Patients hate needles.
This basic fact makes IV therapy a pressing healthcare issue affecting nearly every specialty, according to Lee Steere, RN, CRNI, VA-BC, Manager of IV Therapy Services at Hartford Hospital – especially when you consider that nearly 90 percent of hospitalized patients will require a peripheral IV (PIV) catheter at some point during their stay.
In the United States, PIV failure rates average around 53%, meaning one out of every two catheters fail to last until the end of treatment. This could be the reason that needle sticks are among the top ten patient fears, according to a national survey of hospitalized patients.
“Patients seeking care at healthcare facilities receive too many needle sticks,” Steere said. “My passion is to achieve the goal of one PIV per patient which entails getting an IV inserted on the first attempt and lasting until the prescribed treatment is complete.”
For the last several years, Steere and his team at the 867-bed acute care teaching hospital located in Hartford, CT, have worked to make that goal a reality. They implemented a standardized set of best practices for inserting PIV catheters, known as the PIV5Rights™ Bundle, and published data showing the positive clinical and economic impact of this approach.
As a result of their remarkable work, the IV Therapy Services team was named Hartford Hospital’s 2019 Clinical Team of the Year. They were chosen from a group of 27 teams by a committee comprised of local community leaders, which Steere said was “truly an honor.”
“Lee and his team were especially deserving of this recognition for their innovative work to improve IV care at the bedside,” said Cheryl Ficara, the hospital’s Regional VP of Patient Care Services. “They did extensive research on the topic to bring evidence based care to the bedside, with this best practice bundle. Lee and his team demonstrated their commitment and dedication to improving patient care and outcomes.”
The Beginning
Starting in 2015, Steere and his team began researching and conducting systematic reviews to identify the most common reasons for PIV failure. Their findings included infiltration, phlebitis, occlusion, infection and accidental dislodgement. A key feature of the PIV5Rights bundle is having the insertions performed by a dedicated vascular access specialty team (VAST), as opposed to a generalist clinician.
“IV insertion is both an art and a science, and it needs to be in the hands of clinicians who have a thorough understanding of all aspects of vascular access and how they can affect patient safety,” said Steere. “Along with best-in-class technologies, this expertise is crucial to improving PIV success rates.”
Components of the PIV5Rights Bundle include:
● Right Proficiency – Use of a trained VAST for PIV insertions.
● Right Insertion – Correct insertion, including the use of ultrasound when necessary.
● Right Vein & Catheter – Placing a longer peripheral catheter in the forearm, avoiding areas of flexion.
● 5 Supplies/Technology – An IV start kit, CHG/alcohol prep (Becton Dickinson, Chloraprep™), 22g 1.75” catheter (BBraun, Introcan™ Safety), anti-reflux needleless connector (Nexus, TKO™) and a CHX antimicrobial bordered securement dressing (entrotech life sciences, PrevahexCHX™).
● Right Assessment and Care – Standardized care and management of PIVs, including photo documentation of assessment 1-2 times daily.
Show Me the Data
To justify this new approach to IV therapy, Steere knew hospital management would need to see hard data. They conducted a multi-modal comparator study of 125 patients in one hospital unit from November 2016 through February 2018 to compare outcomes for a patient whose IVs were inserted with the standard-of-care materials and procedures to those who received the bundled approach.
While Steere expected to see positive outcomes, the results far exceeded his expectations. Published in the Journal for the Association of Vascular Access (JAVA), the study found that PIV5Rights was associated with higher insertion success, longer dwell times with fewer complications, greater patient satisfaction and significantly reduced IV therapy costs.
According to the results, 96% of the IVs inserted with the bundled approach were inserted successfully the first time, and 89% lasted until the end of treatment. Compared to the control group, the PIV5Rights catheters lasted three times as long and had a significant decrease in complications, including zero catheter occlusions. In addition, the study calculated a projected cost savings of $2.9 million as a result of using the PIV5Rights Bundle due to the dramatic reduction in the total number of insertions and catheters used.
As a result of the study’s success and financial savings, Hartford Hospital nearly tripled the size of its IV Therapy Services team, going from seven to 23 employees from 2015 to 2019.
“The PIV5Rights Bundle is now a vital part of patient care at Hartford Hospital proving to be the safest and best intervention for our patients,” said Ficara.
What’s Next?
The next step in transforming IV therapy is to conduct the study in other facilities to ensure the success of the bundled approach can be replicated across various clinical environments. Steere plans to repeat the study on a different medical-surgical unit at Hartford Hospital in May 2020, and three other institutions (a small community hospital, a mid-sized hospital and a large tertiary facility) are in the process of implementing the same study.
“If the study yields similar results observed at Hartford Hospital, it could lead to significant changes for the future of IV therapy,” said Steere.