Push to green—encouraging slow IV push of antibiotics (tazocin, teicoplanin, ceftriazone) in NNUH ED. This project was completed as part of the 2025 Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) Green Team Competition. Implemented the Emergency Department (ED) nursing team.
Team members
Theophilus Kusi Nuamah, Registered Nurse.
Isaiah Onumah, Registered Nurse.
Paul Welander, Ed Matron.
Setting / patent group: Patients requiring IV antibiotics in the ED.
Issue:
There has been a historical preference for bag-based administration of IV antibiotics in the NNUH ED. The 100ml saline bags and infusion sets contributes to increased plastic waste and higher consumable costs. Antibiotics administration via 100 ml infusions can delay treatment due to setup time and prolonged infusion duration. Administration of antibiotics as slow IV push, when clinically appropriate, saves money and offers a timely and efficient way of antibiotic administration.
Aim:
To encourage nurses to choose slow IV push to administer clinically accepted antibiotics (tazocin, ceftriaxone, teicoplanin) instead of via 100 ml saline bag in the ED.
Intervention:
A survey on current practice and staff perceptions in ED was undertaken to identify the scale of the problem, support in planning change and to evaluate social impact. The ED pharmacy team identified antibiotics suitable for slow IV push administration. A one-month educational intervention was devised to encourage administration via slow IV push. Components included:
Posters displayed encouraging slow IV push.
Email communications sent via the ED Education Team.
Verbal reinforcement during shift handovers.
Data was collected to quantify the proportion of antibiotics administered via slow IV push versus saline infusion, along with a post intervention survey to evaluate practice and perceptions.
Outcomes:
Outcomes were measured to identify the sustainable value using the triple bottom line approach.
Clinical Outcomes
Patients continued to receive the medication they required as per national guidance.
Care may be more efficient and timelier in terms of sepsis management as medication is administered quicker.
Clarity of guidance across the team has potential to optimise patient safety.
Environmental Outcomes
The number of push IV doses increased by 1,434 from 1,365 (40%) at baseline to 2,799 (82%) post-intervention.
This equates to a yearly carbon saving 450 kgCO2e, the equivalent of driving 1,325 miles in an average car.
Financial Outcomes
The increase of slow IV push doses provide an average yearly saving of £2,954.
Social Outcomes
69% of staff reported they would choose the most environmentally sustainable method.
48% of staff reported increased confidence in using slow IV push.
42% reported slow IV push increased workflow and 27% reported it delayed it.
Administration time reduced by 25 mins for slow push IV, allowing patients greater mobility (e.g. easier to use the bathroom).
Key learning point
This project has demonstrated that an educational package encouraging slow IV push can reduce the environmental and financial cost of administering IV antibiotics, whilst maintaining safe and effective patient care.
Consulting Medusa and peer support provided reassurance regarding the safety of the slow IV push method.
There is potential to scale up to sister facilities, to provide further savings.
Strong collaboration across multiple teams to ensure clinical safety and sustainability outcomes were achieved, contributed to the project’s success.
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