Reply To: SIP accessing in emergency department

  • Dena Mitchell

    Member
    April 29, 2020 at 11:05 am

    ​Hello.  We have had the same experiences as you are describing.  We put a PI into place a few years ago and all of the ED RN’s–new or experienced– spend a day in the outpatient clinic with one of our advance clinical nurses that has taken on clabsi and mediport accessing as her area of focus.  This nurse has worked 1:1 with the Peds ED educators and our quality department as well.  All of the RN’s in the ED have completed the skill competency on a manikin at the very least before coming to clinic.  For the clinic observation experience, the clinic nurse first reviews the procedure again on a manikin and has the ED return demonstrate.  They talk through trouble shooting scenarios as well.  The ED nurse then has the opportunity to access as many patients as we can coordinate for  and are willing.  Most of the patients have welcomed the ED nurse in these circumstances because they know that it will improve their personal experience and other patients in the ED.  We also created a mediport access kit through Cardinal, that has everything needed included sterile flush and blood drawing syringes, stopcock, etc.  That kit has helped them as well.  That being said, they still have struggles due to low volume opportunities to access in the ED.

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    Dena Mitchell, RN, CPON
    Assistant Nurse Manager
    Rainbow Babies and Children’s Hospital
    Cleveland, OH
    United States
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    Original Message:
    Sent: 04-29-2020 09:50 AM
    From: Teresa Munson
    Subject: SIP accessing in emergency department

    ​Our ED nurses have also struggled accessing ports. We currently have the ED spend a day orienting to port access in the Infusion Center. We have a few ports they can practice with and learn how to hold the needle and learn tricks from the Infusion staff. We usually let them watch one access then attempt another one or two depending on the number of patients and the patient allowing them to access their port with our nurse present .. This is work in process so hopefully it increase the ED nurse confidence in accessing ports.

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    Teresa Munson, RN, BSN, CPHON
    Nurse Manager
    Norton Children’s Hospital
    Infusion Center
    Louisville, Kentucky
    United States
    Teresa.munson@nortonhealthcare.org
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    Original Message:
    Sent: 04-28-2020 05:06 PM
    From: Mindy Bibart
    Subject: SIP accessing in emergency department

    ​Hello,

    Over the years, we have heard consistent feedback from our patients and families concerning their distress associated with having their port accessed by a nurse who isn’t as familiar with ports as hem/onc nurses. In response to their feedback, we have implemented hem/onc nurses accessing ports within the ED. Although adding this step has greatly improved patient satisfaction and decreased levels of distress about ED visits, it has negatively impacted our TTA metrics.

    Are any other programs sending hem/onc nurses to the ED or elsewhere to access ports? If so, has it impacted your TTA? If so, have you found solutions that have been beneficial in ensuring patients receive antibiotics quickly?

    Thank you,

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    Mindy Bibart, MSN RN CPHON NE-BC CSSBB
    Director of Patient Care Services, Hematology/Oncology/Blood and Marrow Transplant
    Nationwide Children’s Hospital
    Columbus, OH
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