ICU not wasting

St Vincent’s Hospital Sydney (SVHS) is a busy 350 bed, adult principal referral and tertiary public teaching hospital. The hospital’s 20-bed intensive care unit (ICU) caters to a range of specialties, including adult heart and lung transplantation for NSW. Between April 2022 and April 2023, there were 1489 ICU admissions, of which 208 were patients with a multidrug-resistant organism (MRO).

MRO patients are nursed in an individual bay with a bedside trolley that contains 330 consumables when stocked per the restock checklist. These consumables include essential and emergency products that are used in the delivery of patient care during bedside procedures and are primarily packaged in single-use plastics. Single use plastics serve a fundamental purpose within health care settings, including known sterility of consumables along with convenience of use. However, research shows that plastics can release harmful toxins into the environment, impacting on community health.¹ Due to the nature of the care provided, evidence suggests that activity within the ICU carries some of the highest carbon footprint within all of health care.²

Establishing environmentally sustainable clinical practice

An initial spot audit found that the trolleys were overstocked 100% of the time, and that when a patient with an MRO was discharged, the majority of the unused stock was being discarded as waste. Further investigation identified a culture of chronic incorrect and overstocking of the bedside trolleys, as well as no standard stock management process.

As per the hospital infection control policy, many of the unused clinical products must be discarded upon discharge of a patient with an MRO depending on the type of product packaging. The aim of this project was to reduce the amount of unnecessary waste being generated, and in turn, increase staff and patient satisfaction regarding environmentally sustainable practices, reducing the costs associated with product loss and waste disposal, as well reducing the ICU’s carbon footprint.

Reducing waste through co-design

Diagnostic research was undertaken using a variety of methods including patient and staff surveys, observational audits, focus groups, process mapping sessions, informal and formal staff interactions and data collection from hospital systems. The project team deliberately engaged with ICU staff to ensure co-design of the solutions.

A consensus of required consumables and quantities was established via an anonymous staff survey. This was then tested over four weeks, on four trial trolleys, on patients with various clinical needs, to establish correct stock levels. The refined restock list was then colour coded to clearly outline what items to keep or discard. This solution has been implemented and will be reviewed in six months following further audits. In collaboration with the Infection Prevention & Control team and the ICU nursing staff, an MRO cleaning matrix was developed and printed on the reverse side of the restock list as well as staff identification flip cards. This tool acts as a reference guide for staff to ensure they are using the appropriate cleaning solution for the various MROs and assists with the reduction of waste when used in conjunction the restock list. This solution has been implemented.

Reconfiguration of the trolleys has been abandoned however labelling of consumable names and quantities is currently being implemented. A checklist has been developed in collaboration with ICU management to ensure visibility and accountability when a bedside trolley has been prepared for a new patient admission. This solution is still in the initial stages of implementation.

View this project's poster from the Centre for Healthcare Redesign graduation May 2024.

References