1. Accountable for Vessel Health and Preservation
Presenter Name

2. Learning Objectives Define Vessel Health and Preservation®
Review the evidence supporting the initiative toward Vessel Health and Preservation®
Discuss the Vessel Health and Preservation (VHP) model and components of Right Line, Right Patient, Right Time™
Describe the steps to implement the process of optimal vessel health and preservation through a clinical pathway

3. What is Vessel Health and Preservation®?
Vessel Health and Preservation® (VHP) is a clinical pathway protocol for vascular access that minimizes damage to vessels while preserving them for future use:
Patient Centered
Evidence-based
Intentional
Interdisciplinary
Safe
Collaborative
Systematic
Proactive
For use from patient admission to discharge, regardless of point of entry into hospital. This process in patient centered and each path in the protocol helps to reduce harm, preserve vascular anatomy but also to encourage an intentional assessment, device selection and insertion process.

4. Evolution of VHP:
The importance of early assessment is required for best outcomes 5-10
Ryder 1989
Santolucito 2001
Burns 2006
Pittiruti 2010
Jackson et al, 2013
Hadaway,1993 Ryder,1996
Barton,1998
Kokotis, 1999
Kokotis 2005
Moureau et al,
Patel, Santolucito
2007
This slide shows the timeline of evidence that supports use of assessment. Starting from Ryder almost 30 years ago.

5. Guidelines Supporting Vessel Health and Preservation®
Centers for Disease Control and Prevention,
Infusion Nurses Society,
Society for Healthcare Epidemiology of America,
Registered Nurse Association of Ontario,
Oncology Nursing Society,
National Kidney Foundation,
Institute for Healthcare Improvement,
Joint Commission on National Patient Safety Goals,
Association for Professionals in Infection Control and Prevention,
Association for Vascular Access,
Here is the list of supporting guidelines related to vessel health and preservation.

6. Safety, interdisciplinary, collaboration = better outcomes
Vessel Health and Preservation is a system consistent with Joint Commission’s “Patient Safety Solutions”21
Applies evidence systematically
Reduces patient and organizational risk
Sustains best practice through interdisciplinary effort
Creates new lines of communication
Changes culture by using patient focused goals
Studies have demonstrated that when nurse-physician collaboration is effective, it can23-25
Increase quality of care
Improve communication and coordination of care
Increase patient satisfaction
Increase job satisfaction and retention
Use slide as notes

7. VHP Components Education Selection Insertion Assessment Evaluation
Educate all staff involved in vascular access
Selection
Select the device that is most appropriate for therapy and preserves vessel health
Insertion
Insert the appropriate device using best practice bundles
Assessment
Use guidelines for daily goals and processes
Evaluation
Evaluate and monitor compliance and outcomes
The VHP components should all be done through a collaborative effort. Now lets review each component.

8. Right Line 
Educate all staff involved in vascular access the right training and practices
Assessment with treatment considerations
Selection of the device that is most appropriate for therapy and preserves vessel health
Insert the appropriate device using best practice bundles
Staff education for right training and practices
Assessment with treatment considerations
Interdisciplinary application

9. Device Selection Decision Tree Patient Requires IV Therapy
Osmolarity of solution Less than 900mOsm/L Not listed as irritant or vesicant
Peripheral Access (Three sites or more)
Osmolarity greater than 900 mOsm/L, irritant or vesicant Needs maximum hemodilution
Central Access
Duration less than one year
Consider PICC, Tunneled CVC or Totally implanted vascular access device
Duration less than five days
Maintain by peripheral cannula
Duration greater than five days
Two - Four weeks midline
Duration of greater
than one year
Choosing correct VAD becomes simple
Looks at the following:
Medication characteristics
Quality of venous status
Length of therapy
Review Article: Improving Patient Outcomes through CQI: Vascular Access Planning, by A. Barton, Journal Nursing Care Quality, 1998, 13(2):
This study revealed that patient’s who followed a vascular access planning algorithm had
Fewer IV’s
Less difficulty in IV insertion
Less stress
Waited less time until a CVC was inserted
Had shorter lengths of stay
Tunneled CVC or Totally implanted vascular access device

