Is It Worth Having A Dedicated Infusion Therapy Nurse Impact On Peripherally Inserted Central Venous Catheter Associated Bloodstream Infections Rates And Costs

Background: Peripherally inserted central venous catheters (PICC) are increasingly used in healthcare services and bloodstream infections associated to them (PICC-BSI) leads to increased mortality and costs. We aimed to compare direct costs of PICC-BSI in a 300-bed Brazilian Hospital, before and after employing a dedicated infusion therapy nurse (ITN). Methods: After May/2016, a dedicated ITN for adult patients was admitted to perform the following functions: to apply evidence-based indications for vascular access and avoid its potential overuse, ultrasound-guided PICC insertion, nursing staff capacitation in PICC maintenance, patient education and empowerment for catheter care, management of peripheral line indicators. PICC-BSI episodes occurred before (Jan/15 to May/16) and after (Jun/16 to Nov/17) ITN were detected by active surveillance by Infection Control Team, according to National Healthcare Safety Network criteria. PICC-BSI costs were measured considering an extra length of stay and antimicrobial therapy of 7 days, cost of PICC and laboratorial inputs for BSI detection. Values were converted from Brazilian Real to US dollar (quotation updated 02/15/2018). Results: There were 07 PICC-BSI before and 05 after ITN, which correspond to 0.7 and 0.4/1000 PICC-day infection rate respectively (reduction of 43%). After May/2016, there was an increase of 50% in PICC use per patient-day (8% and 12%). The average PICC-BSI direct cost was $9,900 - extra length of stay: $7,492; antimicrobial therapy: $1,095; cost of PICC: $765; laboratorial samples: $548. Discussion & Conclusions: In this study, we evaluated only the direct and estimated costs of PICC-BSI, but the value should be much higher if we consider indirect costs such as healthcare workers hours, complications and the need for transfers to intensive care units. In our hospital, a dedicated ITN nurse contributed to reduce the rate of infection, generating savings for the service and contributing to the quality of care and patient experience.

This Open access book offers updated and revised information on vessel health and preservation (VHP), a model concept first published in poster form in 2008 and in JVA in 2012, which has received a great deal of attention, especially in the US, UK and Australia. The book presents a model and a new way of thinking applied to vascular access and administration of intravenous treatment, and shows how establishing and maintaining a route of access to the bloodstream is essential for patients in acute care today. Until now, little thought has been given to an intentional process to guide selection, insertion and management of vascular access devices (VADs) and by default actions are based on crisis management when a quickly selected VAD fails. The book details how VHP establishes a framework or pathway model for each step of the patient experience, intentionally guiding, improving and eliminating risk when possible. The evidence points to the fact that reducing fragmentation, establishing a pathway, and teaching the process to all stakeholders reduces complications with intravenous therapy, improves efficiency and diminishes cost. As such this book appeals to bedside nurses, physicians and other health professionals.

Health systems should function in such a way that the amount of inappropriate care is minimized, while at the same time stinting as little as possible on appropriate and necessary care. The ability to determine and identify which care is overused and which is underused is essential to this functioning. To this end, the "RAND/UCLA Appropriateness Method" was developed in the 1980s. It has been further developed and refined in North America and, increasingly, in Europe. The rationale behind the method is that randomized clinical trials--the "gold standard" for evidence-based medicine--are generally either not available or cannot provide evidence at a level of detail sufficient to apply to the wide range of patients seen in everyday clinical practice. Although robust scientific evidence about the benefits of many procedures is lacking, physicians must nonetheless make decisions every day about when to use them. Consequently, a method was developed that combined the best available scientific evidence with the collective judgment of experts to yield a statement regarding the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history, and test results. This manual presents step-by-step guidelines for conceptualising, designing, and carrying out a study of the appropriateness of medical or surgical procedures (for either diagnosis or treatment) using the RAND/UCLA Appropriateness Method. The manual distills the experience of many researchers in North America and Europe and presents current (as of the year 2000) thinking on the subject. Although the manual is self-contained and complete, the authors do not recommend that those unfamiliar with the RAND/UCLA Appropriateness Method independently conduct an appropriateness study; instead, they suggest "seeing one" before "doing one." To this end, contact information is provided to assist potential users of the method.

