A gap analysis and identification of practice and procedural variation , with the goal of establishing standard processes to integrate guidelines , is a necessary part of determining which practices have the greatest risk . resulting in confusion among clinicians about the most appropriate instructions to use for clamping , changing , and disinfecting . In her 2010 and 2011 publications on needleless connectors , Hadaway noted that there are many different devices with differing internal and external designs , causing much confusion within facilities . Her survey showed that 24 percent of respondents were not taught , did not have a standard method for clamping , or did not know the type of needleless connector used by their facility . Of that subgroup , 65 percent said their facility consistently used the same connector .
By standardizing with one brand of needleless connector , staff confusion is reduced and a higher level of consistency is achieved for correct use with disinfecting , flushing , drawing blood cultures , clamping , and replacing connectors . The choice of products often is made amidst pressure from buying consortiums and compliance with the aim of driving down price . These choices may result in use of lower-quality products and poor consistency in practices , with patients paying the ultimate price . Choice of products should be evidence-driven with thought given to standardization throughout facilities .
Standardization promotes patient safety by reducing variability , increasing consistency , and reducing risk . A gap analysis and identification of practice and procedural variation , with the goal of establishing standard processes to integrate guidelines , is a necessary part of determining which practices have the greatest risk . Research indicates that relatively few U . S . healthcare facilities have established a standardized process for maintaining aseptic technique during ultrasound-guided PIV ( UGPIV ) insertions . In a recent survey by the author on UGPIVs , more than 1,000 clinicians reported their common practices and supplies used with the procedure . From the survey responses , it was apparent that many clinicians were unclear about methods for protecting the transducer probe and what supplies to use . Respondents often said that they “ sometimes used one item and other times used another .” The research revealed significant levels of variation in the UGPIV procedure with application of proper aseptic technique , even between departments within the same hospital .
While policies and procedures , along with training , are instituted before clinicians can qualify to perform these UGPIV procedures , little follow-up guidance or observation of compliance is evident . On-the-job training , see one do one teach one , activities also are part of the UGPIV process of learning and are totally lacking in consistency from department to department . Accountability is not required , and patients suffer from the learning curve of UGPIV insertions and multiple attempts to gain successful catheter placement . Ensuring that all staff behave and perform consistently at the highest level of
• care is challenging , but with every example of standardization , the levels of quality increase , risk and inefficiency are reduced , and quality control is elevated . This guarantees that processes minimizing those crucial elements or steps of quality are not overlooked . According to David Mann , “ It is easier to manage a process than a behavior .”
The variability of clinician behavior may reflect their drive to complete tasks quickly , with supplies on hand , and to move quickly to the next patient . While this may be an oversimplification , and one hard to validate , the UGPIV study of supply usage demonstrates the inconsistencies present in this procedure . The inconsistencies manifest in healthcare , with patient reports of many IV attempts , increasing costs associated with supply usage , ineffective training , lack of oversight to verify competency , and waste in many procedures .
The Lean healthcare standard work approach to healthcare , coupled with a Six Sigma systematic evaluation process , can be used to identify areas of waste and apply methods of improvement . In the 2019 study by Steere and associates , they applied a five-component bundle , termed the PIV5Rights Approach , with standard work to reduce waste associated with peripheral catheter insertions . The results of this study were a significant increase in successful insertions by a trained team using ultrasound , longer catheters , anti-reflux needleless connectors , and antimicrobial dressings . They demonstrated longer dwell time , with one catheter used through the completion of therapy in 89 percent of cases . The annual savings reflected in this quality initiative exceeded $ 2 million . A similar approach was used by Morrell and associates for performance improvement , with institution of a policy that integrated catheters would be inserted by a specialized team and site assessments would be performed . Similar results were achieved with fewer attempts , longer dwell time , and annual savings of almost $ 200,000 . When quality is an issue during highly invasive procedures such as IV catheter insertions , the result is higher risk and cost . By establishing standardized processes and procedures within a specialized team , these risks are reduced , waste is minimized , and as a result , cost savings are achieved .
Work and staff activities can be further standardized by establishment of consistent processes for education and training . As discussed in previous columns , improved outcomes for patients are evidence of the value of consistent education . Education and training for clinicians reduces the likelihood that quality elements of procedures are not overlooked . Integrating standardization within training policies and requirements sets a level at which staff must qualify and maintain competency for these high-risk procedures . Establishing training criteria and benchmarks for achievement , with
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