Make the right move to needle safety

Six-step checklist to finding the perfect device

If you’re not sure how to go about selecting the safety device that best suits your needs, here’s a checklist that will help you make the right choice.

1. Reduce the highest risk first.

Lynda Arnold, RN, an activist for needlestick prevention through the National Campaign for Healthcare Worker Safety, says your first step should be to find out where your nurses and patients are at the most risk.

"Identify the biggest risks first, and then work down from there," she says. "The biggest challenge is to identify which types of devices meet the high-risk category, particularly, which are the hollow-bore blood-filled needles? Identify the risk first, then the frequency."

2. Consider everyone at risk.

Your nurses obviously will be at risk, particularly when doing insertions in the home. But it would be an oversight only to consider nurse safety, Arnold says. In fact, standard tubing, cannulas, and catheters present risks to a wide range of individuals.

"Patients themselves see the need for safety devices in the home," says Arnold. "Accidents happen in the home that we think would never happen in a hospital because in the hospital most variables are controlled and there aren’t dogs jumping on the bed. You also want to protect family members and caregivers from exposure to blood. You also have to think of all the people involved in the disposal. What happens to the worker who is responsible for the collection of the device, or the child who comes in contact with a device that was not properly disposed of?"

It was through such careful consideration that Deaconess Home Medical Equipment and Infusion in Evansville, IN, opted for needleless tubing as its first move into safety devices. When looking at the potential risk to patients and caregivers as well as nurses, needleless tubing was the obvious choice.

"When I tell patients we don’t use needles in the home, their faces light up," says Ann Williams, RN, CRNI, an infusion nurse with Deaconess.

3. Prevent major change.

Once you have identified the device that poses the greatest risk to staff and patients, look for a substitute safety device that won’t require a major overhaul in technique.

"Select a device that uses little or no user action training or retraining," says Arnold. "You want to find a device that is comparable to the device you are currently using so the only difference is the safety mechanism."

Arnold recommends finding a "passive" device.

"Most devices require some user action to activate the safety mechanism, but you want as passive a device as possible," she says. "But you may have to go with a product that requires activation, so don’t wait for a totally passive device."

One way to evaluate devices is to get firsthand information from other providers and manufacturers.

"Talk to other providers, see if they have switched and which ones they liked," says Robyn Lit, project officer for Plymouth Meeting, MA-based research agency ECRI. "Also talk to manufacturers and have them in to trial devices."

By doing such research, Williams was able to rule out some complex needleless tubing systems that were reported to have too many pieces. She also settled originally on the Clave system because it didn’t give nurses the opportunity to use needles and forced them to use the safety feature.

"Some of the products didn’t make the nurses go needleless, and I was against that," says Williams. "If you’re going to switch, go all or none. As a nurse, if you are in a hurry and you have a choice you are going to stick the needle in there."

4. Don’t swap risks, eliminate them.

"Make sure the [new] device does not present an additional risk where there was no risk before," says Arnold. "For example, make sure the safety feature doesn’t allow more exposure to blood than the previous device. Even though that’s not as dangerous as a puncture, you don’t want to introduce a new risk, in this case more blood exposure."

Orenstein agrees that some devices simply replace one risk with another.

"With a device that is more difficult or more cumbersome to use, nurses may have to stick the patient three times instead of once, so that exposes them to three times the risk of getting the needlestick, not to mention the patient who is getting stuck more times."

Risk isn’t the only factor to consider. You also have to make sure patient outcomes don’t suffer. An increased infection or phlebitis rate means you’ll soon be shopping once again.

"You want the therapy to finish with a positive outcome with the least amount of complications anticipated or occurring as possible," says Debbie Benvenuto, CRNI, nurse educator for IV therapy with the Intravenous Nurses Society in Cambridge, MA.

Williams points out that she looked at infection studies available from manufacturers on each product she considered.

5. Provide proper training.

"Once the evaluation and selection of the device is complete, there needs to be a commitment to education and inservicing on the part of the manufacturer for that particular device," says Arnold. "Make sure the manufacturer is going to stand by the product and provide the level of education necessary. This is a long-term commitment." Talk with the manufacturer about what kind of commitment you can expect, and ask other users of the device to confirm the manufacturer’s commitment.

Orenstein agrees that ongoing training is critical in making sure your safety devices are being used properly.

"You have a fair amount of turnover in most health care institutions, so you may have people who come from elsewhere that are not familiar with the devices," he says. "You might introduce a needleless system and in a year and a half many of your nurses have changed, so you need an ongoing system of education for everybody coming."

"The inservice program from the manufacturer regarding proper use should be used," says Benvenuto. "A person becomes dangerous to themselves if they think they know all the peculiarities of a device and they really don’t."

6. Evaluate acceptance.

Orenstein says the move to a safety device isn’t complete until you’ve measured acceptance.

"Do pilot studies to make sure the device is accepted," he says. "Initially people think they are using a safer device, then realize they are often more difficult to use than conventional devices."

A pilot study can be as simple as making sure your nurses are comfortable with the device before you make any purchase. What feels right during a demonstration may not be quite as easy to use in the field.

If a device required even a slight change in technique on the part of your staff, it will take some time to find out if they are adapting to the new device or giving up in frustration. Only careful follow-up will provide answers.

Constant follow-up and evaluation also will allow you to stay abreast of what’s on the market and move to more efficient devices as they become available. After nearly two years using the Clave needleless system, Deaconess recently switched to the Ultrasite.

"It has a positive-pressure-effect feature when you take the syringe off," says Williams. "With the Clave we had a number of our midlines that were having clotting-off problems, and we had to declot them."

While Clave also has a new product with a similar positive-pressure feature, the Ultrasite proved less expensive. So by staying on top of problems and what was currently available, Deaconess not only moved to an updated product but also saved money in the process.

Looking for safety device information?

Here are resources to help refine your search

In addition to sales representatives, peers, and manufacturers, the following resources can provide helpful safety device information:

• The International Healthcare Worker Safety Resource and Research Center compiles data on safety devices. Telephone: (804) 924-5159.

• There is an infusion therapy e-mail list available that allows providers to solicit and exchange information. To subscribe, send an e-mail message to majordomo@ohsu.edu with the words "subscribe venous" with no quotes in the body and no subject.

• ECRI has published two reports on safety devices and an evaluation protocol in its August-September 1994 issue. For more information, call ECRI at (610) 825-6000.

• Lynda Arnold’s National Campaign for Healthcare Worker Safety can be reached by calling (800) 936-7370, or by visiting its Web site at www.healthcaresafety.com.