CHANGING INFUSION PRACTICE GENERATES SIGNIFICANT EFFICIENCIES IN NURSING TIME AND RESOURCE USAGE IN PAEDIATRIC INTENSIVE CARE

2016 ◽  
Vol 101 (9) ◽  
pp. e2.16-e2
Author(s):  
Adam Sutherland ◽  
Liz Jemmett ◽  
Rachael Barber
Keyword(s):  
Patient Care ◽  
Improve Patient Safety ◽  
Control Policy ◽  
Central Line ◽  
Nursing Time ◽  
Fixed Concentration ◽  
Infusion Devices ◽  
One Year ◽  
Time Required ◽  
The Impact

IntroductionInfusion preparation in British PICUs uses the Rule of Six (ROS) which was developed for administration without infusion devices. This method is inaccurate.1 Regulators recommend standardised approaches to IV infusions to improve patient safety and quality of care.2 Administration set changes also have an association with resource use and central line infections.3 We report the impact of fixed concentration infusions and reduced administration set changes on nursing time and infusion equipment cost.MethodsMorphine and midazolam infusions were standardised in September 2014. Direct observation of infusion preparation was carried out beforeand after the introduction of fixed-concentration (FC) infusions to quantify the nursing time required to prepare infusions. Administration was prospectively documented using purposive sampling until a population-representative sample for age and weight was obtained (1 month). This data was then scaled up to predict activity over one year. Syringe use and administration set use was calculated. Reducing frequency of administration set changes to 72 hrs in accordance with infection control policy was then calculated retrospectively.ResultsIt takes 40 minutes (2 nurses×20 minutes) to prepare ROS syringes and 30 minutes (2 nurses×15 minutes) for FC syringes.In total ROS infusions required 2433 hrs of nursing time to prepare. FC infusions reduced this time by 25% (608 hrs) releasing 0.5 WTE nursing time back to patient care.Mean duration of IV sedation in these patients was 100 hrs. The cost associated with replacing administration sets with each syringe was £16,060. By changing every 72 hrs, this cost is reduced to £4,400 – a cost saving of £11,660.ConclusionsFC syringes are more efficient than ROS. FC preparations have released 0.5 WTE nurses back to patient care. Changing administration sets 72 hrly realises significant cost efficiencies.

scholarly journals 1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S420-S420
Author(s):  
Katherine Linsenmeyer ◽  
Kalpana Gupta ◽  
Suzanne Mosesso ◽  
Christine House ◽  
Judith Strymish
Keyword(s):  
Improve Patient Safety ◽  
Point Of Care ◽  
Central Line ◽  
Appropriateness Criteria ◽  
Post Intervention ◽  
Before And After ◽  
Quasi Experimental ◽  
One Year ◽  
The One ◽  
The Impact

Abstract Background Nearly 40% of all peripherally inserted central catheter (PICC) placements may be inappropriate. Validated appropriateness criteria (Michigan Appropriateness Guide for Intravenous Catheters or MAGIC) were developed to improve patient safety and decrease adverse events from PICC line use. Recent studies have demonstrated the impact of MAGIC implementation with success but involve multimodal interventions that may not be sustainable. We evaluated the effect of a nursing-driven MAGIC-derived triage tool online utilization. Methods We conducted a quasi-experimental before and after study evaluating the effect of a MAGIC-derived triage tool including all patients for whom a PICC consult was ordered. The triage tool was implemented January 1, 2018 as part of the consult order and required providers to identify an indication for placement. All consults were reviewed by the IV Team Nurses who collaborated with ID providers when warranted. Providers were contacted if MAGIC criteria suggested alternate access was more appropriate and encouraged to either place a mid or peripheral line or to consider an oral medication. Rates of line utilization and line infections pre-intervention and post-intervention were compared. Results Overall, 242 consults for PICC lines were placed during the one year intervention period January 1, 2018 to December 31, 2018. Indications included: antibiotics (54%), TPN/chemo (21%) difficult access (17%), no response (8%). Thirty-five PICCs were averted directly related to the intervention. Appropriate indication of PICC placement with the tool was 88%. During this same time period, the line utilization ratio (lines/1,000 patient-days of care) decreased from a mean of 3.8 (range 3.3 to 4.2 for years 2015–2017) to 2.6, a 32% reduction (IIR 0.72; P < 0.05). Central line bloodstream infection rates (infections/1,000 line days of care) also decreased from a mean of 0.81 (range 0.56 to 1.18 for years 2015–2017) to 0.37, a 54% reduction (IIR 0.4; P = 0.10). Conclusion Even in a setting of low line infection and line utilization rates, further reductions in potential device harm can be achieved using point of care feedback tools. This intervention empowers nursing involvement in device stewardship, thus expanding the range of their involvement in stewardship activities. Disclosures All authors: No reported disclosures.

scholarly journals Research governance review of a negligible-risk research project: Too much of a good thing?

