This case study features in the NHS Innovation Accelerator’s year three research report, Understanding how and why the NHS adopts innovation.
The Non-Injectable Arterial Connector (NIC) is a low-cost, simple device that stops wrong-route drug administration, reduces arterial line-related infections, and prevents blood loss during sampling. The NIC is a needle free arterial connector. Unlike standard connectors, it has a one-way valve safety feature built into it. This safety feature allows clinical staff to use the NIC as per normal clinical practice but if they attempt to wrongly give medication via the arterial line, the clinician is prevented from doing so by the safety feature.
Adoption of the NIC requires minimal staff training and is a direct replacement for Standard Arterial Connectors (SACs.)
Chelsea and Westminster NHS FT (CWNHS FT) Clinical Nurse specialists had become aware of the NIC both through journal articles whilst researching how to improve intensive care units (ICU) and from conference attendance and it was at this point that CWNHS FT decided to trial the innovation.
Decision to adopt
Seeing the patient safety benefits of the NIC and the fact that the ITT meant it was free, the lead nurses at CWNHS FT made the decision to adopt it. Once the decision was made, the order for the NIC was made directly by the department. As this fell within the ICU’s budget control, a procurement process was not required.
There was then a simple trial where the NIC was used within the ICU as a direct replacement of the regularly-used SAC. To begin with, the ICU ordered a few weeks supply of the NIC to understand how staff reacted to it and to identify any major barriers to usage.
Training on how to use the NIC was delivered by the Marketing Director from the NIC’s distribution company. Recognising how busy the unit is and the pattern of shifts, he knew it would not be possible to train every nurse in one session. The Marketing Director therefore visited the unit several times and trained nursing staff individually, whenever they had time to spare to be trained.
Roll out in the ICU
As feedback from staff was positive and there were no identified barriers for use, the ICU committed to ordering the NIC over the long term. The team has indicated that it will continue to use the NIC once the ITT funding ceases because of the safety benefits it delivers, despite the slightly higher cost of the device compared to the SAC.
Nursing-led decision making: Senior nurse leadership made the decision to adopt the NIC – an innovation that they primarily use in ICU. They did not need to be convinced to use it by another staff group and provided the leadership for junior nursing staff to adopt the NIC into routine practice.
Flexible, accommodating training: Training was implemented in a highly flexible way to ensure every member of staff was shown how to use the NIC at a time that suited them. This involved on-the-ward rapid training sessions and all-day ‘drop in’ training. As training can be delivered in 5-10 minutes, it was not a significant challenge to adoption.
Ease of purchase: The ITT raised the profile of the NIC and removed the issue of finance, meaning the ICU could adopt the NIC with ease and within the budget controls of the department. The innovation could also be purchased from within the department budgets without the need to undergo a procurement process and this helped with ease of adoption.
Ease of use: The simplicity of the NIC and that the fact that it is a direct replacement for the SAC meant it did not require a change in practice, and was therefore relatively easy to implement.
An analysis of the NIC by the York Health Economic Consortium provided evidence of the following benefits: comparative cost to the standard device, elimination of bacterial contamination in the NIC, elimination of introduction of medication into the arterial line, reduction in time to take blood samples, and reduction in the need to replace the connector. The estimated costs of wrong route drug administration ranged from £57 to £10,174 and were reported as happening twice per month across the whole NHS. The value of preventing ‘never events’ is likely to exceed these estimates in both financial and reputational damage.
The case for preventing clinical incidents, even if many of the barriers to adoption are removed or lowered, can be difficult to pursue if the incident is considered rare or not recognised as an issue by an organisation. Providing a convincing evidence-base in relation to effectiveness, cost-effectiveness, and ease of implementation is important – but even then, it may not be enough.
Clinical networks with their in-depth understanding of high pressure work environments, like ICUs, can play an important role in bringing innovations to the attention of staff and organisations. The NIC did not enter CWNHS FT through the procurement chain or through a single channel; it required concerted effort across multiple organisations to raise the profile and engage with the right parties.
1. Chris Chaney, Chief Executive, CW Plus
2. Elaine Manderson, Clinical Nurse Specialist, CWNHS FT
3. Maryanne Mariyaselvam, Innovator, NIA Fellow
4. Gedd McGonell, Marketing Director, Amdel Medical
5. Gezz Zwanberg, Nurse and Project Lead, NWLCCN