RECOMMENDATIONS FOR FUTURE RESEARCH This study met its purpose by filling a research gap identified in the literature review. The finding reflected the weaknesses and limitations of this study. To further examine the difference a vascular access teams has on reported CLABSI, the researcher suggests the following approaches for future research.
ROLE OF THE TEAM Tasks of team members vary: these include (a) insertion and management of VADs (Cooley & Grady, 2009; Curry et al., 2009; Holzmann-Pazgal et al., 2012; King et al., 2010) (b) performance of daily assessment (Cooley & Grady, 2009; King et al., 2010), (c) holistic management of all central lines (Curry et al., 2009) and (d) maintenance (Cooley & Grady, 2009; Curry et al., 2009; Holzmann-Pazgal et al., 2012; King et al., 2010; Taylor et al., 2011) of CVADs. Not all teams perform the same level of care related to vascular access device insertion, care or maintenance. Understanding the role of the team may allow researchers to gain a better understanding of what team roles have the most impact on reported CLABSI rates.
TEAM MODEL VARIABLES A number of hospitals have incorporated vascular access teams to insert and maintain both peripheral and central catheters with positive outcomes (Alexandrou et al., 2012; Hawes, 2007; Johnson et al., 2017; McDiarmid et al., 2017). The Infusion Nursing Society (INS) described three infusion/vascular access service models (Hadaway et al., 2014). These models include; primary care, vascular access, and an infusion team. The primary care model is described as having no centralized process for infusion therapy or vascular access, where all related practice is provided and managed by all facility frontline registered nurses. Vascular access insertion team model represents a small group of highly skilled experts who focus on insertion of all VADs, this model includes advanced knowledge and skills in the assessment, insertion, care, and management of vascular access devices which include nurses, doctors, respiratory therapists, technicians, and physician assistants (Carr et al., 2018; Gorski et al., 2021). Studies of teams with well-defined outcomes and clearly defined roles and team compositions are needed (Legemaat et al., 2015). Understanding team variables may allow researchers to gain a better understanding of practice variations which have the most impact on reported CLABSI rates.
INFECTION PREVENTION STRATEGIES AND TEAMS Hospitals have implemented multiple strategies to reduce CLABSI rates. A major component of the quality improvement collaboratives included the CLABSI prevention bundle and the 20
Comprehensive Unitbased Safety Program (CUSP), designed to improve teamwork, communication and patient safety, and culture (Marsteller et al., 2014). This Comprehensive Program includes: (a) educating staff on the science of improving patient safety, (b) identifying patient safety defects, (c) partner with a senior executive to prioritize safety defects and provide resources, (d) learning from at least one defect per quarter using a structured tool, and (e) implementing teamwork and communication tools. Adherence to evidence-based practices has been shown to reduce inconsistencies in practice, significantly improving the overall quality of care, yet healthcare organizations still often find them difficult to implement (IHI, 2018; Stone et al., 2014; Valencia et al., 2016). Understanding the hospitals compliance with current evidence based bundle strategies in addition to the use of a team may allow researchers to gain a better understanding of bundle compliance and use of a dedicated teams impact on reported CLABSI rates.
PRACTICE AND POLICY Hospitals maintain polices to ensure the use of evidencebased practices. Healthcare administrators and front-line providers must collaborate with infection control prevention staff to establish and maintain evidence-based infection prevention policy (Vokes et al., 2018). To further prevent hospital-acquired infections, infection control policies should be updated regularly to reflect best practices, and proper change management techniques should be employed to mobilize and empower staff to increase their ability to prevent such hospital-acquired infections (Vokes et al., 2018). Understanding the hospitals use of current evidence-based polices in addition to the use of a team may allow researchers to gain a better understanding of policy compliance and use of a dedicated teams impact on reported CLABSI rates.
LEADERSHIP ENGAGEMENT Leadership plays a critical role in the implementation science of moving evidence and have an obligation to understand the impact they have on the healthcare organization (Knobloch et al., 2018). Leaders seek to include tools that increase engagement in frontline staff (Knobloch et al., 2018; Owings et al., 2018). Leader rounding allows for direct observation and conversation to find common solutions to clinical needs. Leader rounding has been shown to reduce HAIs such as CLABSI by engaging front line staff with checklists and prompting questions related to risk reduction options during patient engagements (Owings et al., 2018). Identification and removal of barriers is one role leader rounding includes in addition, to promotion of a shared vision of