The manual of choice…perfect for class, clinical, and practice! The perfect resource for any setting where infusion therapy skills are required! Its popular, self-paced approach makes it ideal for classroom and clinical settings as it progresses from the basics to advanced techniques while incorporating theory into clinical application. A focus on evidence-based practice in a streamlined format continues to make this the manual of choice in a rapidly advancing field. “Thorough, comprehensive manual on IV therapeutics. Gorski, the author, is considered the final word in all matters of IV therapeutics. A great go-to guide for any nurse involved with infusions.”—Andrea, Online Reviewer New & Updated Incorporates the 2021 Infusion Therapy Standards of Practice published by the Infusion Nurses Society (INS), new and revised guidelines from the Centers for Disease Control (CDC) and World Health Organization (WHO) as well as the latest guidelines from the Association for the Advancement of Blood & Biotherapies (AABB) and the American Society of Parenteral and Enteral Nutrition (ASPEN) New Chapter! An Introduction to Biologic Infusion Therapies Updated! Follows the INS Core Curriculum for certification. Updated! Uses current literature to support evidence-based practice. Updated! Presents procedures and rationales as well as technology that reflect practice today. Presents “Thinking Critically” boxes, a case study feature. Integrates pediatric and geriatric content throughout. Offers a wealth of additional resources for students online at FADavis.com Features well organized pedagogical tools, including…Learning Objectives, Nursing Fast Facts, Age-related and Cultural Considerations, Nursing Plans of Care, Home Care Issues, Patient Education, Key Points, and Review Questions. Makes must-know information easy to find with icons for key points of theory, nursing fast facts, INS standards of practice, relevant studies in evidence-based practice, nursing points of care, home care issues, patient education, and a media link to the online tools and resources. Presents detailed step-by-step procedures for subcutaneous infusion of pain medication Ÿ peripherally inserted catheters (PICCs) Ÿ epidural pain medication administration Ÿ and patient controlled analgesic therapy. Includes competency skill checklists for evaluating procedures. Examines delivery of IV therapy in the home setting. Highlights critical content in "Nursing Fast Fact" boxes, Spotlights assessment and intervention guidelines in "Nursing Points-of-Care" boxes. Provides competency criteria for hospital policy and procedure development required by The Joint Commission.

A clear, hands-on outline of best practices for infection prevention that directly improve patient outcomes across the healthcare continuum.

With a new focus on evidence-based practice, the 3rd edition of this authoritative reference covers every aspect of infusion therapy and can be applied to any clinical setting. Completely updated content brings you the latest advances in equipment, technology, best practices, guidelines, and patient safety. Other key topics include quality management, ethical and legal issues, patient education, and financial considerations. Ideal as a practical clinical reference, this essential guide is also a perfect review tool for the CRNI examination. Authored by the Infusion Nurses Society, this highly respected reference sets the standard for infusion nursing practice. Coverage of all 9 core areas of INS certification makes this a valuable review resource for the examination. Material progresses from basic to advanced to help new practitioners build a solid foundation of knowledge before moving on to more advanced topics. Each chapter focuses on a single topic and can serve as a stand-alone reference for busy nursing professionals. Expanded coverage of infusion therapy equipment, product selection, and evaluation help you provide safe, effective care. A separate chapter on infusion therapy across the continuum offers valuable guidance for treating patients with infusion therapy needs in outpatient, long-term, and home-care, as well as hospice and ambulatory care centers. Extensive information on specialties addresses key areas such as oncology, pain management, blood components, and parenteral nutrition. An evidence-based approach and new Focus on Evidence boxes throughout the book emphasize the importance of research in achieving the best possible patient outcomes. The user-friendly design highlights essential information in handy boxes, tables, and lists for quick access. Completely updated coverage ensures you are using the most current infusion therapy guidelines available.

