UGPIV Practices: Are they jeopardizing patient safety?

A new continuing education program details how a lack of standardized policies related to ultrasound-guided peripheral IV (UGPIV) catheter insertions can negatively impact patient safety. The webinar also suggests UGPIV performance improvement initiatives that “can help to create a culture of safety across the healthcare continuum,” according to presenter Nancy Moureau, RN, PhD, an internationally recognized expert and consultant in vascular access and CEO of PICC Excellence.

The on-demand webcast, Patient Safety and Ultrasound-Guided Peripheral IV Placement: The Need for Standardized Practices, offers 1 contact hour of continuing education for nurses. It is sponsored by Parker Laboratories.

“While the use of ultrasound guidance to improve success during PIV catheter placements is becoming more common, suboptimal aseptic technique and variations in supply usage poses a very serious risk to patients,” said Dr. Moureau. “To increase safety during UGPIV insertions, healthcare organizations should adopt a multidisciplinary approach to standardize policies and procedures based on current evidence and recommendations, while at the same identifying opportunities for pragmatic, incremental improvements.”

In the 60-minute webcast, Dr. Moureau provides an overview of common safety concerns and presents methods to improve patient safety through the application of standardized policies, training and competency assessment for UGPIV procedures. In addition, she discusses current guidelines and recommendations for application of aseptic technique, device disinfection, probe protection and gel usage.

Dr. Moureau also discusses her recent survey of vascular access and emergency department clinicians, published in the September issue of Journal of the Association for Vascular Access, which revealed significant levels of variation in UGPIV practices and supply use across hospitals and alternate care settings. The survey results confirmed that variations in UGPIV practices occur in a number of areas, including the handling of contamination sources, ultrasound probe protection, and gel use and cleanup. 

To work towards greater standardization, Dr. Moureau says facilities should assess their existing ultrasound use and practices, with emphasis on ultrasound disinfection practices, use of sterile probe covers and sterile gel, and other core infection control recommendations. 

PIV insertion is the most commonly performed invasive medical procedure among hospitalized patients. Over 70 percent of acute care patients require IV access at some point during their stay, and up to 60 percent of those patients may be considered to have difficult vascular access (DiVA). These patients frequently require ultrasound guidance in order to successfully achieve peripheral access and receive necessary treatments. 

The use of ultrasound may increase the risk of contamination during PIV insertions if certain guidelines are not followed to maintain a sterile insertion site and use the appropriate supplies (gel and transducer protection). According to Dr. Moureau, a specialty gel-free insertion dressing that separates the transducer and gel from the insertion site (UltraDrape, Parker Labs) may address and even mitigate many of these issues while reducing the cost of performing UGPIV insertions.

Dr. Moureau’s program is the latest in a series of continuing education webinars on infection prevention in vascular access from Healthcare Hygiene Magazine. The publication also recently issued a special edition on vascular access-related infection prevention imperatives, which featured an article on the importance of improving UGPIV patient safety

“We know we can improve UGPIV patient safety with standardized procedures, quality training, and monitoring compliance,” Dr. Moureau says in the article. “The time has come to decide what these best practices are and implement them consistently across all departments.”

How Vascular Access Clinicians Can Help Hospitals Avoid Infection Penalties

Leslie Schultz
Leslie Schultz

At the recent annual meeting of the Association for Vascular Access (AVA), speaker Leslie Schultz, Director of the Safety Institute at Premier, Inc., introduced a provocative idea. Vascular access professionals, she said, can help their employers avoid the substantial financial penalties they face for high rates of central-line-associated bloodstream infections (CLABSIs).

Schultz was referring to the substantial penalties mandated by the Affordable Care Act (ACA), popularly known as Obamacare. The ACA tries to improve healthcare and lower costs by penalizing hospitals that trail most of their peers in preventing infections.

Schultz has a keen sense of the contributions nurses can make to minimizing a hospital’s CRBSI rate. In addition to her role at Premier, she is an RN as well as a Ph.D. Premier’s Safety Institute offers free information, tools, and resources to advance patient safety.

