“Use of the NIC is considered to be dominant in health economics terms, as it delivers improved patient outcomes at reduced cost.”
Anna Crispe, independent health economist

Overview

NICThis simple medical device, developed by NHS clinicians and NHS Innovation Accelerator (NIA) Fellow Dr Maryanne Mariyaselvam, stops medication being accidentally given into the arterial line that is used to monitor patients in ICUs and operating theatres. It also prevents arterial line infections, prevents accidental blood spillages during sampling and protects both patients and staff.

A wrong-route drug administration error can cost from £57 for a near miss to over £10,000 in the most serious cases, which results in the patient requiring an amputation.

The NIC is a needle free arterial connector, but unlike standard connectors, it has a one-way valve safety feature built into it. This safety feature allows clinical staff to use the NIC normally but prevents them wrongly giving medication via the arterial line.

The NIC won the 2015 Association of Anaesthetists of Great Britain and Ireland Innovation in Anaesthesia Award and the National Patient Safety and Care Award, 2012

As an NIA Fellow, Maryanne has increased the number of trusts using the NIC from five to 14 and is now building national and international momentum.

Challenge / problem identified

Arterial lines are used to monitor blood pressure and take blood samples in patients admitted to critical care and those requiring major operations, but they carry risks.

If medication is accidentally and wrongly administered through the arterial line, patients can suffer serious harm, such as damage to their hand which can lead to patients requiring amputations.

Colour coding, re-education and re-training alone are not enough to prevent this error and fail-safe solutions are required. A simulation study, where junior doctors working in ICU were asked to urgently administer medication to a ‘patient’, showed that 66% wrongly and accidentally used the arterial line – many did not realise they had made a mistake. Incidence data reported to the NHS National Reporting and Learning System suggests this error occurs on average twice a month in the NHS. This is likely to be an underestimate.

Standard arterial lines also carry the risk of infection, which is a serious issue in ICU, but this is eliminated by the one-way valve safety feature of the NIC.

Actions taken

The Non-Injectable Arterial Connector (NIC) is a low-cost, simple device to prevent wrong-route drug administration, arterial line-related infections and accidental blood spillage during sampling. The NIC is a needle free arterial connector, however unlike standard connectors, it has a one-way valve safety feature built into it, effectively stopping drug administration and bacterial colonisation.

The project is led by Dr Maryanne Mariyaselvam (a clinical research fellow at the Queen Elizabeth Hospital, Kings Lynn and Addenbrooke’s University Hospital, Cambridge). Supported by the Eastern Academic Health Science Network (EAHSN), Maryanne led a detailed six-month implementation programme in 11 trusts across the region. This was supplemented by an evaluation by independent health economist, Anna Crispe.

Through the NIA Maryanne has engaged with hospitals through the anaesthetic and critical care doctors, nurses and operating department practitioners. It has also allowed her to:

  • Publish papers and present at major safety conferences
  • Engage national leaders as advocates for patient safety

Impacts / outcomes

The six-month study saw the NIC adopted by 11 trusts and used in 79% (2,881) of all cases requiring arterial lines. A follow-up survey of >250 NHS ICU and anaesthetic staff showed that:

  • 28% had seen adverse events where standard arterial connectors were used and 93% believed these events would have been avoided with the NIC
  • 98% believe it is important to have a device like the NIC
  • 81% wished to use the NIC once the study was complete

The study, which was made possible by the partnership with EAHSN, included a health economic evaluation which showed that:NIC

  • The NIC is easier and quicker to use than standard connectors
  • The NIC stays on the arterial line for the lifetime of the line (and does not have be changed with each blood sample). In equipment costs alone, using the NIC saves £285 per trust per year

The cost of adverse incidents from wrong-route drug administration incidents ranges from £57 for a near miss to over £10,000 when incidents occur, including the need for an amputation. A national survey showed a national incidence of around 9% for wrong route drug administration using arterial lines in ICUs, with 28.5% of participating ICUs reporting incidents in the past five years. Using the NIC could eradicate this error from the NHS.

The NIC won a 2012 National Patient Safety and Care Award and the 2015 Association of Anaesthetists of Great Britain and Ireland Innovation in Anaesthesia, Critical Care and Pain Award.

“Excellent idea (NIC), feel confident this would benefit my family, myself and the NHS.”
Patient feedback, East of England Citizens’ Senate, 2015

Plans for the future

Maryanne is working with NIA towards the nationwide adoption of NIC. This involves co-ordinating recommendations through the AHSNs, with NHS England, professional bodies and patient safety groups.
The NIC meets the specification of the new 2017/18 NHS Innovation and Technology Tariff, and has been free to procure from 1 April 2017, from NHS England.

Which national clinical or policy priorities does this example address?

  • Funding and efficiency
  • Health and wellbeing
  • Care and Quality

Start and end dates

December 2013 – ongoing

Contact for help and advice

Dr Maryanne Mariyaselvam
NHS Clinician, NHS Innovation Accelerator (NIA) Fellow
E: maryannemariyaselvam@gmail.com
W: www.KLIPSuk.com

Rebekah Tailor
Communications and Engagement Manager, NHS Innovation Accelerator
E: rebekah.tailor@uclpartners.com