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P01 - Using Simulation and Competency Assessment to Decrease Inappropriate Referrals to a Comprehensive Vascular Access Team

Background: The blind stick technique for obtaining intravascular (IV) access often renders multiple unsuccessful attempts by nurses which lead to delays in medication administration, unsatisfied patients, and physician intervention likely ending with unnecessary central venous lines (CVLs) for difficult access patients.

Problem statement: Registered nurses (RNs) are requesting a great number of comprehensive vascular access team (CVAT) consults, not only for IV access but for lab work, on patients that are not difficult to gain IV access, in turn, increasing the CVAT volume. Over-use or improper use of CVAT by RNs result in delays in medical treatment, increased expenses, and a decrease in patient satisfaction for those that are truly difficulty to gain access.

Methods: Simulation-based trainings were offered to emergency department (ED) RNs. The training session was led by two expert ultrasound-guided peripheral IV (USGPIV) advanced practice providers (APPs). A total of thirteen RNs volunteered and completed the training. RNs were refreshed with IV starting skills, taught basic ultrasound (US) functions, and then incorporated a combination of the two skills simultaneously.

Results: The goal was to decrease CVAT consults within a six- to eight-week time frame (June 1 to July 15, 2019) by 25%. Of the 430 USGPIVs that were placed by CVAT and the ED RNs within this time frame, 89 were successfully placed in the ED which is a total decrease of 21% in CVAT consults. P value was less than 0.001 after the statistical analysis was performed using Chi Square Test which indicates statistical significance. Control chart is common cause as there was not a significant change in volume from previous months prior to the intervention.

Conclusion/implications: Although the intervention yielded a 21% decrease in volume instead of 25%, the intervention was still statistically significant. After the completion of this project, the quality improvement (QI) team will disseminate the findings with plans to broaden this evidence-based practice to more populations throughout the hospital, in turn, advancing the bedside RN’s skill set, potentially decrease delays in IV medication therapy as well as the length of stay, and increase patient satisfaction.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.