IV team creates setting for customized infusion care
Is a product-line more suited to your agency?
Productivity. Efficiency. Continuity of care. The catch phrases and buzzwords of the industry are easier said than accomplished. But one way of moving toward achieving all three is by creating an IV team.
While geographic teams have their obvious benefits predominately associated with improving efficiency and productivity through reduced travel time product line (also known as specialty) teams have their own benefits. This month, Home Infusion Therapy Management spoke with an agency that has had an IV team since 1981 and interviewed a home care consultant with extensive experience in creating such teams.
Make a choice
Home care agencies generally have one of two types of team structures: geographic and product line. Stephen Tweed, principle, Tweed Jeffries, LLC, a Louisville, KY, consulting firm, defines each:
1. Geographic.
A geographic team is pretty cut and dry. It’s one that is assigned a specific geographic area, and any patients that fall within that range become that team’s responsibility, regardless of the patients’ needs.
2. Product line or specialty.
Tweed defines a product line team as a group of health care professionals within an agency who provide direct care to patients with a particular diagnosis or particular type of service.
However, the responsibilities of a product line team will largely depend on how your agency sets up the team. Nurses in an IV team may do just IVs. Or, if a patient requires home infusion therapy, the IV team provides all of the patient’s care and not just infusion therapy.
It’s important to note that your agency can work with both geographic and product line teams. One agency Tweed worked with had eight teams: Seven were product line, with the eighth a primary care team that handled any patients who didn’t fit the other teams’ specialties. This eighth team was eventually divided into geographic subteams.
Improved communication may be the biggest benefit of having a product line team, says Tweed.
"The team works closely with a smaller group of physicians because physicians are often linked to the diagnoses: Cardiac physicians take care of heart patients; oncologists take care of cancer patients; and so on," he says. "And physicians like getting a call from one nurse caring for several of their patients rather than several nurses caring for one patient." Tweed also notes that managed care organizations similarly appreciate talking with fewer individuals.
Internal communication can also improve, which is exactly what happened at the Visiting Nurse Association of Louisville, says Gail Mansfield, RN, BSN, CRNI, executive manager of infusion and health promotion services at the VNA, whose agency set up its IV team about 15 years ago.
"The members of a team work together, and there is a lot of communication," says Mansfield. "Over the years, we have reduced the number of visits made because of the way we work together. We’re continually having inservices and talking among ourselves about tricks of the trade."
Patient’s like specialty team continuity
The VNA of Louisville’s infusion therapy team meets weekly for one to 11¼2 hours. During that meeting, the team may have a pharmacist discuss new medications on the market, or a physician may lecture on medical developments that may impact home infusion. In the past, the meetings were used as a forum for staff to discuss not only switching over to needleless devices but also the merits of the various brands.
"It helps us stay on the cutting edge," says Mansfield. "Otherwise, we wouldn’t have such specialty inservices."
Tweed adds that patients like such teams because even if they don’t see the same nurse every day, they see the same team members, so there is continuity of care.
Product-line teams present numerous external benefits, but you may have to compromise internally, says Tweed. For example, an IV team may have to serve a very large geographic area. Or if your IV team consists of eight nurses, those nurses must not only schedule their regular daily visits but also provide weekend and evening coverage. "What really suffers is internal operating efficiency," says Tweed.
But that’s not to say that product lines will cost your agency more by cutting into efficiency or profitability. One of Tweed’s clients switched from geographic to product line teams and, over a nine-month period found no significant impact on cost per visit.
Handling internal competition
Teams within the same agency may wind up competing against one another when it comes to productivity. While healthy in some cases, it’s best to minimize such competition, which can create a team vs. team mentality and inhibit in-house cooperation. Tweed says one way to minimize the negative impact of product line teams is to reward team performance, but take into account any cooperation and collaboration between teams.
"If one team has a nurse doing a visit for another team that is overloaded, there must be some way to measure and reward that," says Tweed. You can accomplish this by basing performance reviews or incentives on the number of patients cared for by a team, referrals, visits, or dollars in revenue, to name just a few.
Problems can also arise in deciding who cares for a patient. For example, if a cancer patient requires infusion therapy, would the patient go to the oncology team or the IV team?
IV nurses help on non-IV cases too
At the VNA of Louisville, any patient requiring infusion therapy receives care exclusively from the IV team. This provides continuity of care to patients while also requiring IV team members to stay current in areas other than IV therapy. In fact, the team often visits patients who don’t require home infusion at all.
"We don’t have enough patients that every visit an IV nurse makes is an IV patient, so we supplement their schedule with other patients such as [those requiring] dressing changes that might not relate to IV," notes Mansfield. "We do the difficult sticks for the agency such as patients who need lab work done. If a nurse in one of the other product lines has difficulty drawing blood from a patient, we’ll usually inherit that patient."
If your agency provides services other than home infusion, you may want to look for more than an IV background. When hiring for her IV team, Mansfield requires the applicant come from a background such as intensive care or the emergency room.
"We require they come from a high-volume area, so we know they’ve had a lot of experience with venous sticks," she says.
90% proficiency required
Experience isn’t all it takes to become a member of this team, though. Proficiency also is important. The agency’s own credentialing requires staff to have 90% proficiency, which means they must be 90% accurate in starting IVs. Mansfield says this is important because every time a nurse fails to start an IV, another nurse must make a follow-up visit to start the IV or, in cases when the IV is needed immediately, an emergency room trip may be required.
The VNA of Louisville’s IV team consists of 13 staff and visits more than 300 infusion patients in a 14-county area annually. Five of the staff are CRNIs and all are full time. Mansfield notes that the agency does not use part-time staff, even as fill-in, because it affects the continuity of care and familiarity with patients.
The team is led by a clinical manager and an executive manager. The latter handles marketing, public relations, and physician calls to establish contacts, in addition to other responsibilities. The clinical manager handles the day-to-day scheduling of the nurses, although many nurses, once assigned a patient, develop their own schedule for the patient and turn it in to the clinical manager. This gives the clinical manager time to assist the executive director in her job.
Creating a competitive advantage
Once your product-line teams are in place, you can package and promote the service those teams offer.
"You can go to a managed care company and tell them that you have staff that specialize in a particular area," says Tweed.
In addition to following Tweed’s recommendation of selling a specialty, the VNA of Louisville is able to sell its expertise in that specialty.
In addition to meeting proficiency standards, IV team members also must complete an eight-week orientation course that follows INS standards. After the initial course, each team member must pass an annual review. "We want to be able to say You can count on us; we’re 90% proficient.’" says Mansfield. "Our knowledge is a marketing tool."
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