The state of vascular access teams: Results of a European survey.

BACKGROUND: Many European health institutions have appointed multidisciplinary teams for the general management of vascular access to help improve efficiency, patient safety and reduce costs. Vascular access teams (VATs), or infusion teams, are specifically trained groups of healthcare professionals who assess, place, manage and monitor various outcomes and aspects of vascular access care. OBJECTIVE: To assess the current landscape of vascular access management as a discipline across Europe. METHODS: A Faculty of European VAT leads and experts developed a survey of 20 questions which was disseminated across several European countries. Questions focused on respondent and institution profile, vascular access device selection and placement, monitoring and reporting of complications, and access to training and education. The 1449 respondents included physicians, nurses, anaesthetists, radiologists and surgeons from public and private institutions ranging in size. RESULTS: Availability of dedicated VATs vary by country, institution size, and institution type. Institutions with a VAT are more likely to utilise a tool (eg, algorithm or guideline) to determine the appropriate vascular access device (55% vs 38%, P < .0002) and to have feedback on systematic monitoring of complications (40% vs 28%, P = .015). Respondents from institutions with a VAT are more likely to have received training on vascular access management (79% vs 53%, P < .0001) and indicated that the VAT was a source of support when difficulties arise. CONCLUSION: The survey results highlight some of the potential benefits of implementing a dedicated VAT including the use of a broader range of vascular access devices, increased awareness of the presence of vascular access policies, increased the likelihood of recent vascular access training, and increased rates of systematic monitoring of associated complications. The study reveals potential areas for further focus in the field of vascular access care, specifically examining the direct impact of vascular access teams.

Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams.

BACKGROUND: Vascular access by means of intravenous catheters is essential for the safe, effective and cost-efficient delivery of intravenous fluids, antibiotics, nutrition and chemotherapy, but the use of these devices is not without complications. PURPOSE: A faculty of multidisciplinary European vascular access team (VAT) Leads/Members and experts sought to reframe how the implementation of a VAT could have positive impacts on patients and hospitals. METHODS: Interview data from a Faculty of nine VAT Leads/Members and experts from six European countries on the impact of multidisciplinary VATs in modern healthcare were assessed. A literature search was conducted that included Medline®-cited peer-reviewed articles published in the past 10 years in order to identify impact data and post-implementation of a multidisciplinary VAT that support the benefits to patient safety and satisfaction and to hospital efficiencies reported in the interview program. RESULTS: While VATs vary in structure and function, clarity of purpose and supportive training and education are key. Barriers to the implementation of VATs show commonality across countries, such as lack of investment, insufficient training and lack of awareness. Proven markers of VAT success include rapid referrals, improved patient outcomes and improved organizational efficiency. Standardization of outcomes data capture, processing and reporting are key to monitoring performance against baseline. Awareness of the cost of complications arising from inappropriate choice and placement, and poor care and maintenance, of the vascular access device must be raised. CONCLUSIONS: The implementation of VATs can positively impact patient safety and satisfaction, improve organizational efficiencies and cost-effectiveness, and could create new opportunities for in- and outpatient services, beneficial to both patients and institutions.

Promoting safe IV management in practice using H.A.N.D.S.

The aim of this article is to promote best practice for the insertion and care of intravascular (IV) devices. The H.A.N.D.S. acronym was created to serve as an aide memoire to general and specialist nurses regarding the 5 key interventions to prevent catheter-related bloodstream infections (CRBSIs). In order to promote safe and evidence-based practice in IV therapy a practical guide with clinical information about common IV procedures has been developed. This article provides back-to-basics guidance on how to deliver IV therapy safely and effectively.

HANDS: standardised intravascular practice based on evidence.

Observed and audited variability in the insertion and care of vascular access devices (VADs), despite national guidance, led an intravascular (i.v.) team to develop seven basic standards under the mnemonic of HANDS. This initiative combined the Saving Lives guidance (Department of Health, 2007) with i.v. care bundles to reinforce best practice. The main reasons for the project were to decrease bacteraemia rates related to i.v. devices and to improve practice. The strategy of strengthening care bundling--Project HANDS--with a targeted education programme was adopted to ensure i.v. practice was consistent and evidence based. This project took a novel approach that evaluated the application of infection control measures, using i.v. device care as a tool to influence organisational change. This resulted in quality improvements and better patient outcomes. Further actions include disseminating the learning from this project to healthcare partners and in the community.