Development and Management of an Adult Vascular Access Team

1. Development and Management of an Adult Vascular Access Team Christopher Frith RN BSN CRNI VA-BC

2. Parallon Workforce Management Solutions “Patients First” philosophy with a focus on quality and decreased cost Hospital operators working with other hospital operators Provide unprecedented efficiencies, performance and outcomes for our customers Dedicated to continuous process improvement through our pragmatic, impact-oriented solutions

4. Learning Objectives • To use the S.M.A.R.T. criteria in development of a Vascular Access Team • To use the D.I.S.C. model to build a High Performance Team (HPT) • To highlight the importance of Data mining and how it will directly affect the sustainability of a Vascular Access Team

5. IV Therapy History • 1628 Dr. William Harvey (1578- 1657) described how blood circulates around the body and the part the heart plays • “Anatomical Essay on the Motion of the Heart and Blood in Animals” • 1657 Sir Christopher Wren was the first to perform a intravenous injection in a human

6. Intravenous Injection • Metal pipe was first used • Replaced by silver or gold tube • Opium and purging medication

7. Modern History • 1940- Nurse assigned as I.V. Therapist at Mass General Hospital (Boston, MA) • Metal needle used in World War II • 1945- Plastic catheter was developed • 1970’s plastic containers introduced for infusates

8. Current Infusion Landscape • Greater than 80% of hospitalized patients receive IV therapy • Infusion therapy is now a sub-specialty in nursing • Reduction of CLABSI/BSI are major initiative for all hospital organizations • IV Nurse Specialist’s are now considered a resource to infection preventionists, etc….

9. Modern Vascular Access • Varied procedures in toolkit • Must have multi-departmental integration • Track efficiencies and progress • Infusion Alliance * Lynn Hadaway Associates, Inc.

10. Vascular Access Team • Registered Nurses • Critical Care background • Specially trained/certified in infusion therapy • Multiple devices in tool kit • Schedule flexibility • Trouble shooting • Education • Sustainability

11. Inadequate Goals

12. Smart Goals for Team Development • Specific • Measurable • Attainable • Reasonable • Time-sensitive *Creator George T. Doran (1981)

13. Is this smart? • Hire two IV therapy nurses to stop CLABSI’s • Subjective • Anecdotal • Has no equity • Presents significant risk

14. Specific • Explicitly • Set forth • Definite • Vague goals equals Vague Results Employee two IV therapy Nurses

15. Measurable • A systematic way to assign to each suitable subset a number, intuitively interpreted as the size of the subset • Quantifiable • Assessable To decrease our CLABSI rate from 2%

16. Attainable/Achievable • To gain as an objective • To achieve • Is it possible or idealistic To 1% overall

17. Realistic/Relevant • A statement offered in explanation or justification • Not extreme or excessive Over the next six months

18. Time Sensitive/Time Framed • The indefinite continued progress of existence and events in the past, present, and future regarded as a whole • There must be a dead line • Dates are agreed-upon by all parties involved • Goals without deadlines are generally never met The reduction in our facilities CLABSI rate will be noted on April 1, 2012

19. Final Goal Statement • By employing and training two IVT therapy Nurses, over the next six months we will decrease the facilities overall CLABSI rate to 1% or less. This goal will be noted on April 1, 2012

20. Goal Considerations • Document all performance expectations and goals • Assign each goal a due date • Identify how the goal will be measured • Set reminder dates to review and update goals

22. DISC Model Management • Dominance • Influence • Steadiness/Submission • Conscientiousness/Compliance

23. What is the DISC model • Created in 1928 by Dr. William Moulton Marston (1893–1947) at Columbia University • Focus is based on • Four quadrant behavioral model • Personality styles • Examines behavior within environmental situations.

