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“Waste is endemic in health care” was a statement was made by Derek Foley, president and CEO of the Institute for Healthcare Improvement when he put out a call to action to reduce waste in the US health care system. All this waste is leading to a higher cost to deliver care and creating urgency for all health systems to examine this issue. At an 867-bed, level-1 trauma center in Connecticut, one vascular access specialty team (VAST) has been documenting waste reduction. As a result, this VAST has demonstrated cost reductions and is saving bedside staff nurses’ time, resulting in more quality time spent with patients. With these waste reduction initiatives, this VAST has increased their revenue budget by approximately 8 million over the past 2 years and has increased the team size by 67% since 2015. In this presentation, you will be guided through this VAST’s 7-year journey describing all the initiatives that led the growth of this VAST.

Learning Objectives: At the conclusion of this session, learners will be able to: 

• Describe lean thinking and the importance it has in health care in reducing waste and nonvalue added activities
• Explore all the ways a VAST can show support of key hospital objectives through the care they provide, using lean thinking to drive and sustain their improvement initiatives
• Explain how a VAST can collect and use data to assure they are viewed as a value-added entity to their health care institution

Hospitals have been collecting data on central line associated complications, most notably central line associated bloodstream infections (CLABSI) for many years; however, many do not include PIVC infection surveillance in their scope. Although not yet mandated in the United States at the federal level, clinicians are encouraged to review strategies for collecting and reporting this data to help drive progress in improving safety across all vascular access and infusion activities to enhance vessel health and preservation. In this session, we will review the current literature on PIVC-related infections and complications, discuss strategies for conducting surveillance, and explain how to use of the data to improve patient outcomes.

Learning Objectives: At the conclusion of this session, learners will be able to: 

·      Describe the current literature on PIVC-related infections and other complications

·      Discuss strategies for conducting surveillance on PIVC infections

·      Explain how to use the surveillance data to advocate for your patients

Because of the invasive nature and the pervasive use of vascular access devices (VADs) in all health care settings, use of expert assessment skills throughout the life of each VAD is crucial to enhance patient safety and optimize VAD function. Knowledge of VAD-related complications and associated risk factors is essential to ensure proper VAD function and to mitigate potential patient harm through early recognition. Once a particular VAD is selected and successfully placed, continued assessment based on VAD, on the patient, and on infusate risks is crucial. This talk will review VAD-related complications and related global VAD assessment parameters that are utilized to optimize patient outcomes. These concepts will then be applied to the proper assessment and management of peripheral and central VADs in a variety of clinical settings.

Learning Objectives: At the conclusion of this session, learners will be able to:

· Describe global VAD assessment parameters that will enhance optimal VAD function and early recognition of complications

· Discuss utilization of patient and infusate-based assessment parameters to improve peripheral IV management

· Relate the use of device-specific CVAD assessment criteria to optimal device performance and positive patient outcomes

With the rapid expansion of an ultrasound to guide vein cannulation, first-time access success rates have improved. However, this has also led to some problematic peripheral vascular access device placements. Due to the invasiveness of the procedure and the risks associated with it, adherence to a systematic process on all cannulation under ultrasound guidance is optimal to promote the success of device utilization and the health of the vein. Proper sequence, prompt assessment, and ongoing evaluation ensure the enhancement of patient satisfaction, reduce risks, and deliver quality of care. 

Learning Objectives: At the conclusion of this session, learners will be able to: 

1.     Describe clinical assessment parameters for the difficult intravenous access patient and probe technique that maximizes acoustic return improving visualization

2.     Explain how rounding on all vascular access devices (VAD) has reduced our incidence for complications as it relates to the appropriate device

3.     Verbalize common problems associated with ultrasound-guided peripheral intravenous catheter and midline insertions 

4.     Discuss how disseminating the standards of practice with proper technique and VAD knowledge contributes to better outcomes

Establishing a goal of one vessel, one catheter to complete the prescribed therapy requires careful assessment, careful selection, and proficient insertion of the most appropriate catheter size and length. Technology used with catheter materials, needleless connectors, and management practices can extend or limit catheter life, and consideration of a hemodilution ratio, as outlined by Roethlisberger, may help to evaluate the optimal location for catheter insertion and infusion of the treatment plan designed to achieve the one goal. In this session, we will discuss characteristics of optimal vein selection incorporating the INS Standards regarding insertion and vein visualization; consider VAD technology and management practices; and explore the impact of hemodilution upon one cannulation, one vessel, one VAD.

