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Small changes, big differences

Standardising blood pressure cuffs

Derby Teaching Hospitals NHS Foundation Trust

Derby Teaching Hospitals NHS Foundation Trust has over 1,100 beds and cares for more than one million people every year. With such a high volume of patients, there is a need for staff to work as efficiently and effectively as possible.

Blood pressure monitoring was a case in point. A routine task that should be completed in seconds was often taking much longer. Staff had access to a range of BP machines, cuffs and different connectors, and would spend lots of time looking for the right match. Some machines were under-used as a result, and others were not used at all. Boxes of incorrectly ordered cuffs had begun to build up across wards in the Trust.

The consensus amongst staff was that a single blood pressure cuff supplier was needed.

Considerations

The Trust had already successfully standardised other core products including examination gloves, so blood pressure cuffs seemed an obvious candidate for a similar process. However, before this could happen the benefits had to be clearly understood.

Any new blood pressure measurement system had to enhance patient safety. Using an incorrectly sized cuff can affect accuracy and cause mistakes.

On a busy ward, with hundreds of measurements being taken every day, attaching tubes and finding the right cuffs placed a considerable strain on staff time. An alternative system was needed to release this time back to caring for patients.

Cost effectiveness was also an important factor in the project, with an initial savings target of seven per cent.

NHS Supply Chain

A cross-functional team was assembled to evaluate the options available. Following agreement on the price per unit, a decision was made at the end of 2014 to go with Welch Allyn. A purchasing route was established through NHS Supply Chain.

The new cuff was easier to fit, use and remove. Patient comfort was significantly improved because of a rotatable port that could be swiftly moved aside during surgery. The product range was also increased, including five sizes for adults, disposable and single-patient use equivalents. The manufacturer also offered to support the launch with an on-site representative.

Product testing

The project group decided to test the new system in February 2015 on the Medical Assessment Unit (MAU), one of the busiest wards in the hospital with a daily turnover of more than 50 patients. Conversion of the MAU’s ten blood pressure devices averaged just one minute per product – around 25 per cent faster than had been anticipated.

The trial was reviewed in March 2015 and received universally positive feedback. Over the next two months more than 2,000 blood pressure devices were equipped with the new fitting.

A full roll out was phased over a number of weeks and based on hospital geography, which minimised disruption and allowed engineers to convert the maximum number of devices in the shortest possible time.

The product supplier supported with a range of internal communications materials including posters and screensaver reminders. Training was also offered to senior nurses, who in turn spent time training other ward staff.

Conclusion

By consolidating purchasing power, it enabled the Trust to find the best solution at a competitive price. Staff time has been released and there are no longer issues with stock management.

Spending on cuffs is anticipated to decrease by 75 per cent – enough to cover half a staff nurse’s salary for each year of implementation.