Staff development and competency assessments may have suffered due to staffing and patient care prioritization , but it is time to re-establish those core expectations , remembering that after initial competency is obtained ongoing recompetency is based on identified needs .
If outcomes have deteriorated , it is time to evaluate why .” teams , along with infection prevention in many facilities have struggled to fully implement many of the recommendations while managing the seemingly more pressing needs of daily patient care . This was emphasized in a survey presented at the 2022 Infusion Nursing Society annual conference in June in which core recommendations on topics such as vessel visualization technology for difficult venous access patients , use of securement methods for peripheral IVs ( PIVC ) in addition to the primary dressing , formal implementation of the Aseptic Non-touch Technique ( ANTT ) framework , avoidance of PICC usage for patients at risk of developing or with confirmed chronic kidney injury , limiting the dwell time of temporary , non-cuffed , non-tunneled hemodialysis catheters , and pain management for PIVC insertion for adults were among the recommendations implemented at less than 70 percent of settings in a global survey conducted more than 18 months after the Standards of Practice were published . This could be an indicator of need for more critical review of implementation of evidence-based practices . The Compendium was more recently updated but the same critical evaluation of implementation could be useful as facilities prioritize responses to sustained increased in adverse patient outcome .
Any conversation with staff reflecting on their bedside experience will bring up frustration not just with staffing but with supply chain struggles . Of course , the need to ration personal protective equipment in the early months and the reality of shortages or complete lack of availability at times of the very basics of gowns , gloves , and adequate respiratory protection made headlines and resulted in CDC developing a framework for conservation and tracking of “ burn rates ” but these were far from the only disruptions experienced by staff . Other basic tools like the germicides used for maintaining patient rooms ( at a time when clinical staff were also providing most of the environmental services role in COVID rooms ) were also challenging to obtain in some areas , and alcohol-based handrubs – both key parts of adequate infection prevention strategies in hospitals . Throughout the months ( and years now ) healthcare facilities felt the impact across skin preparations , catheters , flush syringes , dressings , medications and at some point almost every product which touches a patient . Patient-care procedures needed to shift at times to accommodate the quick changes to whatever could be obtained which was another challenge . Carefully thought out “ bundles ” could not always contain the products the frontline staff and clinical leaders brought in based on high levels of evidence and instead needed to do the best we could with whatever could be obtained .
Another reality is that some of the workarounds that were put in place during the most acute phases of the pandemic are going to take conscious effort to re-baseline . Bedside practices which pulled staff away from direct site visualization and palpation of sites with frequency based on medications and patient status , thorough documentation and even decisions regarding pump locations distant from the bedside need to return to their pre-pandemic baseline best practice . Staff development and competency assessments may have suffered due to staffing and patient care prioritization , but it is time to re-establish those core expectations , remembering that after initial competency is obtained ongoing re-competency is based on identified needs . If outcomes have deteriorated , it is time to evaluate why . Education is not always the underlying need but if staff have not had the opportunity to participate in professional development it may be a strong component of the solution , when coupled with accountability both for care given and for the institution to ensure staff receive the supplies and staffing they need to provide safe care . A final thought is navigating the new staff joining the workforce . Nursing , in particular , is providing a group of clinicians who received an education unlike any generation of nurses before them . Collectively we need to support them and understand any gaps that resulted from the non-traditional approached and reduced clinical exposure that recent years necessitated .
The impact on our patients , our institutions and our staff will linger long after our surge units have been decommissioned . Acknowledging the continued impact and working together to provide the best possible solutions , despite limitations is how we will move forward .
Michelle DeVries , MPH , CIC , VA-BC , FAPIC , has been involved in infection prevention and hospital epidemiology for more than 25 years , with a career spanning community , university and federal healthcare systems . With a background in hospital and molecular epidemiology , her focus has been at the intersection of vascular access , patient safety and infection prevention . She is the incoming president-elect for the Association for Vascular Access ( AVA ) and a senior adjunct research fellow with the Alliance for Vascular Access Teaching and Research .
Nancy Scott , NP , ACNS-BC , CIC , VA-BC , PCCN , CNRN , has practiced as a clinical nurse specialist ( CNS ) and infection preventionist ( IP ) for the past 14 years in community and academic acute-care healthcare settings , as well as served 25 years in critical care . As a CNS , an IP , professor , and a direct-care provider , Scott has had the opportunity to work with students , frontline staff , interdisciplinary teams , patients , and organizations to address patient safety and quality care . She currently serves on the board of directors for a local AVA network .