Changing behaviors through education to improve patient outcomes associated with vascular access devices

Transcription

1 Changing behaviors through education to improve patient outcomes associated with vascular access devices Fiona Fullerton Clinical Nurse Consultant Vascular Access Surveillance Princess Alexandra Hospital, Brisbane

2 Vascular Access Surveillance Team (VAST) Established in late 2012 Goal is to prevent or minimise HCA infections related to vascular access devices Surveillance activities Advice for vascular access device management Interdisciplinary education and training Evaluation and coordination of initiatives and strategies Evaluation and implementation of vascular access devices and related products Research Assistance with difficult peripheral access

3 Changing behaviours to improve outcomes Multimodal program Reviewed local data and assessed risk Target peripheral IV cannulation Standardise education, training and practice Surveillance Auditing and real-time feedback to areas Benefits of digital hospital surveillance Using surveillance as an education opportunity

4 Education Our first opportunity PIVC Inequity in training and education across all disciplines Nurses had a structured training and assessment program for many years Would medical officers be open to having a nurse teach and assess them How would we provide this to 100 new interns in an already busy orientation week How would we capture other medical officers at different levels new to the hospital Needed to standardise practice, training and assessments

5 How Support of passionate Infectious Diseases Physicians and Medical Education Unit We had to prove ourselves 2013: building relationships, updating procedures and resources, offering drop in sessions for medical officers, support with difficult access 2014: negotiated time in the intern orientation program for PIVC simulated training, offered support in the clinical areas, undertook a survey Simulated training each intern rotated through 3 stations One on one cannulation Phlebotomy Infection control principles and hand hygiene

6 Intern Survey Results 80% wanted Qld Health to provide PIVC training and support to medical students How did you practice as a medical student? 69% learnt by see one do one 77% practiced on patients 80% practiced on a training arm first 34% practiced on another medical student 65% stated that they manage to locate a vein and often succeeded when cannulating 12% can locate a vein but are often not successful 31% admitted to re-palpating the insertion site after antisepsis 20% said that they remove the finger off their glove

7 Great feedback became embedded into annual orientation program and hospital procedure Mandatory assessment monitored by VAST and MEU We still had a high risk gap medical students

8 Medical Students Inexperienced Often cannulated without supervision, putting themselves and the patient at risk Curriculum: learn beginning of 2 nd year but don t cannulate to 3 rd year Pilot group 2014 to assess resources needed Changed hospital procedure students are not to cannulate until they have completed training and assessment with VAST Wrote to uni and worked with them to establish a program

9 Student program 5 rotations a year (20 to 100 students per rotation) Utilise same resources as hospital staff Undertake: face to face simulated training and assessment Minimum 2 clinical sign offs with VAST Feedback positive Practical advice Supportive environment Support when first cannulating real patients Part of their normal curriculum since January 2015

10 Education package, video, quiz Simulated training Clinical assessment (by an approved endorsed assessor or Nurse Educator) Standardised practice - No matter who you are (nursing, interns, house officers, medical students)

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12 How do we know it works? QA process Observe practice when in the wards (all HCW categories) and record in database Provide feedback at the time Intervene if there is a patient safety risk or document the PIVC as being inserted in an emergency situation and remove within 24 hours if AT breached Aseptic technique auditing Don t be afraid to: Mark as not yet competent during training Instruct HCW to return for further training and assessment if observed post sign off Write to their Line Manager and MEU (word gets around)

13 Results 8 months post training Demonstrated retained knowledge of Process and equipment Skin preparation Documentation Observation revealed poor compliance with: Hand hygiene Use of PPE

14 Surveillance Activities Investigation of BSI associated with VAD Preventable factors Hospital wide quarterly audits (snapshot) Real-time feedback audits to reduce the percentage of redundant PIVC Digital hospital surveillance of patients Pre-digital era no way of knowing which patients in the hospital had an IV device Only patients we could follow were post ICU as they have had a digital system for many years

15 Digital surveillance Jan 2016 Report of all patients through ED (flagging interhospital transfers) Jan 2017 iemr report (excel format) Track every patient with an IV device including details of dwell times, complications etc Allowing targeted interventions Sept 2017 dashboard Allow us to: Identify patients that need an intervention Flag and work with Clinicians Visit the high risk patients Every interaction is an education opportunity

16 Results post interhospital transfer surveillance

17 Hospital wide IV audits Undertaken quarterly on all inpatients in every unit (excluding ICU) Conversations with the bedside staff Traffic light report to areas including checklist Now also receive benchmarking of their results over time and against hospital results Clinical units take ownership of results

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19 Redundant PIVC put patients at risk Used our hospital wide IV audit data Identified that medical areas had a high percentage of redundant cannulas Initiative Worked with advanced trainee ID Registrar Met with both medical and nursing staff in areas Literature review posters and stickers not always successful Implemented auditing with real-time feedback Multiple conversations - Changed behaviours

20 Percentage redundant PIVC by audit

21 RESULTS OF CHANGE

22 As at 1/11/17 Flow on effect, decrease

23 Inpatient PIVC Associated Bloodstream Infection (BSI) as at 1/11/17 IV starter kit introduction VAST established Interhospital transfer cannula surveillance iemr report surveillance implemented Intern cannulation credentialing Medical students and JHO cannulation training International medical graduates

24 Vascular Access Outcomes Successfully complete therapy Reduced complications including infections Reduced number of venepunctures per patient Patient satisfaction Reduce exposure to blood borne pathogens