BACSIG: VASCULAR ACCESS DEVICE USE IN SKILLED NURSING FACILITIES

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VASCULAR ACCESS DEVICE USE IN SKILLED NURSING FACILITIES

More than 1.6 million patients are cared for in the 15,000 licensed skilled nursing facilities (SNFs) in the United States (Centers for Disease Control and Prevention [CDC], 2016). Approximately 3% (48,000) of patients in these facilities require vascular access for intravenous therapy (LTC Pharmacy Provider, source). As of date, there are only five studies over the last 15 years, that have been published on this patient population in this care setting.

Comparatively, there are approximately 6,000 hospitals in the United States. A search of articles published since 2007 related to vascular access device (VAD) utilization and outcomes in acute care settings yields hundreds of results.

The limited studies in SNFs demonstrate significantly higher complication rates for VADs compared to acute care settings including CLABSI, catheter migration and dislodgment, catheter occlusion, and deep vein thrombosis, leading to resident transfers to the emergency department and subsequent hospitalizations (Hand, 2016; Harrod et al., 2016; Chopra, Montoya, et al., 2015).

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Additional studies found that 35-40% of hospital readmissions from SNFs were related to vascular access device complications; studies concluded residents with VADs in SNFs were significant predictors for hospital readmissions, and unplanned (Huang et al., 2018, Schmidt et al., 2017).

Patients in SNFs are older, have multiple comorbid conditions, and are at an increased risk of developing VAD complications (Lin et al., 2016). Skilled nursing facilities face staffing challenges due to high staff turnover and nurseto-patient ratios. The majority of the direct care staff in SNFs is unlicensed (over 60%); 23% are licensed practical nurses, and only 12% are registered nurses.

What about all the standards and guidelines we have access to drive evidence-based practice (EBP) in VAD utilization? For various reasons (staffing, culture, complex care setting), implementation of EBP in SNFs is deficient.

HOW DO WE RESPOND TO THIS CHALLENGING SITUATION?

The first thing we need to do – is respond. How can we collaborate with our SNF partners to support improved patient outcomes?

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1. Connect and build relationships with key staff at skilled nursing facilities where your hospital discharges patients.

2. Encourage your SNF contacts to become a part of AVA.

3. Identify areas where we can collaborate on education and research initiatives related to VAD care and utilization.

I am confident that this group of professionals has a vested interest in VAD best practice for our most vulnerable patient population.

Any other ideas? Please reach out to me: Gwen Coney DNP MA RN CRNI VA-BCTM , gconeyrn@gmail.com