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Smoothing the Way for Central Venous Access Device Insertions: Reducing road-bumps for cancer patients

St Vincent's Hospital
Project Added:
4 May 2015
Last updated:
18 May 2015

Smoothing the Way for Central Venous Access Device Insertions: Reducing road-bumps for cancer patients

Summary

Approximately 50 Central Venous Access Devices (CVADs) are inserted per month by CVAD Procedural Clinical Nurse Consultants (CNCs) at SVH. By implementing small-scale changes within the hospital, St Vincent’s Hospital (SVH) has been able to reduce the usual incident rate for CVAD patient bookings from one in five at the beginning of 2014, to one in 20 by the end of the year. 

Aim

To reduce delays, cancellations and other inconveniences for patients and staff, as well as incidents for patients admitted for insertion of CVAD at SVH by the end of 2014.

Benefits

Patient benefits

  • Reduced number of health professionals contacting patients.
  • Reduced number of unnecessary trips for patients, particularly those from rural and regional areas, with greater consideration for family logistics.
  • Reduced cancellations and delays for patients.
  • Reduced inconvenience and anxiety for patients.

Staff benefits

  • Greater clarification of roles.
  • More certain workload allocation with reduced delays or cancellations.

Department benefits

Greater understanding and respect between the Admissions Office, Day Procedure Centre, Operating Theatre, Hematology and Oncology Day Unit, ward staff and other areas such as the Cytotoxic Pharmacy.

Project Status

Project status: Sustained - the project has been implemented and is sustained in standard business.

Project completion date: November 2014. 

Background

Since the establishment of The Kinghorn Cancer Centre in late 2012, there has been an increase in delays, patient incidents and resourcing for staff responsible for CVAD insertions at SVH.

On review of these issues, the following problems were identified:

  • the new cancer centre was in a different physical location to the main hospital and staff had interrupted work flows
  • patients were often admitted and the insertion procedure cancelled, or admitted and the procedure was delayed, resulting in delayed treatment
  • patients often arrived without a procedure booking
  • documents such as admission forms, patient consent forms and a paper diary often went missing
  • the late referral process was not clear, resulting in further delays and omissions.

CVAD Procedural CNCs and Haematology/Oncology CNCs raised concerns in early 2014 around the challenges faced by staff and patients in booking processes, delays, cancellations and other incidents for CVAD procedures. At this time, there was an incident rate of approximately one in five in patients booked for a CVAD procedure at SVH.

Implementation

  • Stakeholders were brought together to develop a greater understanding of the significant number of departments involved in progressing a patient through the system for a CVAD procedure.
  • Clearer processes were mapped for routine and late bookings.
  • Better access to operating theatre information technology systems was provided by CVAD CNCs.
  • An additional paper diary was eliminated.
  • Agreement about who cancels a booking and who communicates with patients was defined.
  • Liaison took place with the reformed SVH Lines Committee, regarding overall monitoring.

Results

As a result of this project, incident rates are monitored by CVAD and Hematology/Oncology CNCs and have been reduced from one in five CVAD bookings in late 2014, to around one in 20 by the end of the year. Implementation of clinical governance for this project is now managed by:

  • a revamped and reconstituted SVH Lines Committee
  • the Cancer Program Clinical Governance Committee
  • the Patient Safety & Quality Committee.

Lessons Learnt

  • Importance of getting to the right people and ensuring that stakeholders across departments are engaged from the start.
  • Understanding of routine processes and roles. For example, it was realised that Haematology/Oncology CNCs were not aware of the cut-off for submissions of late bookings for urgent cases, which is a regular need.
  • Importance of returning to the process map to ensure that staff have not found ways to change instructions they do not like or are finding solutions for a small problem without considering the overall impact on the project.
  • Importance of good communication and adding value to other services. For example, a new pre-admissions clinic was established at the same time as this project was implemented, resulting in opportunities to share key learnings.

Contact

Gabrielle Prest
Medicine Clinical Stream Manager
St Vincent’s Hospital
St Vincent’s Health Network Sydney
Phone: 02 9355 5610
Email: gabrielle.prest@svha.org.au

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