Infection Control Today

AUG 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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20 ICT August 2018 www.infectioncontroltoday.com I nfusion teams — whose members are highly skilled in the placement, maintenance and removal of all types of lines — perform a critical service in the acute-care environment, yet as a cost center, they are being scrutinized in an era of cost-cutting. In its whitepaper, Infusion Teams in Acute Care Hospitals: Call for a Business Approach (Hadaway and Dalton, et al. 2014), the Infusion Nurses Society (INS) reminds us that demonstrating the value of these teams is essential for continued, long-term viability of such a program. As INS explains, "Vascular access teams are small groups of skilled experts who focus only on the insertion of PICCs and are now beginning to insert other types of CVADs. CVAD insertion is an important aspect of patient care and is now associated with improved outcomes related to ultrasound for venipuncture and electrocardiogram for tip locations. Nevertheless, the insertion procedure represents only a short time frame in the life of that VAD. Successful and safe completion of infusion therapy requires much more than a successful insertion procedure. Infusion teams, commonly known as IV teams or IV therapy teams, have a wider scope of service. These teams are involved with safe insertion of all types of VADs, as well as serving as the resource for other infusion-related services. The role of change agent is a prominent one for infusion nurses through staff development and performance improvement." The benefits of an infusion team are weighed equally in the increased comfort and safety of patients, and the cost savings to the healthcare institution. As Hadaway and Dalton, et al. (2014) remind us, "Peripheral catheter insertion requires skills derived from experience to minimize patient discomfort and complications, decrease risk of needlestick injury and blood exposure, and enhance patient satisfaction. A recent literature Infusion Teams: Demonstrating Value to Ensure Continued Viability review reported frst venipuncture attempt success rates between 74 percent and 88 percent in the general population and 46 percent to 76 percent in pediatric patients. Unsuccessful or failed venipuncture attempts are caused by numerous factors. Venous depletion, vein wasting, and vein preservation are concepts gaining attention as a means to increase appropriate use of peripheral veins and reduce the need for central vascular access devices (CVADs). Excessive venipuncture attempts also increase the cost to the facility through delays in treatment; waste of peripheral catheters, insertion kits, individual supplies, and valuable nursing time; and the need for central venous access when peripheral access proves too diffcult. The cost of inserting a short peripheral catheter on the frst attempt using one catheter, kit, fush syringe, needleless connector, and 20 minutes of nursing time is reported to be $45. Multiple unsuccessful attempts only increase these non-reimbursed costs." The discouraging trend is that many hospitals have either disbanded infusion teams or downsized these teams to perform only insertions of peripherally inserted central catheters (PICCs); however, INS says there is no known method to quantify the actual number of infusion teams that have been lost: "The outcomes of disbanding or downsizing infusion teams are virtually unknown. A 1998 editorial used details of lawsuits to highlight the serious complications that can occur when nursing staff lack adequate knowledge and skills associated with infusion therapy. Another report provided details of how an infusion team transitioned from 11 nurses to two in a 200-bed acute care facility over a nine-month period using a methodical, planned approach. Positive and negative outcomes were discussed; however, no data were provided. Another study focusing on the quality improvement process reported an increase in infusion- Vascular access insertion teams are small groups of skilled experts who focus only on the insertion of PICCs and are now beginning to insert other types of CVADs. Ò By Kelly M. Pyrek cover story

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