3M Health Care Academy

SM

Asia Best practice sharing

Adam Low
August
SM
2016
3M Health Care Academy © 3M 2015. All Rights Reserved

PIVs are failing around the globe
43%
51%
53% 38% 43%
26% 58% 27%
100%

42% 26%

34%
54%

Incidence from published PIV studies are not directly comparable
since definitions & study questions have varied, but……we do
seem to have a problem!!
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© 3M 2015. All Rights Reserved

Status of IV Nursing in Philippines
Located at the heart of the country’s primary central business district, MakatiMed
with 600-bed capacity delivers quality and compassionate service.

63.5 %
of the patients
receive Infusion Therapy

Ratio of Central Catheter v.s.
1:6 Peripheral used

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© 3M 2015. All Rights Reserved

Scientific Updates.Philippines Standards of Practice for IV Nursing Each hospital has their own set of Standards of Practice for IV Nursing . MakatiMed and other JCI Hospital adopted International standards. Institutionalized standards are reinforced thru conduction of Skills Training. and Quality measures 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

All Rights Reserved .Best Practices Medication Management CVAD Education for Pediatrics Program Training Program Quarterly Quarterly Conduction for Conduction for RNs RNs Basic Intravenous Therapy Scheduled during CARE Nurse Residency Program Intravenous Therapy Update Intensive Chemotherapy Monthly Education Program Conduction for RNs Quarterly Conduction for RNs 3M Health Care Academy SM © 3M 2015.

• Each institution benchmark from either national or international guidelines • Resources and management • Leadership through professional organization What are the top 3 concerns related to the practice of IV therapy in your country? • NO standards: Different techniques and practices • Available Resources and innovations. All Rights Reserved . policies and guidelines. • Data and Monitoring 3M Health Care Academy SM © 3M 2015.Philippines Challenges to Establish an IV Nursing Specialty What are the challenges or obstacles to doing this? • There is no national standard.

All Rights Reserved . China Overview • 医院建于1904年 Established in 1904 Shanghai Sixth People’s Hospital • 三级甲等综合性医院附属上海交通大 学医学院 General Teaching Hospital Affiliated with Shanghai Jiao Tong University School of Medicine • 开放床位1965张 1965 beds • 医院职工2968人 2968 full-time staffs • 护理人员1362人 1362 nurses 3M Health Care Academy SM © 3M 2015.

All Rights Reserved . 1999 3M Health Care Academy SM © 3M 2015. CINS  1990年成立 Established in 1990  是我国静脉输液领域中最具学术影响力的专业委员会 Most influential society in IV nursing in China  每年举办静疗会,促进国内外静疗专家交流 National infusion nursing conference held annually  1999年10月《输液治疗护理实践指南与实施细则》 Published the first guideline for IV practice in China in Oct.Infusion Nursing in China 静脉治疗专业委员会 Chinese Infusion Nurses Society .

IV Team in Hospital 上海市第六人民医院静疗小组全体成员 IV Team Members of Shanghai Sixth People’s Hospital • 组员Team Member:33 护理骨干 • 临床科室Clinical Department:19 15% • 护士长Head Nurse:28 • 护理骨干Clinical Nurse:5 护士长 85% 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

Outcomes  完成《静脉输液导管应用与维护图谱》的编印 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

All Rights Reserved . 钢针使用比例下降 Systematic Training 输液工具 PICC 1% PICC 8% Steel Needle CVC 5% 23% CVC 9% PVC 17% Steel Needle 77% PVC 60% 2010年 2015年 3M Health Care Academy SM © 3M 2015. Outcomes  教育培训: 合理选择输液工具.

All Rights Reserved . 高渗药物输液途径改善 Systematic Training: 输液工具 Central Line 33% PVC 16% PVC 67% Central Line 84% 2010年 2015年 3M Health Care Academy SM © 3M 2015. Outcomes  教育培训: 合理选择输液工具.

focus on the process • 优化标准化操作流程 Optimize the SOPs to meet the clinical needs • 制定核查表 Make related Checklists 3M Health Care Academy SM © 3M 2015.Trends and Challenges 如何提高护理人员操作依从性 How to improve nurses’ compliance? • 护理管理模式改变,更关注过程管理 Change Nursing Management method. All Rights Reserved .

