Intravascular Therapy Process Improvement in a Multi-Hospital System

2.50
Hdl Handle:
http://hdl.handle.net/10755/150439
Type:
Presentation
Title:
Intravascular Therapy Process Improvement in a Multi-Hospital System
Abstract:
Intravascular Therapy Process Improvement in a Multi-Hospital System
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Painter, Julie
P.I. Institution Name:Community Hospitals Indianapolis
Litigation and hospital claims related to intravenous therapy are increasing across the nation. Concerns come at a time when nursing schools are eliminating the subject from curricula, when hospitals across the nation are eliminating specialty intravascular teams, and the occurrence of the largest nursing shortage in history. At this four-hospital system the Quality Resource Department and marketing had noted an increase in complaints, concerns, and questions related to intravascular therapy. Prevalence data related to practice outcomes showed a lack of compliance with policy. As well as newly hired nursing staff often shared that what was taught in the orientation class was not what was occurring in practice when they went to the units for their hands on experiences. Practice within intravascular therapy should be reliant upon national standards and recommendations that have been developed such as those from the Intravenous Nursing Society(INS), Oncology Nursing Society(ONS); and the CDC(Centers for Disease Control). Although standards for practice and care exist, one must not assume that the standards are utilized, adhered to, or even taught. Competency related to such standards is often a result of frequency of performing the procedure or process. Questions arose related to the standards, specifically “how would a nurse become competent in intravascular care without formalized instruction?” And “how should healthcare organizations prepare all nursing personnel with the basic competencies related to intravascular care?” and “Are we as a network delivering quality patient care related to intravascular care?” These questions were the impetus for process improvement related to intravascular care. Previous improvements included: continuing education for nursing related to intravascular care; improved documentation forms; improvement in nursing policies(less policies, more simplistic, and easier to use); and alterations in products utilized for intravenous care(dressings, preparations, labels, etc). Improvement efforts then turned to focus on the nurse entering the network as a new employee. A team of nursing education staff, clinical nurse specialists, and the director of nursing education met over a period of twelve months to discuss education related to intravascular therapy. The process improvement included review of current data from orientation, current practice data, and implementation of improvements, and outcome measurements. Review of the current intravenous orientation process showed that nurses were offered one of two options. One option was a two (2) hour class for those with satisfactory skills, which felt that they required minimal training. The second option was an eight (8) hour class for those who required more information to develop their skills. Nurses self selected to one of the subgroups for intravenous orientation by completing a self-assessment related to their knowledge, previous training, and hands on experience. The self-assessment gathered information related to years of experience vs. new graduate. The data from self-assessment was collated and found to be very interesting. Surprisingly the data revealed that many nurses rated themselves as competent in intravascular skills, even though they had not had any training in school, and minimal hands-on experience. Other data such as the course pre-test and post-test revealed that even nurses with numerous years of experience often did not know the correct response to basic questions related to assessment, positive pressure flushing of lines, and blood transfusion. Other data revealed that nurses did not come with critical thinking skills related to the appropriate venous access device selection for various patient populations. The process improvement team developed a core curriculum for all nurses in orientation related to intravenous therapy and to eliminate the two options. The curriculum became an eight- (8) hour day with consistent didactic content and hands on experience. The team developed all didactic content with PowerPoint overheads, storyboards, and handouts. Every educator or CNS who taught the intravenous course would be required to use the same handouts and content. Revisions were made on the self-assessment tool and the pre and posttest. By all nurses attending the same course, it could be assured that all nurses were given correct information related to the expected standard to which they would be held accountable. The course emphasizes critical decision making and the use of an intravenous device decision tree as guidance. Each nurse has hands-on experiences in the classroom with the opportunity for further clinical hands-on time as deemed appropriate. Clinical outcomes are measured by ongoing prevalence data related to patient care assessments, documentation, and overall intravenous care. Current data reveals that there a 90% compliance rate with documentation, labeling, and assessment of IV’s. Data related to the number of central lines placed and the rationale for usage is reviewed on a monthly basis. The data related to central lines is helpful in the review of critical thinking and decision making. Data regarding self-assessment and the pre and posttest data for the orientation course is compiled and reviewed after every orientation course. Financial outcomes include the consideration of the increased cost of nursing orientation time (from 2-hour course to an 8-hour course) to the outcomes of patient care. Financial outcomes are also linked to patient complaints and litigation. Since the inception of the intravenous process improvement there have been no claims filed related to intravascular therapy. Customer satisfaction data is reviewed on a monthly basis; patient satisfaction is greatly improved. Data related to patient satisfaction is reviewed monthly and specific unit data is used to target educational efforts. Lessons learned are that a consistent format, overheads, and handouts have greatly improved the intravenous orientation class reducing variability by instructor. Also that monthly review of data regarding the self-assessments and the pre and posttest data allows the course instructors to focus on key areas in future classes. Ongoing data collection and constant re-education is necessary regardless of how orientation is done. Frequent assessment and feedback on each patient care area and ongoing education is needed to assist in the prevention of slipping back into old, comfortable habits. Also that no matter how many resources are in place for nurses such as policies, decision trees, and other things, some nurses will not use them. We must look at creative ways to assist nurses in these hectic times to use the resources and information that would behoove them and their patients. Next steps will include ongoing bimonthly meetings of the instructors to review data and make adjustments to the class curriculum; ongoing data collection related to outcomes; unit education; and assessment of future process improvements needed.
