Lean Project: Arterial Line Access

Donna DeGennaro RN, MSN, CRNI, CUPI, BCVA Director of Infusion Services

Patient

Our Mission

• “To provide the best patient experience with the best staff”

Contents • Introduction—Identify the problem

• Complications---Why it is a problem

• Solution----What can be done to correct the problem.

Lean Goals Toward Arterial Lines

• To organize and implement a process that is precise with providing best patient care in a structural manner when inserting a arterial line.

• To be consistence utilizing a evidence base data collection process with concise step-by-step instructions for all proficient staff members.

• To establish better productivity that requires less time, less space, is cost efficient and increase patient safety and satisfaction.

Implementing Poka-Yoke

• Definition- Poka-yoke is a mechanism used to avoid making simple mistakes .

• Implement Poka-yoke by decreasing the opportunity for a stressful situation to occur- this can be done by having readily easy accessible adequate supplies available within a arterial line procedure.

• (not having the appropriate supplies when starting a procedure can increase stress which can increase the risk for a mistake to happen.

Before Lean

• Staff had no organization with supplies.

• (different staff members were using different types of apparatus for a arterial line.)

Before Lean • Supplies were kept in multiple areas and/or in

different areas per location.

Before Lean

• Staff spent wasted time searching for supplies

• Average of 15 minutes per procedure

Before Lean

• There was no consistency with initiating arterial lines.

• Best evidence data was not routinely being practice---due to the lack of readily available supplies.

Spaghetti Diagram

• Grey: Office • Purple: Patient Rooms • Light Blue: Storage • Light Orange: Desks • Dark Blue: Nourishment

Closet • Medium Blue:

Lunch/Break Room • Pink: Supply Room • Orange: Pyxis Room

• Before Diagram – Travel Multiple

Locations

– Time Consuming

Implemented Lean by Utilizing the 5 “S”

• Sort------Supplies organized in identical containers with the same supplies and check list.

• Simplify---Designated placement for the container to be located in the same area of each location.

• Sweep----Supplies are easily accessible, accountable and organized using the kanban calculations. ( The kanban would identify activity and material replenishment.) (after each procedure, restock and locked)

• Standardized---Policy and protocol created, utilize same supplies for each time.

• Sustain—Maintain discipline with restocking and following protocol.

Kanban Method

• Allows for quality control

• Give immediate access to supplies

• Quantity from procedure

Implementing Lean

• Purchase arterial line containers

• Consistent- Stock each container with the same supplies in the same spot.

• Designated an area for each container in a specific area and marked for easy identification.

• Created policy with a step-by-step protocol to follow on initiating an arterial line access.

• Educated all stakeholders involved of the new system.

• Establish a additional system for replenishing supplies used and charge appropriately.

Spaghetti Diagram

• Grey: Office • Purple: Patient Rooms • Light Blue: Storage • Light Orange: Desks • Dark Blue: Nourishment

Closet • Medium Blue:

Lunch/Break Room • Pink: Supply Room • Orange: Pyxis Room

• After Diagram – Travel One

Location

– Reduced MUDA

Accomplishments

• MUDA (eliminated waste) – Unnecessary motion—saved 12 minutes per

procedure/at 50/per month = 120 hrs annually

– Standardized supplies- decrease in expenses and stock room by designing a “procedure packet”

– Organized container-Same supplies in each container—Decrease staff stress level

– Color coding (Easy identifiable)

– Arranged designated area for container (layout design)

• Supplies are organized in a easy identifiable container. • Supply containers are located in specific designated

area. (same area of different location). • Supplies are in one location minimizing multiple steps,

eliminating wasted time. Time decreased down to less than 3 minutes!

• Savings: 12mins x 50 pro/per mo. x 12mo. / 60mins=120hrs annually at an average of $25.00/hr = $3,000.00 annually.

• Method is consistence with protocol. • Decreased risk toward patient and staff safety.

After Lean

Arterial Line Set-Up Kit!