All Rights Reserved .958 Therapy Attendances 300 Operations 1.140 Lab Tests 3M Health Care Academy SM © 3M 2015.396 Outpatient 454 Emergency Attendances Admissions Attendances 94 Ambulance Cases 1. Singapore 155 Inpatient 2.188 Radiological 30% Inpatient Investigations 70% Day Surgeries 13.

nurses (taught during IVM course) 3M Health Care Academy SM © 3M 2015.g. Status of IV Nursing For RN Governance on Scope of IV Nursing Practice at three levels: • MOH • SNB • TTSH No national IV Nursing Association IVM Training for Registered Nurses through: • Formal training in Nursing schools. All Rights Reserved . • Compulsory in-house course to train & certify competent to practice IV peripheral cannulation training through in-house courses Peripheral catheter e. insertion by interventional radiologist Care of PICC by respective dept. PICC.

All Rights Reserved . Possible sources for MRSA Bacteraemia from Case Review Perm Catheter Peripheral catheter Central line Intra Arterial catheter Peripherally Inserted Central Catheter (PICC) 3M Health Care Academy SM © 3M 2015.

During Insertion 2.Points of Contamination 3. Contaminated Infusate Rare but possible 1. Contaminated catheter hub & inadequate site care 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

How to prevent infection Before insertion of vascular catheter Peripheral Catheter Hand Hygiene Cleansing of skin Aseptic Technique Central Line Hand Hygiene Cleansing of skin Sterile Aseptic Technique Procedure 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

Hand Hygiene Before and after • Palpating catheter insertion sites • Inserting catheter • Accessing catheter site • Dressing of catheter 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

All Rights Reserved . Aseptic Technique • Before opening of package • Hand Hygiene • Hands are dry • Check package integrity & expiry date • Open without contamination • Insert without contaminating IV cannula 3M Health Care Academy SM © 3M 2015.

All Rights Reserved .Cleansing of Skin Cleansing Solution • Peripheral IV Cannulation • Alcohol Swab • Central Catheter • Chlorhexidine 2% with Alcohol 70% 3M Health Care Academy SM © 3M 2015.

surface contaminants and micro-organisms 3M Health Care Academy SM © 3M 2015.Cleansing of Skin Contact / Chemical • Sufficient amount of cleansing solution • Cover appropriate surface area • Antiseptic should be allowed to DRY Friction / Physical • Remove the dirt. All Rights Reserved .

Insertion of Central Lines Staff performing the insertion • Cap • Mask • Sterile gown • Sterile gloves Patient • Full Drape 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

All Rights Reserved .How to prevent infection After insertion of vascular catheter SCRUB the HUB Daily Review Dressing 3M Health Care Academy SM © 3M 2015.

All Rights Reserved .Scrub the Hub Scrub the hub with alcohol swab at least: • 10 times on the septum • 10 times on the thread (using luer locked syringe) 3M Health Care Academy SM © 3M 2015.

All Rights Reserved . Scrub the Hub 3M Health Care Academy SM © 3M 2015.

All Rights Reserved . Insertion Site Care Daily review of:  line necessity  insertion site Change dressing when:  soiled  wet  loose 3M Health Care Academy SM © 3M 2015.

How to prevent infection Before insertion of vascular catheter Peripheral Catheter Hand Hygiene Cleansing of skin Aseptic Technique Central Line Hand Hygiene Cleansing of skin Sterile Aseptic Technique Procedure 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

Preventing CLABSI Requires Teamwork • Inter-professional collaboration • Nurses • Physicians • Pharmacists • Other using CVADs • Support from administration • Staff involvement at all levels 3M Health Care Academy SM © 3M 2015. All Rights Reserved .

Thank you 3M Health Care Academy SM © 3M 2015. All Rights Reserved .