10. Right Patient Evaluation of patient risk factors
Insertion of device in a timely manner to avoid delay in treatment
Assessment of patient factors daily using guidelines for daily goals and processes

11. Right Time Daily assessment and goals for device necessity
Prompt removal of the device when no longer used
Evaluation of all processes and outcomes upon discharge

12. How does it work? The VHP Goal:
Patient admitted to hospital
Implement VHP within the first hours of admission
Initiate VHP protocol assessment and tools
Appropriate device selection on VHP assessment protocol based
Insert indicated device within 48 hours
Daily assessment tool used throughout hospitalization
Determine VAD necessity each day based on the assessment tool
Complete patient and clinician evaluation tools
Patient discharge
The VHP
Vascular Access Pathway: Intentional VAD assessment and selection26-31
Goal:
Right Line
Right Patient
Right time™
Include multiple disciplines in daily assessment (MD, bedside clinician, Pharm D)
Device not necessary-Remove
The goal of the VHP is provide patients with the best device selection based on a systematic, intentional process that considers the patient diagnosis, treatment plan and duration, acuity and vessel health.
The most appropriate device is one with the lowest risk for infection, including insertion site selection (subclavian vein) and number of lumens-INS, SHEA, CDC
VAD still required for treatment

13. Implementation Evaluate vascular access processes to identify gaps
Select a unit and present VHP™ program
Educate inserters and unit staff on Vessel Health and Preservation
Implement the tools and process in selected unit
Promote good communication between healthcare workers
Evaluate compliance and outcomes
Share success with hospital and spread the process
Describe each step in the implementation process.
VHP Accountability

14. Benefits Consistency of care Device selection with intention
Best practice guideline implementation
Fewer vascular access devices for greater patient satisfaction
Cost savings
VHP Accountability

15. Putting it All Together
Outcomes built in through assessment and evaluation26-31
Patient satisfaction improves
Fewer attempts at access per patient
Treatment completed without delay
Reduction in complications and improved outcomes
Cost savings related to fewer complications
Compliance with regulations
Promotion of interdisciplinary collaboration
Establishing an intentional process from assessment, device selection, daily assessment of correct device, necessity and function to device removal and discharge will improve patient satisfaction and facilitate completion of treatment plan

16. What is your next step?
Discuss the process in their facility, how would they apply this process in practice? Have the attendees share examples of what they currently do in relations to VHP.
VHP Accountability

17. References
Barton A., Danek G., Johns P., & Coons M. (1998). Improving Patient Outcomes through CQI: Vascular Access Planning: The Clinical Impact of Cost Reduction. Journal of Nursing Care Quality, 13(2),
Hoggard J, Saad T, Schon D, Vesely TM, and Royer T. Guidelines for Venous Access in Patients with Chronic Kidney Disease: A Position Statement from the American Society of Diagnostic and Interventional Nephrology Clinical Practice Committee and the Association for Vascular Access. Seminars in Dialysis, (2):186–191.
Royer T. (2010) Implementing a Better Bundle to Achieve and Sustain a Zero Central Line-Associated Bloodstream Infection Rate. Journal of Infusion Nurses; 33(6):
Warren DK, Zack JE, Mayfield JL, et al. (2004) The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest; 126:
Ryder M. Peripherally Inserted Central Venous Catheters. Nurs Clin North Am. 1993;28(4):
Kokotis K. Cost containment and infusion services. J Infus Nurs. 2005;28(3Suppl):S22-32;quiz S33-26
Moureau, Nancy L , Nancy Bagnall-Trick, Heather Nichols, and George Moureau. Forge New Pathways: Following an Intentional Process for Early Assessment of Vascular Access Selection for Patients Requiring Intravenous Therapy. Nursing Critical Care 2, no. 6 (2007 ): 28-36
A Retrospective Look at Tip Location and Complications of Peripherally Inserted Central Catheter Lines. James, Linda CRNI 1; Bledsoe, Lynn CRNI 2; Hadaway, Lynn C. CRNI 3 [Article] Journal of Intravenous Nursing. 16(2): , March/April 1993
Bowen Santolucito, Jamie. “The Role of Peripherally Inserted Central Catheters in the Treatment of the Critically-Ill.” Journal of the Association for Vascular Access 12.4 (2007): 208–217.
CDC Centers for Disease Control. (2011) Guidelines for the prevention of intravascular catheter-related infections: Centers for Disease Control and Prevention.
Infusion Nurses Society. (2016). Infusion therapy standards of practice. Journal of Infusion Nursing, 34(1S)
Marschall J, Mermel L, A, Fakih M, Hadaway L, Kallen A, O'Grady N., P., Yokoe, D. S. (2014). Strategies to prevent central line-- associated bloodstream infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35 (7), doi: /676533
O’Grady NP, Alexander M, Burns L A, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S and the Healthcare Infection Control Practices Advisory Committee (HICPAC). (2011) Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Disease 52: e162–e193.