2017 ◽  
Vol 14 (3) ◽  
pp. 1-12 ◽  
Author(s):  
Amanda Rush ◽  
Rod Ling ◽  
Jane E Carpenter ◽  
Candace Carter ◽  
Andrew Searles ◽  
...  
Keyword(s):  
Research Governance ◽  
Research Projects ◽  
Regulatory Requirements ◽  
Research Activity ◽  
Research Project ◽  
Human Research Ethics ◽  
Risk Research ◽  
One Year ◽  
Time Required ◽  
The Impact

There are increasing concerns that research regulatory requirements exceed those required to manage risks, particularly for low- and negligible-risk research projects. In particular, inconsistent documentation requirements across research sites can delay the conduct of multi-site projects. For a one-year, negligible-risk project examining biobank operations conducted at three separate Australian institutions, we found that the researcher time required to meet regulatory requirements was eight times greater than that required for the approved research activity (60 hours versus 7.5 hours respectively). In total, 76 business days (almost four months) were required to obtain the necessary approvals, and site-specific processes required twice as long (52 business days/approximately 10 weeks) as primary Human Research Ethics Committee and Research Governance Office processes (24 business days/ approximately five weeks). We describe the impact of this administrative load on the conduct of a one-year, externally-funded research project, and identify a shared set of application requirements that could be used to streamline and harmonise research governance review of low- and negligible-risk research projects.

Assessing the Impact of a Clinical Pharmacist in a Postsurgical Inpatient Population

2020 ◽  
pp. 089719002093819
Author(s):  
Farrah C. Tavakoli ◽  
Victoria L. Adams-Sommer ◽  
Lynn S. Frendak ◽  
Nicole D. Kiehle ◽  
Stacy E. Dalpoas
Keyword(s):  
Adverse Events ◽  
Patient Care ◽  
Clinical Pharmacist ◽  
Multidisciplinary Team ◽  
Patient Population ◽  
Improve Patient Safety ◽  
Care Patient ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
The Impact

Objective: To quantify the number and type of clinical pharmacist interventions with an impact on patient care in a postsurgical nonintensive care patient population. Background: Studies have shown that pharmacists are able to improve the quality of patient care; however, the pharmacist role in postsurgical nonintensive care areas is not well defined. Methods: A clinical pharmacist provided care for 2 postsurgical floors for 2 weeks and collected information about the number and type of interventions made and adverse events avoided. In addition, the study team conducted an anonymous survey amongst the multidisciplinary team who collaborated with the pharmacist at the end of the trial period to understand the perception of having access to a clinical pharmacist who was designated to their floor. Results: In a 2-week time period, the clinical pharmacist was able to make 218 interventions, including 38 recommendations for optimization of antimicrobials, 26 recommendations for anticoagulation optimization, and providing education for 20 patients planned for discharge on high-risk medications. Interventions made by the clinical pharmacist helped decrease adverse events, improve patient safety and knowledge, and potentially avoid readmissions and reduce hospital length of stay. The survey results revealed that 100% strongly agreed that a clinical pharmacist should be a member of the multidisciplinary team for the postsurgical floors. Conclusion: This data signifies that having a clinical pharmacist dedicated to the postsurgical patient population allows for optimization of antimicrobial and anticoagulant use, improves outcomes for patients through medication education, and enhances provider satisfaction.

scholarly journals ‘Time to clean’: A systematic review and observational study on the time required to clean items of reusable communal patient care equipment

2017 ◽  
Vol 18 (6) ◽  
pp. 289-294 ◽  
Author(s):  
David Scott ◽  
Hayley Kane ◽  
Annette Rankin
Keyword(s):  
Systematic Review ◽  
Observational Study ◽  
Nosocomial Infection ◽  
Patient Care ◽  
Infection Rates ◽  
Protected Time ◽  
Pressure Cuff ◽  
Hospital Patients ◽  
Time Required ◽  
The Impact

Background: Concerns have been raised over poor standards of hospital cleanliness and insufficient time for staff to clean reusable communal patient care equipment. These items may then act as vectors for the transmission of nosocomial pathogens between hospital patients. Aim: To evaluate the impact of cleaning duration on nosocomial infection rates and estimate the time required to clean care equipment in accordance with national specifications (i.e. a ‘time to clean’). Methods: A systematic review of the published literature on cleaning times and an observational study in which nine healthcare workers cleaned seven items of care equipment while the duration of time taken to clean each item was measured. Results: A limited volume of low-quality evidence indicates that increased cleaning times in hospitals can reduce the incidence of healthcare-associated infections (HCAIs). The mean ‘time to clean’ for care equipment ranged from 166.3 s (95% confidence interval [CI] = 117.8–214.7) for a bed frame to 29.0 s (95% CI = 13.4–44.6) for a blood pressure cuff. Discussion: ‘Time to clean’ estimates for care equipment provide an indication of how much protected time is necessary to ensure acceptable standards of cleanliness. Clinical trials are needed to further evaluate the impact of increased cleaning times on nosocomial infection rates.

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