YEARS AND COUNTING

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 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

patient safety (Owings et al., 2018).

Empowering team members in the decision-making process has shown to increase morale, motivation and job satisfaction (Dromey, 2014). Today’s health care leaders are obligated to understand the impact they can have on both organizational and also unitbased safety climates (Knobloch et al., 2018). Each interaction between a leader and a frontline staff person has the opportunity to foster psychologic safety, which can lead to open problem-solving to reduce barriers and promote implementation (Knobloch et al., 2018). Understanding the level of leadership engagement in addition to the use of a vascular access team may allow researchers to gain a better understanding of leader behaviors that may impact reported CLABSI rates.

RECOMMENDATIONS FOR FUTURE PRACTICE

This section outlines recommendations for future practice based on the results and findings of the study. The recommendations are directed to healthcare leaders, vascular access teams and those interested in the impact of team models on hospital acquired conditions.

HEALTHCARE LEADERS

The first recommendation is directed to healthcare leaders tasked with improving patient outcomes. According to Marschall et al. (2014), healthcare leaders are accountable for identifying and implementing resources for hospital acquired infection (HAI) prevention. According to Porter-O’Grady and Malloch (2016), leadership must establish foundational team elements, to include purposeful information, effective deliberative processes, clearly defined roles of the team members, and terms of 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). Both teaching and non-teaching hospitals can benefit from the presence of a vascular access team.

VASCULAR ACCESS TEAMS

The second recommendation is directed to vascular access teams. A number of hospitals have incorporated vascular access teams to insert and maintain both peripheral and central catheters with positive outcomes (Alexandrou et al., 2014; Hawes, 2007; Johnson et al., 2017; McDiarmid et al., 2017). 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).

Implementation of a vascular access team positively impacts the hospital due to reduced supply costs, decreased the number of attempts to gain intravenous access, and increased time to treatments for patient care, and has been found to be beneficial to both patients and