New system ensures IV skills competency
New system ensures IV skills competency
Study packet, hands-on work key to IV update
Creation of an intravenous update inservice that travels to nurses in outlying branches and a study packet chock full of tips and other references has proven successful for a Maine home health agency.
When setting up your own inservice, give nurses plenty of time to work with the various IV devices and become comfortable with them, says Jackie Fournier, RN, MS, CS, director of clinical support at HealthReach HomeCare and Hospice in Waterville, ME.
"Every learner is so different, but the one thing that seems very important to us adult professionals is, Let me play with it. Don’t just tell me about it, just let me do it,’" she says.
HealthReach Home Care and Hospice, a 28-year-old nonprofit agency in central Maine, has three branch offices, including its central office in Waterville. Previously, yearly IV updates had been held in the Waterville office, with nurses traveling from branches in Augusta and Skowhegan, each about half an hour away.
Taking the training out to all the branches has improved efficiency and productivity, Fournier says. "We offer it four times a year. Now we offer two centrally in Waterville: One goes to Skowhegan for their day, and the other goes to Augusta for their day."
An IV committee decides upon the dates before the start of the year, at the same time that committee members review IV policies and procedures for updating. Another improvement the committee has made in the past few years is to beef up the study packet, providing nurses with handy guides to clinical pathways, tips, and other important reference information.
"We send the packet two to three weeks before the IV update," Fournier says. "We review the forms we use for IV care, a flow sheet, patient teaching sheets, and a quick reference chart. There’s a pre-test with 10 questions that all refer back to the policies. It makes them go back to the policy books, to remind them what the policy is on this."
Focus on each visit
Here is some of the information found in the packet:
• Recent articles in medical literature on dealing with IV devices, including one on managing complications of central venous access devices and one on how to care for peripherally inserted central catheters (PICCs).
• Tip sheets for care and maintenance of PICC lines in a pediatric patient and for removal of a PILL/MIDLINE/PICC line.
• A chart that lists at the size and volume of various catheter types.
• Several forms, such as patient teaching sheets, and a quick access reference chart, which shows at a glance the various attributes of the whole range of IV access devices.
• A clinical pathway, which includes a teaching component for IV care so that families and other caregivers can learn what they need to know. "For the new clinicians, it sort of focuses them on what they might want to do per visit," Fournier says.
• An IV flow sheet. "We used to have one for each of these different kinds [of devices]. There’s only one IV flow sheet now, so it doesn’t matter what kind of line it is, all the information we need is there."
With these resources, nurses enter the 3.5 to four-hour inservice. After reviewing the forms in the study packet and going over a pre-test that came with it, instructors present highlights of the policies and procedures. There is a session on management and care of intrathecal/epidural lines and a video from vendor Abbott Labs about declotting PICC lines.
"[Declotting] is new to our agency," Fournier says. "It used to be that our vendors did it. We’ve created a policy that we can have home care nurses do it themselves."
After this portion of the inservice, the agency usually offers a break, with refreshments. Then comes the hands-on work — eight stations with mannequin hands, arms, and chests to give the nurses a chance to work on the various techniques covered in the training. Fournier says each nurse must attend each station, successfully demonstrate the skill, and be signed off by the instructor.
She says the exercise serves as more than a testing opportunity, allowing time to work with the equipment and speak with instructors. "Each station, each instructor is one-on-one. People can take time on their questions."
Service station central
The stations cover the following skills:
• Heparin flush, turbulent flush, and SASH technique.
• Accessing implanted ports, removal and dressing changes.
• Peripheral IV insertion.
• Pumps: The agency uses pumps provided by vendors.
• MID/PICC/PILL care and removal.
• Venipuncture and needleless techniques.
• Glucometer testing: While this isn’t an IV skill, Fournier says it is a great opportunity to measure competencies. There are five different models of glucoscans, and nurses pick one model to be tested on.
• Declotting PICC lines: Vendors help teach this new competency.
Stations that take longer or for other reasons tend to have backups on them, such as central line access, have two or three instructors and two or three mannequins set up. "Some others that don’t have that kind of backup, you have one instructor at that station," she says. "Like the glucometer — people don’t take a long time with that one."
Giving staff time to work with the devices and to ask questions about them really makes a difference, she says. "Nurses are used to performing tasks — we’ve done it since nursing school," she says. "Stations really lend themselves to that kind of learning."
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