Development and evaluation of an intravascular link nurse network to sustain improvements in practice.

Link nurses have been used to support many areas of specialist nursing practice since the 1980s. They add value as they provide a practical and timely way of sharing information and knowledge and raising awareness with the wider multidisciplinary team. One strategy to improve standards and sustain improvements in the care of vascular access devices was to develop an intravascular link nurse network: 'Finding the missing link'. The link nurses are supported to attend quarterly masterclasses underpinned by the current evidence base. The masterclasses provide forums and workshops for learning, sharing initiatives, processes, progress and feedback. Results from the 2018/2019 sessions evaluation showed that 80% of the link nurses scored the workshops as excellent, 14% good, less than 1% fair and poor, and 4% did not provide an answer. Overall, 87% of link nurses were extremely likely to recommend the programme, 13% were likely to recommend it, and 93% found it helpful in their personal and professional growth. The network with supporting masterclasses has proven to be an effective strategy within the Trust.

Evaluation of clinically indicated removal versus routine replacement of peripheral vascular catheters.

Latest clinical guidelines for peripheral vascular catheters (PVC) recommend that they should be removed only when clinically indicated and not routinely removed and replaced. In 2017, the authors' hospital policy was changed to align with the new recommendations and, between March and July 2019, 500 PVCs were audited at two main sites to evaluate the efficacy of the change. Of the 500 PVCs, 31% (n=155) were in situ for more than 3 days (range 4-22 days). Analysis of the combined data showed an overall prevalence of phlebitis at 8%, but variation in trends looking at each individual site (7% and 9% respectively) with a wide variation for PVCs in situ for more than 7 days. Implementing clinically indicated removal of PVCs has resulted in better patient experience with fewer PVCs for a course of treatment. Implementation has also resulted in cost savings for the Trust with a notable decrease in number of PVCs used.

Reassessing standards of vascular access device care: a follow-up audit.

This article reports on the findings of a repeat audit of vascular access devices (VADs) in a district general hospital undertaken 4 years after a previous audit. The first demonstrated poor standards of care and low compliance with evidence-based guidelines, indicating that a change in practice was necessary. A strategy of training, education and standardisation for intravenous devices was introduced, with the goal of transforming practice to raise standards and improve compliance. The findings of the follow-up audit show that the strategy has been successful in raising standards of care and reducing infections.

Assessing standards of vascular access device care.

Vascular access devices (VADs) are essential in health care as they provide vital access for treatment including the infusion of medication, fluids, blood products and nutritional supplements. However, their invasive nature predisposes patients to potential complications, primarily bloodstream infections. This article examines the current standards of VAD care and assesses compliance with current guidelines (national and trust policy) in one hospital setting utilising a practice audit. The audit was conducted in a 500-bed district general hospital over 6 non-consecutive week days. The medical division where the audit took place had 13 wards with 288 beds. A total of 120 VADs were audited, averaging n=9.2 per ward (with a range of 4-18 on each ward). The results demonstrated a collective non-compliance rate of 48%. Although overall compliance was 52%, a poor standard of care was highlighted across the division for all components of the care elements. The post-insertion care of VADs is an essential component of a comprehensive strategy to prevent complications. Consequently, initiatives such as audit, education and feedback should be used in an effort to improve practice and maintain optimal care.