Extending IV Administration Set Use in the NICU: A One-Year Concurrent Study

2.50
Hdl Handle:
http://hdl.handle.net/10755/148292
Type:
Presentation
Title:
Extending IV Administration Set Use in the NICU: A One-Year Concurrent Study
Abstract:
Extending IV Administration Set Use in the NICU: A One-Year Concurrent Study
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Grieb, Jane
P.I. Institution Name:Keesler Medical Center/81 MDOS/SGOCN
Objective: The purpose of the Neonatal Intensive Care Unit (NICU) implementation project was to evaluate the change in practice from changing intravenous administration sets from every 24 hours to every 72 hours with the expected outcomes that (1) the incidence of infections associated with intravascular devices would decrease, (2) expenditures associated with intravenous administration sets would decrease, and 3) nursing care would be streamlined freeing nurses for other duties. The prevention of infections associated with intravascular devices is complicated in this very vulnerable population by their fragile state and relative difficulty in achieving and maintaining vascular access. Evaluation of this practice change was indicated since newer recommendations to change administration sets every 72 hours (except in certain circumstances) were extrapolated from studies in adult populations or on consensus opinion in the absence of definitive studies (Turner, Rhoton and Donowitz, 1998). Further, IV administration sets represent the single largest line item in the unit’s budget accounting for 15% of the total budget. Design: Evidence Based Practice Implementation Design. Sample: All peripheral, umbilical venous or umbilical arterial, PICC and Broviac intravenous sites in patients admitted to the Neonatal Intensive Care Unit. Setting: 16 bed Neonatal Intensive Care Unit in a 100-bed military medical center. Name of Variables/Concepts: the practice innovation was to evaluate the change in practice of changing intravenous administration sets in neonatal intensive care patients every three days if the fluid is D12.5 or less and maintain daily tubing changes if the fluid is greater than D12.5, blood, blood products or lipid emulsions. The independent variable was the # of IV access days by type of intravascular site and the dependent variables were 1) # of volutrols changes and associated nursing care hours, 2) cost of volutrols and labor and 3) device-regulated bloodstream infection rate. Measures/Instruments: The trigger for the change in practice was knowledge-focused based on National Organizational Guidelines, rather than a problem-focused Trigger. The practice change was reviewed and approved by the NICU medical director (a neonatologist), the infection control committee, and appropriate executive staff and nursing personnel were inserviced on the change of practice. Data is concurrently collected on the impact of the change in practice for one calendar year to account for seasonal differences in census and infection rates. The significant measurement problem was calculating nursing hours. In this setting, there is a combination of military and civilian nurses and nurse managers per se do not budget dollars for staff but whole persons. To calculate labor cost savings it was necessary to undertake time trials of the time it took to change each IV type’s administration set (PIV – 6 min, UVC/UAC – 11 min, PICC – 21 min) and research the cost of military active duty, civil service, and reserve nurses. Findings: Data collection will be completed in April 2001, but as of December 00 for 1712 IV access days: 1) There has been one device related bloodstream infection since 1 April 00; 2) There has been a 55% decrease in the cost of administration sets from the comparable 9-month period in 1999; 3) IV administration sets now account for 6% of the total supply budget versus 15% before the practice change; 4) There has been a 60% decrease in actual labor costs associated with changing IV administration sets; 5) Total cost savings $13,202 in 9 months. Conclusions: Changing intravascular administration sets every 72 hours in Neonatal Intensive Care unit patients for all IV sites/solutions except Dextrose solutions greater than D12.5, blood, blood products, and lipid emulsions is a safe and cost=effective change in practice. Implications: Change of practice in pediatric/neonatal populations is often based on studies in adult populations. This should not preclude changes in practice but they should carefully be monitored and evaluated when undertaken.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleExtending IV Administration Set Use in the NICU: A One-Year Concurrent Studyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/148292-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Extending IV Administration Set Use in the NICU: A One-Year Concurrent Study</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Grieb, Jane</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Keesler Medical Center/81 MDOS/SGOCN</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jane.grieb@keesler.af.mil</td></tr><tr><td colspan="2" class="item-abstract">Objective: The purpose of the Neonatal Intensive Care Unit (NICU) implementation project was to evaluate the change in practice from changing intravenous administration sets from every 24 hours to every 72 hours with the expected outcomes that (1) the incidence of infections associated with intravascular devices would decrease, (2) expenditures associated with intravenous administration sets would decrease, and 3) nursing care would be streamlined freeing nurses for other duties. The prevention of infections associated with intravascular devices is complicated in this very vulnerable population by their fragile state and relative difficulty in achieving and maintaining vascular access. Evaluation of this practice change was indicated since newer recommendations to change administration sets every 72 hours (except in certain circumstances) were extrapolated from studies in adult populations or on consensus opinion in the absence of definitive studies (Turner, Rhoton and Donowitz, 1998). Further, IV administration sets represent the single largest line item in the unit&rsquo;s budget accounting for 15% of the total budget. Design: Evidence Based Practice Implementation Design. Sample: All peripheral, umbilical venous or umbilical arterial, PICC and Broviac intravenous sites in patients admitted to the Neonatal Intensive Care Unit. Setting: 16 bed Neonatal Intensive Care Unit in a 100-bed military medical center. Name of Variables/Concepts: the practice innovation was to evaluate the change in practice of changing intravenous administration sets in neonatal intensive care patients every three days if the fluid is D12.5 or less and maintain daily tubing changes if the fluid is greater than D12.5, blood, blood products or lipid emulsions. The independent variable was the # of IV access days by type of intravascular site and the dependent variables were 1) # of volutrols changes and associated nursing care hours, 2) cost of volutrols and labor and 3) device-regulated bloodstream infection rate. Measures/Instruments: The trigger for the change in practice was knowledge-focused based on National Organizational Guidelines, rather than a problem-focused Trigger. The practice change was reviewed and approved by the NICU medical director (a neonatologist), the infection control committee, and appropriate executive staff and nursing personnel were inserviced on the change of practice. Data is concurrently collected on the impact of the change in practice for one calendar year to account for seasonal differences in census and infection rates. The significant measurement problem was calculating nursing hours. In this setting, there is a combination of military and civilian nurses and nurse managers per se do not budget dollars for staff but whole persons. To calculate labor cost savings it was necessary to undertake time trials of the time it took to change each IV type&rsquo;s administration set (PIV &ndash; 6 min, UVC/UAC &ndash; 11 min, PICC &ndash; 21 min) and research the cost of military active duty, civil service, and reserve nurses. Findings: Data collection will be completed in April 2001, but as of December 00 for 1712 IV access days: 1) There has been one device related bloodstream infection since 1 April 00; 2) There has been a 55% decrease in the cost of administration sets from the comparable 9-month period in 1999; 3) IV administration sets now account for 6% of the total supply budget versus 15% before the practice change; 4) There has been a 60% decrease in actual labor costs associated with changing IV administration sets; 5) Total cost savings $13,202 in 9 months. Conclusions: Changing intravascular administration sets every 72 hours in Neonatal Intensive Care unit patients for all IV sites/solutions except Dextrose solutions greater than D12.5, blood, blood products, and lipid emulsions is a safe and cost=effective change in practice. Implications: Change of practice in pediatric/neonatal populations is often based on studies in adult populations. This should not preclude changes in practice but they should carefully be monitored and evaluated when undertaken.</td></tr></table>en_GB
dc.date.available2011-10-26T09:43:02Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:43:02Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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