Starting may be hardest part of data collection
Beginning useful, painless outcomes collection
There is a world of difference between making a decision and making an informed decision. It seems that, even with data collection requirements such as ORYX already in full swing, some providers still have yet to fully grasp the process and benefits of outcomes. If you feel slightly embarrassed in knowing you fall a bit short in data collection and putting that information to use, you should know you’re not alone.
"I had been called in to two very large institutions," says Lynn Moeser-Manly, RN, CRNI, and owner/director of IV Technologies, a consulting firm in Biloxi, MS. "One said, We’re using this particular catheter and it’s causing infections, and we want you to come in and help us know what’s going wrong’. And the other call was that a certain catheter was occluding so much they wanted to get rid of it."
Moeser-Manly’s first question to both institutions was, "How many catheters a year are you placing?"
"These very large, and I might add prestigious institutions, looked at me dumbfounded and said, We don’t have any idea,’" she recalls. "The first hospital only tracked catheter infection rates within their ICU/CCU. The second hospital said they had record of four catheters in the past year occluding after discharge to home care. They also commented that they had a lot of problems with catheters occluding all the time on the various units.’ They had no idea of the total number of catheters placed, in use, or total discharged to home care. It could have been 4,000, 400, or 40. Nobody knew. I can’t understand why the importance of this information isn’t recognized."
Getting started
If you need any motivation to collecting data or finally putting all those numbers sitting in a database somewhere to use, realize that it could provide answers to most of the questions you’re currently asking yourself and your peers. If providers took the time to collect, compile, and evaluate outcomes data, they would more often than not have their answers.
"Sometimes people call me and say, We flush with 10 units of heparin per cc, but everybody else says that’s wrong. What should we do?’" says Moeser-Manly. "If you had outcomes, you would know whether that procedure works for you."
But outcomes allow for more than quality patient care and patient satisfaction. They should also help bring in new business.
"The practice you are promoting, selling, or claiming is good practice has to be validated in some way," says Moeser-Manly. "There has to be something that shows you do good practice. Clinicians have no business promoting their practice if they don’t have outcomes to show."
Lastly, Moeser-Manly notes that information collected can ultimately lead to improvement in infusion therapy practice. She believes that "IV therapy is a continuum of learning. IV clinicians could/would/should be involved in practice design, direction and change, and that practice design, direction and change could/would/should involve the IV clinician.
"They don’t realize that they could actually help change practice by publishing information," she continues. "Just because you aren’t a research institution doesn’t mean you can’t do something relative to research. You work in the real world. Collect data about what you are doing, write about it, and get it out there."
Even if you don’t publish such information, Moeser-Manly says there is still a valid reason to collect data and use it: "Practice success and practice validation."
If you’re just starting out, Moeser-Manly agrees that it’s OK to begin with a very specific goal in mind rather than jumping in with both feet right away.
"Data collection is essential, but this can be as horrendous as someone chooses to make it," she says. "You don’t have to necessarily start by tracking every IV catheter that is in place. You can begin with just PICCs placed in radiology, for example. Or you can begin by evaluating 20 out of 100 peripheral IVs. Start small and build from there with an ultimate intention of capturing 100% of the information in the future."
Good places to start, according to Moeser-Manly, are:
1. Evaluating PICC or midline catheters that remain operational to the end of treatment.
"But that’s a tough one, because how do you define end of treatment? In a hospital setting is end of therapy when the patient is discharged? Not really. You might consider creating your own definition as a starting point, and in a perfect world it is the first step toward everyone using the same definition. Ultimately, we must strive toward a universal definition."
2. Phlebitis rate.
Moeser-Manly suggests using the INS phlebitis scale.
3. Occlusion.
"Everybody wants to argue about whether saline locks or heparin locks are most effective in maintaining catheter patency. If outcomes are being collected, they can check their own outcomes and see what is working for them," she says.
4. Catheter breakage or catheter leakage.
"Infusion nurses can do themselves in by thinking that they have to track 52 different monitors," notes Moeser-Manly. "Start with four, or even one, and build from there. Take in validating information on what you hope to show or prove without going into too many other areas of information. Just make sure to capture enough information that your end result is valid."
Two keys to success
Moeser-Manly notes that there are two ways to ensure that your data collection/outcomes process is productive. First, keep it as simple as possible.
"Ease of use is imperative," she says. "Any tool must be short, clear and concise. I like to see check boxes and objective reporting."
To help ensure the latter, make sure that everyone is defining phlebitis, for example, the same way. Issue a directive on how something is defined, such as a phlebitis scale chart," says Moeser-Manly.
The second way to ensure success is to provide feedback to those who are collecting the data.
"Somebody has to give feedback to the clinician in the field about results," says Moeser-Manly. "It has to validate practice or change practice, and that is the point of outcomes."
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