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.titleIntravascular Therapy Process Improvement in a Multi-Hospital Systemen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150439-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Intravascular Therapy Process Improvement in a Multi-Hospital System</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">Painter, Julie</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Community Hospitals Indianapolis</td></tr><tr><td colspan="2" class="item-abstract">Litigation and hospital claims related to intravenous therapy are increasing across the nation. Concerns come at a time when nursing schools are eliminating the subject from curricula, when hospitals across the nation are eliminating specialty intravascular teams, and the occurrence of the largest nursing shortage in history. At this four-hospital system the Quality Resource Department and marketing had noted an increase in complaints, concerns, and questions related to intravascular therapy. Prevalence data related to practice outcomes showed a lack of compliance with policy. As well as newly hired nursing staff often shared that what was taught in the orientation class was not what was occurring in practice when they went to the units for their hands on experiences. Practice within intravascular therapy should be reliant upon national standards and recommendations that have been developed such as those from the Intravenous Nursing Society(INS), Oncology Nursing Society(ONS); and the CDC(Centers for Disease Control). Although standards for practice and care exist, one must not assume that the standards are utilized, adhered to, or even taught. Competency related to such standards is often a result of frequency of performing the procedure or process. Questions arose related to the standards, specifically &ldquo;how would a nurse become competent in intravascular care without formalized instruction?&rdquo; And &ldquo;how should healthcare organizations prepare all nursing personnel with the basic competencies related to intravascular care?&rdquo; and &ldquo;Are we as a network delivering quality patient care related to intravascular care?&rdquo; These questions were the impetus for process improvement related to intravascular care. Previous improvements included: continuing education for nursing related to intravascular care; improved documentation forms; improvement in nursing policies(less policies, more simplistic, and easier to use); and alterations in products utilized for intravenous care(dressings, preparations, labels, etc). Improvement efforts then turned to focus on the nurse entering the network as a new employee. A team of nursing education staff, clinical nurse specialists, and the director of nursing education met over a period of twelve months to discuss education related to intravascular therapy. The process improvement included review of current data from orientation, current practice data, and implementation of improvements, and outcome measurements. Review of the current intravenous orientation process showed that nurses were offered one of two options. One option was a two (2) hour class for those with satisfactory skills, which felt that they required minimal training. The second option was an eight (8) hour class for those who required more information to develop their skills. Nurses self selected to one of the subgroups for intravenous orientation by completing a self-assessment related to their knowledge, previous training, and hands on experience. The self-assessment gathered information related to years of experience vs. new graduate. The data from self-assessment was collated and found to be very interesting. Surprisingly the data revealed that many nurses rated themselves as competent in intravascular skills, even though they had not had any training in school, and minimal hands-on experience. Other data such as the course pre-test and post-test revealed that even nurses with numerous years of experience often did not know the correct response to basic questions related to assessment, positive pressure flushing of lines, and blood transfusion. Other data revealed that nurses did not come with critical thinking skills related to the appropriate venous access device selection for various patient populations. The process improvement team developed a core curriculum for all nurses in orientation related to intravenous therapy and to eliminate the two options. The curriculum became an eight- (8) hour day with consistent didactic content and hands on experience. The team developed all didactic content with PowerPoint overheads, storyboards, and handouts. Every educator or CNS who taught the intravenous course would be required to use the same handouts and content. Revisions were made on the self-assessment tool and the pre and posttest. By all nurses attending the same course, it could be assured that all nurses were given correct information related to the expected standard to which they would be held accountable. The course emphasizes critical decision making and the use of an intravenous device decision tree as guidance. Each nurse has hands-on experiences in the classroom with the opportunity for further clinical hands-on time as deemed appropriate. Clinical outcomes are measured by ongoing prevalence data related to patient care assessments, documentation, and overall intravenous care. Current data reveals that there a 90% compliance rate with documentation, labeling, and assessment of IV&rsquo;s. Data related to the number of central lines placed and the rationale for usage is reviewed on a monthly basis. The data related to central lines is helpful in the review of critical thinking and decision making. Data regarding self-assessment and the pre and posttest data for the orientation course is compiled and reviewed after every orientation course. Financial outcomes include the consideration of the increased cost of nursing orientation time (from 2-hour course to an 8-hour course) to the outcomes of patient care. Financial outcomes are also linked to patient complaints and litigation. Since the inception of the intravenous process improvement there have been no claims filed related to intravascular therapy. Customer satisfaction data is reviewed on a monthly basis; patient satisfaction is greatly improved. Data related to patient satisfaction is reviewed monthly and specific unit data is used to target educational efforts. Lessons learned are that a consistent format, overheads, and handouts have greatly improved the intravenous orientation class reducing variability by instructor. Also that monthly review of data regarding the self-assessments and the pre and posttest data allows the course instructors to focus on key areas in future classes. Ongoing data collection and constant re-education is necessary regardless of how orientation is done. Frequent assessment and feedback on each patient care area and ongoing education is needed to assist in the prevention of slipping back into old, comfortable habits. Also that no matter how many resources are in place for nurses such as policies, decision trees, and other things, some nurses will not use them. We must look at creative ways to assist nurses in these hectic times to use the resources and information that would behoove them and their patients. Next steps will include ongoing bimonthly meetings of the instructors to review data and make adjustments to the class curriculum; ongoing data collection related to outcomes; unit education; and assessment of future process improvements needed.</td></tr></table>en_GB
dc.date.available2011-10-26T10:24:31Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T10:24:31Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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