As a nurse, I recognize the extraordinary amount of work that nurses take on, sometimes in chaotic environments. I understand that nurses work long hours on their feet, lifting patients, precepting, attending staff meetings, educating, and advocating for patients and their families. I get that. But, too often, I hear nurses make excuses for taking shortcuts with safety practices or ignoring them all together. "It's just an IV." "I don't have time." "I'm just too busy." None of these is a valid reason for shirking responsibility for patient safety. Infection is no longer an acceptable risk of infusion therapy.
Nurses, like other professionals, tend to get complacent over time. Sometimes you run on autopilot. Many tasks are routine, and you don't really stop to think what your next step is. In this case, experience can be hazardous to the health of your patients. Smith et al,1 in the May/June 2011 issue of the Journal, looked at factors influencing nurses' intention to disinfect needleless intravenous feeding systems. They concluded that recent nursing graduates were more likely to consistently use optimal disinfection techniques than experienced nurses.1 The authors posited that experienced staff failed to take advantage of educational opportunities that emphasize best practice disinfection techniques. "Too busy," some said. A number of the experienced nurses admitted that they sometimes forgot to take alcohol swabs when going into a patient's room to access a catheter and so they didn't bother to "scrub the hub." That is unacceptable. We need to make time to ensure that safe practices are embedded in the care the nurses deliver. The stakes are high and consequences are serious when shortcuts are taken, workarounds done, or basic fundamental practices ignored.
The Centers for Disease Control and Prevention2 recently released a report announcing that bloodstream infections in intensive care unit (ICU) patients with central catheters decreased by 58% in 2009 compared to 2001. That is good news, but not great news. Our goal must be a 100% decrease in central line-associated bloodstream infections (CLABSIs). Sustainability is difficult to maintain, but it is necessary to achieve the "zero" target of CLABSIs.
Dr Peter Pronovost of The Johns Hopkins University, an expert on patient safety, has expressed some frustration that all hospitals are not participating in programs to reduce rates of CLABSIs.3 One program, supported by the Agency for Healthcare Research and Quality, reduced CLABSIs in ICUs by 35%.2 But 80% of hospitals did not participate, even though data show that a checklist based on evidence-based practices and a teamwork model known as the Comprehensive Unit-Based Safety Program can improve patient safety.4 I think that many clinicians have mastered the checklist and the use of the central catheter bundle as part of the patient's plan of care; however, now the emphasis needs to shift to the care and maintenance of these indwelling devices.2 In addition, promotion of CLABSI elimination must expand outside the ICU settings, as central vascular access devices are seen in many other patient settings.
The main barriers to success are the lack of collaboration and systems integration, as well as a culture that is resistant to change.2 To reach zero CLABSIs, health care professionals must first make safety a priority, accept shared accountability, monitor and correct staff shortcuts and errors, communicate effectively with each other, and change the organizational culture so that "this is how we've always done it" is no longer supportable.
Infusion nurses understand the invasive nature and inherent risks of infusion therapy. I'm not sure all health care providers do, so there are teaching opportunities in all we do. We need to determine the most effective ways to promote best practice and integrate standards into patient care. So, please, no more excuses.
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