title: Downsizing. Use intravenous clinicians to maintain quality venous access care.
abstract: 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.
authors.affiliation: Department of Veterans Affairs Medical Center, San Francisco, California, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Miller
mesh_terms: D017046:Cost Savings; D006754:Hospital Restructuring / Q000458:organization & administration*; D006801:Humans; D007262:Infusions, Intravenous / Q000451:nursing*; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D013041:Specialties, Nursing / Q000592:standards*