Miller P K
Department of Veterans Affairs Medical Center, San Francisco, California, USA.
J Intraven Nurs. 1998 Mar-Apr;21(2):105-12.
Many authors demonstrate the cost effectiveness of using intravenous teams to provide quality venous access care. Despite this evidence, many hospitals are dissolving their i.v. teams as a way of cutting costs. This article provides a guide for downsizing while maintaining quality i.v. therapy. The article chronicles events before and after the disbanding of the i.v. team of the San Francisco Veteran's Administration Medical Center. The focus of the article demonstrates how creating two advanced practice positions is instrumental to maintaining quality i.v. care. Quality is defined as line-associated bacteriemia rates and compliance rates to i.v. care standards, remaining unchanged or better after the downsizing of the i.v. team. Line-associated bacteriemia rates are presented in terms of infections per 1000 line days when possible. Compliance percentages are obtained by auditing compliance to site changes, central line policy. The data are provided in chart form, and definitely show a sharp decline in line-associated bacteremias after the advent of the i.v. clinician role. These data provide clear evidence to support the Intravenous Nurses Society position on the role of the intravenous nurse specialist. Conclusions emphasize the need for i.v. nurse clinicians to provide critical care coverage, ongoing educational programs, outcome auditing, and nursing research in vascular access and i.v. therapy.
许多作者证明了使用静脉输液团队提供优质静脉通路护理的成本效益。尽管有这些证据，但许多医院仍在解散其静脉输液团队以削减成本。本文提供了在维持优质静脉输液治疗的同时进行精简的指南。本文记录了旧金山退伍军人管理局医疗中心静脉输液团队解散前后的事件。文章重点展示了设立两个高级实践职位如何有助于维持优质静脉输液护理。质量定义为与导管相关的菌血症发生率以及静脉输液护理标准的依从率，在静脉输液团队精简后保持不变或有所改善。只要有可能，与导管相关的菌血症发生率以每1000个导管日的感染数来表示。依从率百分比通过审核对置管更换、中心静脉导管政策的依从性来获得。数据以图表形式呈现，明确显示在静脉输液临床医生角色出现后，与导管相关的菌血症急剧下降。这些数据为支持静脉输液护士协会关于静脉输液护士专家角色的立场提供了明确证据。结论强调静脉输液临床护士需要提供重症护理覆盖、持续教育项目、结果审核以及血管通路和静脉输液治疗方面的护理研究。