Before diving into how vascular access professionals can leverage their expertise to reduce CRBSIs and the associated penalties, here’s some crucial background. Continue reading “How Vascular Access Clinicians Can Help Hospitals Avoid Infection Penalties”

What Does Healthcare Transformation Mean for Risk Managers?

Susan Carr, editor of Patient Safety & Quality Healthcare, does a good job on the PSQH blog of beginning to answer questions about healthcare risk managers and the transformation of care. Carr discusses comments by futurist Ian Morrison at the annual conference of the American Society for Healthcare Risk Management.

Morrison says the Affordable Care Act isn’t the only factor shaping the changing world of healthcare risk managers. Other influences —consolidation, cost reduction, and realignment of risk—are also crucial.

Morrison’s key issues as outlined in Carr’s article:

1. ) Implementation of the Affordable Care Act and expansion of healthcare coverage to previously uninsured individuals. We may be heading toward two Americas, represented by Texas and California. The difference? The first is one of about half of the states that have refused to expand Medicaid. California, in comparision, has embraced the ACA and expanded Medicaid.

2.) Growth of the individual consumer market in which people have to make many more choices about details of their health insurance: “Morrison believes that individuals’ awareness of the narrow provider networks that come with ‘cheap’ plans is a ‘shoe still to drop.’ “

3.) Realignment of risk. Morrison foresees a country of “100 to 200 large regional systems of care across the country that assume risk on a population basis.”

4.) The changing business model for hospitals and health systems. That means more price pressure, along with an emphasis on value-based purchasing. “Morrison believes this shift ultimately means that hospitals will go from being in the business of filling beds to the business of emptying beds” – while trying to remain financially viable.

5.) Implementing and sustaining a culture of low risk and high quality is critical, and we’re not there yet. It will, he said “make the difference between life and death, between affordability or not.”

More from Carr’s article here.

 

Patient Safety and Educating IV Nurses

As nurses have more demands placed on them to ensure patient safety, effective tools for educating nurses become increasingly important.

After all, how can we expect nurses to handle sophisticated technology in the most effective way, if we don’t do a good job of teaching them and involving them in the learning process?

One new tool for that educational process, when it comes to vascular access and infusion therapy, is an infographic recently presented as a scientific poster at the annual conference of the Association of Professionals in Infection Control and Epidemiology (APIC).

You can view a brief video about the infographic — which features a disinfection cap for protecting needleless IV connectors from contamination — on the PICC Excellence website of presenter Nancy Moureau, RN, BSN, CRNI, CPUI, here.

Study Shows Promise of Disinfection Cap as Weapon in the War on Infections

For years, efforts to reduce central-line associated bloodstream infection (CLABSI) rates have focused on relatively complex initiatives – including “bundles” of evidence-based practices and technologies that together create multi-layered protection against infections. Now, the early results of a prospective, peer-reviewed clinical trial suggest that the use of a simple but ingeniously designed device can contribute to improved disinfection and allow for reduced CLABSIs.

That device – SwabCap® by Excelsior Medical – is also known as a disinfection cap. SwabCap supplements manual disinfection of IV connectors, long thought to be a weak point in CLABSI prevention because the method is subject to variation and noncompliance. The study results were recently reported at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).

Early results of the prospective, peer-reviewed clinical trial demonstrated that SwabCap® improved disinfection and allowed for reduced central-line associated bloodstream infection rates of more than 79%. Those improvements were seen in the four-hospital NorthShore University HealthSystem (Evanston, Ill.) after SwabCap was implemented for use on all central lines.

Notably, the gains were made even though the hospitals already had a low rate CLABSI rate of 1.95 per 1,000 catheter days before SwabCap was tried.

NorthShore also studied the device’s effectiveness a second way: it compared the density of colony-forming units (CFUs) of bacteria in blood samples when SwabCap was used to CFUs in samples when it wasn’t. During the SwabCap phase of the research, contaminated samples were 75% less dense with bacteria.

