patient satisfaction. Needlesticks
hurt and are remembered. We have
seen patients crying due to previous
admission pokes. Many others believe
this must change, too. Peripheral IVs
are beginning to generate interest
related to safety concerns; ECRI Institute
has designated IV starts as one of its
top 10 patient safety concerns. It is a
problem and we cannot keep looking
away from this issue.
Constance Girgenti, BSN, RN, VA-BC, and Sheri Pieroni, BSN, RN, VA-BC
HHM How did your advocacy efforts get started?
Girgenti and Pieroni (G&P): Sheri and I were at
work and saw the American Nurses Association (ANA) Hill
Day and thought it would be a good opportunity to learn
about lobbying. Once we booked our flight and registered,
we agreed that we needed to bring the message about the
need for vascular access specialists in every hospital and
how this would impact safe staffing. Clinicians are called
to other floors and away from their patients to help start
peripheral IVs for other clinicians, leaving their patients
with other nurses. This practice reduces patient safety by
having to many patients for one clinician to oversee. We
also know the benefits of Lean Six Sigma in having those
that master a technique have better outcomes, save money
and reduce complications. After exploring “how to lobby”
we discovered how to get a Bill to congress with the use of
a petition. We found “We the People,” where you need to
get 100,000 signatures. We knew it was a lofty goal, but
where optimistic. In the end, we got 1,000 signatures, far
from the goal but we learned a lot about what we needed
to do in the future.
HHM Why is it so very crucial to get a specialist/
specialty team in every hospital?
G&P: First, we are in no way suggesting that bedside
nurses should not assess and try to start an IV if they have
had training and competency and see or palpate the vein.
The issue we are faced with today is that vascular access is
not a part of most nursing schools’ curricula. Nursing today is
not nursing of the 1960s and 1970s. Second is the fact that
our patients today have a higher comorbidity and mortality
rate than ever before. Today, we read, hear and see patients
that are poked multiple times in an admission. This not only
leads to the increased risk of infection, venous depletion,
product waste, and nurse time, but delays care and impacts
www.healthcarehygienemagazine.com • february 2020
HHM This is an ambitious con-
cept –what’s the clinical and fiscal
business case to be made to a
potentially skeptical hospital
leadership?
G&P: There are hospitals today
that have explored business side of
having a vascular access team (VAT)
and have seen the cost saving. I don’t
think hospital leadership looks into
this problem, and so, if you don’t look
there is no problem, right? If CEOs or
CNOs walked the halls and talked to
the families and patients, they would
see and understand the problem. The fi-
nancial impact includes reduced length
of stay, reduction of catheter-associated
bloodstream infections, product waste
and improved workflow to mention a
few. If it is required to start reporting
all vascular access devices as a source
of bloodstream infections, hospitals
will have an even bigger problem with
getting to zero BSI than with central
catheters alone.
Peripheral IVs
are beginning
to generate
interest
related
to safety
concerns; ECRI
Institute has
designated IV
starts as one
of its
top 10
patient safety
concerns.
HHM What is your sense of how
well a specialist/specialty team would
be embraced by other clinicians?
G&P: When you talk to hospitals
that have teams, they love them. A
VAT saves a nurse time instead of
spending 30 to 45 minutes to “try” for
an IV. You can read on nurse forums
about the struggles that nurses face.
The VAS advocates for and places the
right device based on the medications,
duration of therapy and assessment.
Instead of completing a task, and then
after failed IV attempts and failed dwell
time, decide the patient would benefit
from a more advanced device, such as
a midline, PICC or CVC.
33