24. William Moulton Marston • Psychologist • Created Lie-Detector test • Systolic blood-pressure test • Feminist (Creator of Wonder Woman) • Theorist • Inventor

25. DISC Model • All individuals possess all four of these behaviors • The degree of each varies • Focuses on self and others • Thinking styles • Personality typology • Personality traits

26. Dominance “D” Relating to control, power and assertiveness! High D Low d Need to do more research before taking action Conservative Low keyed Agreeable Peaceful Mild Cooperative • Can deal with problems and challenges • Demanding • Forceful • Energetic • Strong willed • Aggressive • Determined • Dominant • Driving *Donald Trump

27. Influence Relating to social situations and communication High I Low i Influence by data and facts not feelings Reflective Factual Calculating Skeptical Logical Critical • Influence others with talking and activity • Emotional • Convincing • Magnetic • Warm • Optimistic • Persuasive • Inspirational • Influencing *Oprah Winfrey

28. Steadiness/SubmissionRelating to patience, persistence, and thoughtfulness +/- High S Low s Like change and variety Restless Impatient Demonstrative Eager Impulsive Intolerant • Do not like change, like steady pace and security • Calm • Relaxed • Patient • Predictable • Deliberate • Unemotional • Steady • Stable * Mother Teresa

29. Conscientiousness/Compliance Relates to structure and organization ? High C Low c Change rules and yearn for independence Self –willed Stubborn Opinionated Arbitrary Unconcerned Unsystematic • Adhere to rules, regulations and structure • Cheerful • Cautions • Exacting • Neat • Systematic • Tactful • Competent • Careful * Albert Einstein

30. Circular Model Circumplex

31. Team Dynamics • Typical team has varying degrees of compatibility • Goal is to identify and refine gaps to increase efficiencies • What motivates each individual

32. DISC Deployment • Pre employment screening • Attitude • Hostility • Integrity • Conscientiousness • Abuse • Harassment

33. DISC for an Existing Team • Development tool • Team Building • Coaching • Communication Insight • Succession Planning • Team Analysis

34. Team Development Identify Team Issues

35. High Performance Team (HPT) • Team "A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable" • Understands the big picture • Common Goals • Works collaboratively

36. High Performance Team • Develop goals • Provide a mission statement • “Parallon Business Solutions is committed to transforming the business of healthcare.Our strength is our people who are experienced in executing and managing complex processes with the support of enabling technology.  We are dedicated to continuous process improvement through our pragmatic, impact-oriented solutions” • Positive relationships • Nonaggressive confrontation • Effective problem-solving • Identify and repair

37. High Performance Team (HPT) • Team leadership • Respond and respect leadership • Provide support and action to decisions • Open communication • Feedback model with Brainstorming • Training and development • Leadership principles • Organizational effectiveness • Communication skills • Provide resources

38. Data Mining • The extraction of hidden predictive information from large databases • Algorithms • Database management • Massive data collection • Reports

39. Electronic Health Record (EHR) • Systematic collection of electronic health information about individual patients or populations • The legal patient record created in hospitals and ambulatory environments as a data source • Recorded in a digital format • Shared across the network

40. Data Mining/EHR Advantages • Promotes evidence based practice • Cost reduction • Improved quality of care • Mobility • Trend identification

41. Data Mining/HER Disadvantages • Cost • Time to learn new systems • Privacy/Liability • Legal interoperability • Regulatory compliance • Health Insurance Portability and Accountability Act (HIPAA) 1996 USA • Personal Information Protection and Electronic Documents Act (PIPEDA) 2000 Canada

42. Vascular Access Data • Patient tracking and log • Infection prevention • Insertion disposition • Surveillance • Occurrence reporting • Productivity monitoring • Device related monitoring

43. Sample Data Points • Total insertions • Procedures for a specific date range • Catheter tip termination • Number of attempts • Total number of CVC catheter insertions • Average catheter line days • Total number CLABSI per proceduralist

44. Visual Presentation • Chart types • Column • Histogram • Bar • Radar • Surface • Bubble • Pie

45. Sample chart

46. Sample Data Pivot