Authors: (including presenting author): :
Ng TYD(1), Wong KY(1)
Affiliation: :
(1)Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital
Keyword 1: :
Neonatal care
Keyword 3: :
Central line
Keyword 5: :
Standardisation
Introduction: :
Central line insertion, a common, standard procedure in NICU, often requires effective and prompt preparation during emergencies. Meanwhile, disorganized trolleys with extra, unnecessary items often leads to increased non-value-added time during procedure preparation with risk of delayed therapies and staff frustration. Baseline audit shown preparation time for central line insertion of around 10 minutes, this warrants the initiation of a workgroup for re-organizing a standardized central line trolley. The 5 Ss methodology utilized (Sort, Set in Order, Shine, Standardize, Sustain) helps create an efficient, systematic working environment, which is also in line with LEAN methodology, emphasizing on continuous improvement for higher efficiency, effectiveness and elimination of waste including time and extra processing.
Objectives: :
1. Reduce time used in equipment gathering for central line insertion 2. Increase precision in medical supplies usage, reduce waste 3. Increase staff confidence and efficiency in assisting the procedure
Methodology: :
Direct observations during pre-post intervention (1 month after re-organization) period were done. Time required in each of the 12 trials (2 staff from each of the 3 experience group using convenience sampling, identical staff in both period) to gather equipment for central line insertion was recorded. Trolley re-organization was done as follows: - Medical items were sorted (removing all unnecessary, excessive supplies), arranged in optimal place and order for easy selection with clear labelling. - Trolley inspection was done regularly by ward in-charge according to pre-set checklist. HCA were being updated on new setup of trolley and were responsible for routine trolley cleansing and supplies filling to a set quantity. - Labels and photos as visual controls were used for clear illustration for maintaining the trolley. - Comments from medical and nursing staff were sought consistently, followed by necessary modification. Online evaluation survey was conducted one year later among nurses in NICU, composing of 5-Point Likert scale questions, assessing satisfaction, confidence on trolley utilization.
Result & Outcome: :
1. Mean time preparation time for central line insertion was reduced by 6 minutes (63.2%), from 9.5 minutes to 3.5 minutes (p=0.000011). 2. Online evaluation survey (48 respondents) revealed 47.9% of staff strongly agreed that the new central line trolley can improve their efficiency at work, whereas 50% of them rated “Agree”. 3. Mean confidence level to prepare for central line insertion was 4.5/5 post intervention.