18. References
15. Royal College of Nursing. (2010) Standards of Infusion therapy. London: RCN
16. Access Device Guidelines: Recommendations for Nursing Practice and Education (Third Edition) 2012 Oncology Nursing Society
17. Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates: Hemodialysis Adequacy Peritoneal Dialysis Adequacy Vascular Access National Kidney Foundation, Inc Accessed May 10, 2016.
18. IHI. Implementing the Central Line Bundle. Institute for Healthcare Improvement
19. Joint Commission. Accreditation Program:2012 Hospital National Patient Safety Goals. In: Commission TJ, ed2011:1-24.
20. APIC. Association for Professionals in Infection Control and Epidemiology
21. AVA. SAVE That Line!
22. Joint Commission. Improving America’s Hospitals: The Joint Commission's Annual Report on Quality and Safety, Quality and Safety. NPSG :2016.
23. Boone BN, King ML, Gresham LS, Wahl P, Suh E. Conflict management training and nurse-physician collaborative behaviors. J Nurses Staff Dev. 2008;24(4):
24. Schneider MA, Nurse-physician collaboration; Its’ time has come. Nursing Jul;42(7):50-3.
25. Saxton R. The Negative Impact of Nurse-Physician Disruptive Behavior on Patient Safety: A Review of the Literature. Journal of Patient Safety, September 2009 ; 5 (3):
26. Hanchett M, Poole S. (2001). Infusion Pathways: Planning for Success. Journal of Vascular Access Devices.
27. Moureau NL, Trick N, Nifong T, Perry C, Kelley C, Leavett M, Gordan SM, Wallace J, Harvill M, Biggar C, Doll M, Papke L, Benton L and Phelan DA. (2012) Vessel health and preservation (Part 1): a new evidence-based approach to vascular access selection and management. Journal of Vascular Access 13: 351–356.
28. Jackson T, Hallam C, Corner T, Hill Steve. (2013). Right Line, Right Patient, Right Time: Every Choice Matters. British Journal of Nursing 22 (Suppl) S24-8.
29. Hallam C, Weston V, Denton A, Hill S, Bodenham A, Dunn J. and Jackson T. (2016). Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborative. Journal of Infection Prevention 1–8 DOI: /
30. Rotter, Thomas et al. “A Systematic Review and Meta-Analysis of the Effects of Clinical Pathways on Length of Stay, Hospital Costs and Patient Outcomes.” BMC Health Services Research 8.1 (2008): 265.
31. Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D and Reed JE. (2013) Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety 23: 290–298.
32. Hallam C, Weston V, Denton A, Hill S, Bodenham A, Dunn H and Jackson T (2016) Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organizational collaborative. Journal of Infection Prevention 17(2): 65-72

19. Questions?
Any Questions?

20. Thank You
Thank You