© 2011 Parallon Business Solutions, LLC.

Development and Management of an Adult Vascular Access Team

Christopher Frith RN BSN CRNI VA-BC

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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

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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

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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

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Intravenous Injection

• Metal pipe was first used• Replaced by silver or gold

tube• Opium and purging

medication

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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

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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….

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Modern Vascular Access

• Varied procedures in toolkit

• Must have multi-departmental integration

• Track efficiencies and progress

• Infusion Alliance

* Lynn Hadaway Associates, Inc.

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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

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Inadequate Goals

Goal

Outcome

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Smart Goals for Team Development

• Specific

• Measurable

• Attainable

• Reasonable

• Time-sensitive

*Creator George T. Doran (1981)

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Is this smart?

• Hire two IV therapy nurses to stop CLABSI’s

– Subjective– Anecdotal– Has no equity– Presents significant risk

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Specific

• Explicitly • Set forth• Definite• Vague goals equals Vague Results

Employee two IV therapy Nurses

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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%

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Attainable/Achievable

• To gain as an objective• To achieve• Is it possible or idealistic

To 1% overall

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Realistic/Relevant

• A statement offered in explanation or justification

• Not extreme or excessive

Over the next six months

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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

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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

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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

Goal

Process

Team

Task

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DISC Model Management

• Dominance

• Influence

• Steadiness/Submission

• Conscientiousness/Compliance

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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.

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William Moulton Marston

• Psychologist• Created Lie-Detector test

– Systolic blood-pressure test• Feminist (Creator of Wonder Woman)• Theorist • Inventor

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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

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Dominance “D” Relating to control, power and assertiveness !

High D• Can deal with

problems and challenges– Demanding– Forceful– Energetic– Strong willed– Aggressive– Determined

• Dominant• Driving*Donald Trump

Low d• Need to do more

research before taking action– Conservative– Low keyed– Agreeable– Peaceful– Mild– Cooperative

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Influence Relating to social situations and communication

High I• Influence others with

talking and activity– Emotional– Convincing– Magnetic– Warm– Optimistic– Persuasive

• Inspirational• Influencing*Oprah Winfrey

Low i• Influence by data and

facts not feelings– Reflective– Factual– Calculating– Skeptical– Logical– Critical

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Steadiness/SubmissionRelating to patience, persistence, and thoughtfulness +/-

High S

• Do not like change, like steady pace and security– Calm– Relaxed– Patient– Predictable– Deliberate – Unemotional

• Steady• Stable* Mother Teresa

Low s• Like change and

variety– Restless– Impatient– Demonstrative– Eager– Impulsive– Intolerant

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Conscientiousness/Compliance Relates to structure and organization ?

High C• Adhere to rules,

regulations and structure– Cheerful– Cautions– Exacting– Neat– Systematic– Tactful

• Competent• Careful* Albert Einstein

Low c• Change rules and

yearn for independence– Self –willed– Stubborn– Opinionated– Arbitrary– Unconcerned– Unsystematic

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Circular Model Circumplex

• Sincerity• Dependability

• Competency• Quality

• Enthusiasm• Relationships

• Action• Results

D IS

C

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Team Dynamics

• Typical team has varying degrees of compatibility

• Goal is to identify and refine gaps to increase efficiencies

• What motivates each individual

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DISC Deployment

• Pre employment screening– Attitude – Hostility– Integrity– Conscientiousness– Abuse– Harassment

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DISC for an Existing Team

• Development tool– Team Building– Coaching– Communication Insight– Succession Planning– Team Analysis

Goals

Roles

ManagementProcess

Interpersonal Relationships

Team

Dev

elop

men

t Identify Team Issues

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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

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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

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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

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Data Mining

• The extraction of hidden predictive information from large databases– Algorithms– Database management– Massive data collection– Reports

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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

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Data Mining/EHR Advantages

• Promotes evidence based practice• Cost reduction• Improved quality of care• Mobility• Trend identification

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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

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Vascular Access Data

• Patient tracking and log• Infection prevention

– Insertion disposition– Surveillance

• Occurrence reporting• Productivity monitoring• Device related monitoring

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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

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Visual Presentation

• Chart types– Column– Histogram– Bar– Radar– Surface– Bubble– Pie

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Sample chart

6 Fr47%

5 Fr39%

4 Fr14%

PICC Insertions

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Sample Data Pivot

Jon

Evan

Denise

Cheryl

0 50 100 150 200 250 300 350 400

4 FR5 Fr6 Fr

Smart Goals

DISC

DataPivot

Vascular Access Team

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Results

• Decreased CLABSI/HAC• Cost reduction• Shorter hospital stay• Increased quality and

patient satisfaction

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Contact Information

Email• christopher.frith@parallon.net• christopher.frith@hcahealthcare.com

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Financial Disclosures

• Parallon Business Solutions– Parallon.net

© 2011 Parallon Business Solutions, LLC.

Q & A

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References

• Adams J. Utilizing evidence-based practice to support the infusion alliance. J Infus Nurs. 2010; 33(5):273-277.

• Centenary of Hypodermic Injection. G. A. Mogey, M.B., B.Ch. Department of Pharmacology, University of Leeds

• Hataway, L Development of an Infusion Alliance. J Infus Nurs.2010; 33(5):278-284.

• Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH). Oakbrook Terrace, IL: JCAHO; 2009.

• Szalados JE. Legal issues in the practice of critical care medicine: a practical approach. Crit Care Med. 2007;35(suppl 2):S44-S58.