste bags, paper hygiene, exam gloves, surgical gloves, hearing aids, respiratory therapy, textiles, inks and toners, general wound care and audiological implantable devices.
David insists that when communicating changes to key stakeholders, it’s important to focus on the positive impacts on end user, and refer to any financial savings as a by-product of the process.
‘The achievements over the last 24 months, including improving drug administration and sharp safety, and lower infection rates for patients, have been outstanding’, says David.
‘The fact that these improvements have been made whilst realising significant financial savings is a testament to the power of clinical engagement. When the procurement plan is aligned with clinical goals, huge improvements can be made, with real bankable savings.’
The Trust plan to use their learning to evaluate numerous other products including respiratory and oxygen therapy consumables, pressure relieving systems and the standardisation of catheters.