CNS as project manager of vascular access team
Topic of Interest
Quality Initiatives
Capture Value of the CNS
Interprofessional Collaboration
Abstract
The role of the CNS is multidimensional lending itself to project management. To effectively manage a project you need to recognize the micro and macro system effects, which relate to the patients, nurses, and leadership when developing a new nursing team. The development of our hospital vascular access team (VAT) began at our Associate Vice President level who then developed a task force with a vascular access staff nurse and myself, the CNS. As the CNS, I oversaw all training and orientation developed, mentorship for leadership in the staff nurse, as well as the footwork of in servicing with the product company and VAT nurses. To ensure buy in there was multidisciplinary teamwork with physicians and APPs and numerous presentations to leaders across the hospital.
In 2018, our medical center identified an increase in patient length of stay (LOS) related to increased wait time for placement of an appropriate vascular access device (VAD). LOS is historically attributed to an increase in hospital-acquired infections (HAI) and increased mortality rates1. Increased LOS also results in less available beds for other patients especially during times of peak hospital census. Avoidable days totaled 70 avoidable business days over July 2018-October 2018
In addition to LOS, each peripherally inserted central catheter (PICC) placement performed with fluoroscopy in Interventional Radiology (IR) resulted in radiation exposure for the patient. Leading to unnecessary radiation exposure for PICC patients. VAT uses ECG tip confirmation for placement to improve patient safety and decrease radiation exposure compared to IR. Additionally, patients who returned with dislodged or malfunctioning lines had to wait for IR services availability to replace line.
Central Line Associated Blood Stream Infection (CLABSI) rate was higher than the desired goal at medical center during fiscal year (FY) 2019, with the targeted goal of a CLABSI Standardized Infection Ratio (SIR) of 0.74.
Per the Infusion Nurses Society “a designated infusion team decreases infusion related complications and related costs and increases patient satisfaction”2. In an attempt to improve patient safety, decrease CLABSI and LOS we created the VAT.
Since creation, the VAT has also started daily rounding on their lines utilizing standard work practices created by a VAT nurse and CNS to ensure care and maintenance is meeting the most current evidenced based practices. This also provides the bedside nurse an opportunity to follow up on any questions, concerns, or learning opportunities with a VAT RN to improve their patients care and outcomes.
For FY 2020 the VAT consulted 1,382 patients, placed 1,003 lines, has had an overall success rate of 96.9%, decreased overall radiation exposure by 88.7% as well as has attributed to zero avoidable LOS days. The medical center also successfully decreased their SIR for FY 2020 even in the wake of COVID-19 pandemic.
- Weiss AJ, Elixhauser A. Overview of Hospital Stays in the United States, 2012: Statistical Brief #180. 2014 Oct. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK259100/
- Infusion Nurses Society,. (2016). Policies and procedures for infusion therapy.
- Gorski L, Hadaway L, Hagle, ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. J Infus Nurs. 2016; 39 (suppl 1): S1-S159.
- Girgenti, Constance & Moureau, Nancy. (2013). The Need for Comparative Data in Vascular Access: The Rationale and Design of the PICC Registry. Journal of the Association for Vascular Access. 18. 219–224. 10.1016/j.java.2013.07.003.