The new data is the most extensive ever gathered on SwabCap. The device is in use at multiple institutions, sometimes allowing for a drop in infection rates that is even more dramatic than at NorthShore. More at http://www.swabcap.com.

IV Connectors: Younger Nurses May Be More Diligent Cleaners

We often think of young people as rebels and their elders as better at following rules. But the opposite is true in American hospitals, a new study says – at least when it comes to disinfecting IV connectors.

Recent graduates of nursing school were more likely “to consistently use optimal disinfection techniques” than were more experienced nurses, according the study, in the May-June issue of the Journal of Infusion Nursing,.

The research examined whether younger or more experienced nurses adhered more closely to the “scrub-the-hub” manual method for disinfecting connectors. The method requires nurses to scrub the connector hubs with alcohol for up to 10-15 seconds and then wait up an additional 30 seconds for the alcohol to dry before accessing the line.

This protocol is widely recommended by infection control experts, but it must be performed meticulously to have any chance of being effective. The method’s several steps mean that variation is common, and busy nurses are known to sometimes skip disinfection altogether. The consequences of variation or noncompliance are great because incomplete disinfection increases the risk for sometimes deadly central line-associated bloodstream infections (CLABSIs).

The study found that nurses just out of school were more likely to perform the protocol exactly as it was taught – a good thing. The more experienced nurses, conversely, rated higher than younger nurses in such qualities as autonomy and “self-efficacy” (essentially, belief in one’s own competence). One can assume from this that more experienced nurses felt more free to stray from the protocol – not a great idea in this case and one that put patients in danger.

The findings may point toward one reason hospitals should be using a disinfection cap such as SwabCap® to supplement manual disinfection. SwabCap, from our client Excelsior Medical, is ingeniously designed to eliminate variation and noncompliance.

By prolonging the hub’s contact with alcohol, it may also increase the bacteria kill over manual methods, especially when compliance with the manual method is not optimal.

Considering what’s at stake, it seems to us that using the cap is a no-brainer – even if a nurse just graduated magna cum laude.

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Patient Safety and Cloud Computing

There are loads of advantages to cloud-based sharing of medical data, but bottom-line, it’s about patient safety, says radiologist Murray Reicher, M.D.

Writing in the latest issue of Patient Safety & Quality Healthcare (“Riding the Cloud to Improve Patient Safety,” November/December 2010), Reicher says that sharing data via the cloud makes it possible to move information much faster than old methods. This can save patients from unnecessary procedures and radiation – and in emergency cases, potential injury from delayed treatment. (Full article at http://psqh.com/novemberdecember-2010/684-information-exchange.html.)

Dr. Reicher is the founder and chairman of DR Systems, which created eMix, one of the first of the new cloud-based medical information sharing services. He’s also a practicing radiologist.

In the article, Dr. Reicher describes a number of common scenarios that can harm patients because the conventional ways of sharing data – such as burning files to CDs and sending them by express mail – are too slow and clumsy. For instance, if doctors assigned to an emergency patient need to see a prior CT scan from another facility before starting treatment, the patient’s condition could worsen while they wait. In other circumstances, facilities might re-image a patient whose files can’t be obtained in time, which exposes the patient to extra radiation.

Cloud-based data-sharing such as eMix addresses all these situations because it moves data quickly on the Internet, which also overcomes the hurdle of incompatible, proprietary IT systems at different facilities. It is also secure, trackable, and affordable because it is priced on a low, per-use basis without any software or hardware purchase. It is versatile, too. Besides medical institutions, the files can be pushed to patients’ computers, doctors offices, and other remote locations.

“The limitation is no longer the technology itself but simply the speed of adoption,” Reicher writes. The rest of the business world is catching on – 20 million businesses and more than a billion people use cloud-based services, he says, citing a Microsoft claim. His gentle nudge to his own industry: Get with the program!

Full article — http://psqh.com/novemberdecember-2010/684-information-exchange.html.