Implementation of a vascular access specialist team in a tertiary hospital: a cost-benefit analysis.

BACKGROUND: The use of peripherally inserted central catheters and midline catheters is growing due to their potential benefits. These devices can increase patient safety and satisfaction while reducing the use of resources. As a result, many hospitals are establishing vascular access specialist teams staffed by nurses who are trained in the insertion and maintenance of these catheters. The objective of the study is to evaluate previously to the implementation whether the benefits of introducing ultrasound-guided peripheral venous catheters, midline catheters and peripherally inserted central catheters compared to current practice by a vascular access specialist team outweigh their costs. METHODS: Cost-benefit analysis from the perspective of the healthcare provider based on administrative data. The study estimates the reduction in resources used when changing the current practice for the use of ultrasound-guided midline and PICC catheters, as well as the additional resources required for their use. RESULTS: The use of an ultrasound-guided device on peripherally inserted central carheter, results in a measurable resource reduction of approximately €31. When 3 peripheral venous catheters are replaced by an ultrasound-guided peripherally inserted central catheter, the saving is €63. Similarly, the use of an ultrasound-guided device on a midline catheter, results in a reduction of €16, while each ultrasound-guided midline catheter replacing 3 peripheral venous catheters results in a reduction of €96. CONCLUSION: The benefits of using ultrasound-guided midline and PICC catheters compared to current practice by introducing a vascular access specialist team trained in the implantation of ultrasound-guided catheters, outweigh its cost mainly because of the decrease in hospital stay due to the lowered risk of phebitis. These results motivate the implementation of the service, adding to previous experience suggesting that it is also preferable from the point of view of patient safety and satisfaction.

Individualization process of the standardized care plan in acute care hospitalization units: Study protocol.

AIM: To understand the individualization process of the standardized care plan (SCP) that nurses design for hospitalized patients. BACKGROUND: To apply the nursing process, it is advisable to use SCP to standardize the diagnosis, planning and evaluation stages. However, the fundamental element of this methodology is the individualization of the care plan. DESIGN: A qualitative study, framed within the constructivist paradigm and applying the Grounded Theory method, in accordance with Strauss and Corbin's approach. METHODS: Multicentre study. Theoretical sampling with maximum variation will be used. The data collection will consist of: in-depth individual interviews, participant observation, document analysis, focus group, and the questionnaires for Critical Thinking Assessment in relation to clinical practice and Nursing Competency Assessment for hospital nurses. The qualitative data will be analysed according to the constant comparative method of Strauss and Corbin's Grounded Theory, which involves performing open, axial and selective coding. The questionnaire results will be used to make a qualitative analysis that will consist of a triangulation between the level of critical thinking, level of expertise and record of the individualization process performed by the nurses. This protocol was approved in July 2015. DISCUSSION: By knowing the possible stages used in the individualization of a SCP, together with the elements that facilitate or hinder said individualization and nurses' attitudes and experiences regarding this phenomenon, it could help direct improvement strategies in the standardization and individualization process. In addition to recommendations for teaching and research.

Administración y suministro de medicamentos por enfermeras en zonas rurales o aisladas / Administration and provision of drugs by nurses in rural or isolated areas

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