And future considerations / Mary Anne Rizzolo

Based on recognized standards of practice, Mosby's Pocket Guide to Infusion Therapy offers RN and LPN nursing students and practitioners a practical, concise resource for learning or reviewing current approaches to infusion therapy as well as a dependable IV pocket reference. Divided into consistent key sections, such as Troubleshooting Tips, Guidelines for Specific Procedures, Pain Management, and Helpful Hints, nurses can rely on this powerful pocket reference daily for their infusion therapy needs. And with the latest information on products, guidelines, and screening procedures, nurses can be sure they are staying current with the latest innovations and trends in the field. Presents the principles of infusion therapy in a thorough yet concise manner to facilitate learning and review as well as the easy retrieval of important IV information Highlights Clinical Alerts, Trouble Shooting Tips, and Potential Complications with consistent icons to point out specific clinical practice tips, to save time, and to help prevent common errors Illustrates the use of all drug calculation formulas to clearly explain the calculation process and help prevent drug administration errors Provides patient/family teaching guidelines to assist the nurse in providing appropriate infusion therapy education to their patients Provides multiple-choice study questions at the end of relevant chapters to help the reader evaluate his or her understanding of content and to prepare for the Intravenous Nurses Society Certification exam. Includes a Clinical Competency section at the end of relevant chapters to provide health care institutions and clinical educators with a tool that facilitates meeting JCAHO accreditation requirements. Identifies pediatric drug calculations with a special icon to easily distinguish between adult and pediatric calculations New and updated information on needleless IV therapy products, products that meet JCAHO/CDC safety recommendations, CDC/ANA safe practice guidelines, latex allergy, and blood products New content on CDC recommendations for screening West Nile Virus and SARS New content on Central Venous Catheters for child, adolescent, and geriatric patients New product information and illustrations familiarize readers with the latest innovations Expanded content on serum electrolytes keep readers up-to-date Updated discussion of chemotherapy drugs

"I would definitely recommend this book to all staff with an interest and involvement in intravenous drug therapy." —The Pharmaceutical Journal "There is no doubt that nurses will find this small book useful. It should be available for consultation in any clinical area where drugs are administered to patients by the injectable routes." —Journal of Clinical Nursing The safe administration of injectable medicines is key to patient safety. The NPSA recognises the use of injectable medicines is a high risk activity and recommends written information about injectables to be available at the point of preparation. The UCL Hospitals Injectable Medicines Administration Guide is a practical, accessible guide covering many important aspects of administering medicines by injection. It provides clear, concise information on the preparation and administration of over 245 injectable medicines for adults, paediatrics and neonates. It is an essential resource for nurses and other healthcare professionals: it provides the key information and advice needed for the safe and effective administration of injectable medicines. The Guide’s introductory section provides a concise yet comprehensive overview of injectable therapy, including the risks and benefits of IV administration, infusion devices, and pharmaceutical aspects of injectable therapy. For each drug the alphabetically tabulated monographs provide: A practical method of preparation and administration via the IV, IM and SC routes, with risk reduction in mind at every step Expert advice from the team of specialist pharmacists at UCLH to ensure safe and pragmatic use of each medicine Monitoring advice for the management of reactions that may occur during administration Y-site and syringe driver compatibility data Minimum infusion volume data for fluid restricted patients Extravasation warnings, pH, sodium content, displacement values, stability and flush data New to this edition: 40 new monographs including recently marketed, unlicensed, rarely used and specialist medicines Detailed advice for the administration of high risk medicines such as heparin, with access to UCLH’s medicine related guidelines at www.wiley.com/go/UCLH A colour-coded NPSA risk assessment for every mode of administration for every medicine, to highlight the safest method of administration A user guide and tutorial to give new readers confidence in using and understanding the Guide Revised chapters on administration methods and devices, aseptic non-touch technique, and latex allergy Fully revised and expanded Y-site compatibility section Spiral binding to allow the book to be left open at the relevant page The Guide is also available electronically at www.uclhguide.com.