Know your needles, and take time to choose one

There are myriad products to study and try

In the wake of state and federal directives calling for increased use of needle safety devices, agencies are scrambling to find out what’s available and to pick the right group of products to serve both nurses and patients.

While many efforts are still in the fledgling stages, agencies that are further along in the process agree on an important element — introducing nurses to the wide variety of products available so they can assess the usefulness of each and allow the agency to make an informed choice.

At Ramona VNA and Hospice in Hemet, CA, new state regulations that took effect in mid-1999 prompted a push toward safer devices, says Lauren Mahieu, RN, quality improvement manager. There had been interest in the subject before, but the higher cost of alternative devices had been an obstacle.

"We began looking at it in early 1999," Mahieu says. "It didn’t really become a priority until the law was passed."

She says Ramona sent its infection control nurse to an inservice created to address the state Occupational Safety and Health Administration (OSHA) requirement. There, the nurse got a chance to try out a range of devices and get a feel for how they worked.

Similarly, Home Health Care Management in Wyomissing, PA, was responding to the federal requirements and proposed state legislation when it tapped Mike Brown, RN, CRNI, clinical director of affiliate Phoebe Care Connection, to look at alternatives to standard needles.

Test drive new devices

Previously, the company used a needleless system produced by Bioject Inc. to deliver mass flu immunizations.

Brown is now in the midst of putting together field trials of several devices in each of four major groups: injectables, capillary sampling products, blood draw devices, and venipuncture products.

A team of nurses will test one product at a time in each group until they’ve worked with all the products. Brown is developing evaluation forms the nurses can use to detail the advantages and drawbacks of each product. He hopes to trial each product for two to four weeks, completing the process by the end of the year.

Romayne Keener, RN, Home Health Care Management’s community health educator, compares the tryout phase to test driving a car before buying it: "It would be stupid not to do it," she says.

Ramona VNA’s tryout stage was handled differently. Mahieu says different devices were brought in during inservices so nurses could work with them and provide feedback.

She says getting the nurses to "buy-in" to a product is vital. "You have to make sure it’s user-friendly for the nurses and that they like it. Because if they don’t like the product, then they’re not going to use it properly."

Donna Haiduven, RN, PhD, CIC, who conducted nurse focus groups to study needle safety in home health, says nurses’ assessments of needle safety devices can be quite subjective, varying greatly even within one agency.

One nurse might see a safety device as a barrier, while others might like it, she says.

"It was really striking — I found much variation within agencies on the products available," Haiduven says.

Some of the factors that helped determine whether nurses liked a product: Did it require more than one hand to use properly? How often did the nurse use it? Did it require that she change her technique? Was she properly educated on its use?

"In some of the focus groups, nurses would show products and people in the same agency hadn’t seen it, didn’t know it was available," Haiduven says. "A lot of education is needed and a lot of support."

That education and support should continue well after the devices have been introduced.

Feedback proves valuable

Mahieu says that after Ramona VNA and Hospice introduced its first safer phlebotomy devices, feedback showed that nurses weren’t as well-educated in their use as first thought.

"We thought they understood how they worked, but they really didn’t," she said. "We needed to reinservice."

Part of the problem was that the safety feature — a sheath that was pulled over the needle — had to be manually activated, and nurses would sometimes forget to do that.

A recent safety alert by the National Institute for Occupational Safety and Health suggests that so-called "passive" needle safety devices, in which the safety feature is activated automatically, are preferable to those that must be activated manually.

Other suggestions from Haiduven, based on recommendations from her nurse focus groups:

Train nurses as close as possible to the time when they’re going to be using the devices in the field. Haiduven says nurses in her focus groups complained about training held so far in advance of actual use of the devices that nurses had forgotten what they’d learned.

Limit the number of different devices used for the same procedure, to avoid confusion.

Use a "buddy" system, in which a nurse learning how to use a device is accompanied in the field with someone who is experienced with it.

Hold feedback sessions where nurses can pool their experience with the new products and work through problems.

Coordinate efforts with providers

Brown says it’s important for agencies to understand that they’re not working in a vacuum.

"We’re checking with major providers to see if they’re going to be using any of these safety devices, if they’ll be providing them to patients when they purchase their supplies and their medication," he says. "We really have to be familiar with what products the other companies are using."

He also suggests letting the companies know about an agency’s findings, to help convince them to use devices that have proved successful. "As we get through this trial period, we’ll be in contact with DMEs [durable medical equipment] again to say this is what we feel is a safe product and an easy product to use for the clients."

And the process shouldn’t end with the selec-tion, says Mary St. Pierre, RN, BSN, director of regulatory affairs for the Washington, DC-based National Association for Home Care. She notes that OSHA requires agencies to continue to monitor improvements in needle safety as technology produces better alternatives. "They really need to have a person designated, to keep on top of the latest out there."

Scott D. Alcott, Northeast Regional Sales Representative, Bioject Inc., 7520 S.W. Bridgeport Road, Portland, OR 97224. Telephone: (215) 362-7821. Fax: (503) 624-9002. E-mail: salcott@bioject.com.

Mike Brown, Clinical Director, Phoebe Care Connection, 1005 Brookside Road, Suite 185, Allentown, PA 18106. Telephone: (610) 395-2500. Fax: (610) 794-5461. E-mail: rnmike@fast.net.

Carol Coburn, Director of Investor Relations, Bio-Plexus Inc., 129 Reservoir Road, Vernon, CT 06066. Telephone: (860) 870-6112, Ext. 317. Fax: (860) 870-6118. E-mail: bio.plexus@snet.net.

Lori Douglass, Owner, OccuHealth Consultants, P.O. Box 578095, Modesto, CA 95357-8095. Telephone: (209) 847-6296. Fax: (209) 847-6297. E-mail: lmdouglass@ earthlink.net.

Donna Haiduven, Infection Control Supervisor, Santa Clara Valley Medical Center, 751 S. Bascom Ave., San Jose, CA, 95128. Telephone: (408) 885-5762.

Romayne Keener, Community Health Educator, Home Health Care Management, 1170 Berkshire Blvd., Wyomissing, PA 19610. Telephone: (610) 378-0481. Fax: (610) 378-9762.

Lauren Mahieu, RN, Quality Improvement Manager, Ramona VNA and Hospice, 890 W. Stetson Ave., Suite A, Hemet, CA 92543. Telephone: (909) 658-9288. Fax: (909) 765-6229. E-mail: lmahieu@vhs.dst.ca.us.

Mary St. Pierre, Director of Regulatory Affairs, National Association for Home Care, 228 Seventh St., S.E., Washington, DC 20003. Telephone: (202) 547-7424. Web site: www.nahc.org.