Learning Objectives: At the conclusion of this session, learners will be able to: 

·      Explore the characteristics of optimal vein selection including quantitative assessment of size, flow, and valve locations

·      Discuss INS Standards and evidence for selection and recommended forearm placement for peripheral intravenous catheters

·      Explain the 4Vs of hemodilution and the 3:1 ratio to achieve one vessel, one cannulation, one VAD

Reducing contamination incidence in blood culture, an immediate health care priority, is solvable with available techniques and technology. While nearly all patients with suspected bloodstream infection have blood cultured, contamination is substantially more prevalent in communities without access to dedicated (and expensive) phlebotomy teams and is thus substantially more costly to communities with fewer personnel and financing resources. Antibiotic resistance is a global concern and antimicrobial stewardship must be a global initiative with proactive investments. To illustrate with a practice-pertinent example, in patient safety we invoke the current state of blood culture, where contamination may be eliminated with the adoption of cost-saving techniques and technology, but a lack of awareness and outdated standards have impeded uptake. This session will provide nurses with knowledge on specific guidelines and interventions to reduce specimen contamination during blood culture procedure.

Learning Objectives: At the conclusion of this session, learners will be able to: 

1.     Recognize that outdated blood culture practice standards have led to negative local and global consequences for patient safety, health care equity, and antimicrobial stewardship

2.     Describe how modern tools and techniques can circumvent the collapse of blood culture protocol that frequently occurs in the presence of environmental stressors associated with nursing

3.     Explain strategies to meet blood culture practice targets that sustainably exceed both established and anticipated quality standards

Sepsis is a life-threatening condition which requires immediate intervention. If not promptly treated, patients with sepsis can experience shock, organ failure, or even death. Whether sepsis is identified in the community or in acute care, decreasing the time in which the patient with sepsis obtains necessarily treatment is critical. In this session, we will discuss sepsis assessment tools, the most recent sepsis related guidance, and initiatives and community awareness education.

 Learning Objectives: At the conclusion of this session, learners will be able to: 

1.     Describe sepsis condition, existing tools, and criteria related to the hospital admission of a sepsis suspected patient

2.     Discuss effectiveness of monitoring and preventing measures within hospitals according to new sepsis guidelines

3.      Explain the importance community awareness education

The prevalence of obesity has risen exponentially over the past several decades, also leading to a significant rise in the number of bariatric procedures performed for weight loss and comorbidity abatement. The association between obesity and iron deficiency, as well as iron deficiency as a long-term effect of bariatric procedures, is just now being fully appreciated, which is leading to a rapid increase in the use of intravenous iron. Best patient outcomes result when the infusion nurse is knowledgeable about the etiology behind the treatment and the safety issues related to iron infusion therapy. This session will describe the relationship between obesity and iron deficiency, explain the ways in which bariatric procedures cause iron deficiency, and provide guidance for the safe provision of intravenous iron infusions to this patient population. 

Learning Objectives: At the conclusion of this session, learners will be able to:

1.     Discuss the relationship between obesity and iron deficiency

2.     Explain three bariatric surgical procedures that can result in iron deficiency

3.     Assess a patient for 3 symptoms of iron deficiency anemia

4.     Recognize the indications for intravenous iron replacement Describe at least two potential complications of iron administration and appropriate interventions

Hospitalized adult patients often require more than 1 PIVC to complete the prescribed intravenous (IV) therapy due to catheter failure and the practice of routinely replacing PIVCs. The purpose of this quality improvement project was to increase the number of PIVCs dwelling for the entire duration of the IV therapy in hospitalized adult patients using a bundled approach. In order to reduce the number of PIVC insertions and catheter failures, clinicians implemented an engineered securement device, educated staff pertaining to modifiable risk factors, and changed the practice to remove PIVCs upon clinical indication. This session will allow the learner to identify methods to safely increase the dwell time for PIVCs.

Learning Objectives: At the conclusion of this session, learners will be able to:

1.     Identify two interventions utilized to reduce the number of PIVCs per patient

2.     Summarize the cumulative outcomes of the interventions including reducing the number of PIVCs per patient, catheter failures, central line bloodstream infection (CLABSI) rates, cost savings, and location and gauge risk of failure

3.     List two change management methods utilized to implement the quality improvement initiative at the rural hospital