HI- our nursing administration financial analyst has asked us to report on our IV nursing functions on a daily data sheet. The purpose is to assign a formula of # functions/day and assign a time to each function in order to assess if we can add more FTE's. Is there an "industry standard" that is accessible that assigns an average time (that should be spent) for: PIV insertion, PICC insertion, midline insertion, portacath access/deaccess, PICC remove, PICC weekly dressing change, declot/"troubleshoot" PIC, etc. We did a staff survey, but we are also being asked for any "published" comparisons. Any help? Thanks-Andy
No such standards exists. The 3rd edition of the INS textbook, Infusion Nursing-An Evidence Based Approach includes a chapter "Infusion Therapy Across the Continuum" that contains a discussion of infusion teams. It does not contain any information about data as you are requesting. I am involved with some efforts involving these issues and I have not found anything that would come close to what you are requesting. Sorry it is not available, although it should be. Time and motion data is what you are asking for but there are no industry standards or even any published data that I have found for successful benchmarking. Some hospitals may have done their own internal time and motion studies and be willing to share their data. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks Lynn. That was helpful. We'll see if anyone posts any links to their internal time and motion studies. Andy
You can find the "Infusion Therapy Team Implementaion Module" on the INS web site, on page 62 they give an example of the time it takes for the things you are requesting. Its not a standard, but may help.
Thanks for pointed this out. I had forgotten about that book. It reports Nursing Time in 10 minute increments and one hour would equal 6 NT units. In looking at their list, I do have numerous questions about most of them. For instance, their numbers indicate a peripheral catheter insertion would be 1.4 NT or 14 minutes. A PICC evaluation is assigned 2 NT or 20 minutes. A PICC insertion is 6 NT or 1 hour. There is no explanation of what is included in this time assigned (assessment, education, collect of supplies, actual procedure, documentation, etc). They have calculated costs based on nursing salarys, but this was published in 2005. So this data is old. A more recent study by Roszell, et.al, used 20 minutes of nursing time for PIV insertion and calcluated the total costs including labor, supplies, overhead, and markup to be $45. There is a great deal of work needed in this area. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
I could agree with you more. More work is needed for this area. In our facility, I can spend 10 minutes looking for a table to set up my sterile field on and then clean it. Even though I take it out of a "cleaned" room sometimes I get so much grime off of it. I can spend 20 minutes or so just gathering what I need from the floor, under pads, blanket or pillow to put arm on. Clean off the patients table for their arm. Arrange the room, move the bed so as to have enough room to work and so on. This is before I even start to assess the arm.
I like going to the patients room as many of them are much more comfortable there. But extra time is involved. I have tried to get the floors to dedicate a overbed table for our use but to no avail. One floor did it for a while but then it "disappeared" even though it was clearly marked for "STERILE PROCEDURES ONLY".
Mary Penn RN
Appendix 1: Professional Organizational Procedure/Labor Requirement
Infusion Nurses Society (INS)
(Terry 1995 pg 27/Alexander 2010 pg 129/Baldwin 1988 pg 310,311)
Procedure
Description
1995 Time
Terry
2010 Time
Alexander
Facility Time
PIV Start
Simple
20 minutes
15 minutes
PIV Start
Difficult/2 attempts
45 minutes
PIV Restart
Simple
20 minutes
PIV Restart
Difficult/2 attempts
45 minutes
Long arm
Dressing not incl.
60 minutes
Midline
32.5 minutes
PICC line insertion
Dressing not incl.
Assessment incl.
120 minutes
PICC line insertion
With ultrasound
90 minutes
PICC line insertion/assist
Reposition PICC
CVC assist
45 minutes
X-ray verification/release
Site assessment
4.5 minutes
Site check
10 minutes
CVC dressing change
10 minutes
15 minutes
PIV dressing change
10 minutes
5 minutes
Discontinue PIV
10 minutes
4.5 minutes
Discontinue CVC
10 minutes
10 minutes
Access implantable port
30 minutes
17.5 minutes
Lab blood draws
15 minutes
12 minutes
Troubleshoot
Tubing, alarms
5 minutes
Fribrolytic treatment
22 minutes
Code blue
30 minutes
Inservice/teaching time
Repair tunneled catheter
20 minutes
Data entry/record keeping
Total # prepared
5 minutes
Blood product administer
45 minutes
TPN administration
4.2-4.8
(Baldwin 1988 310)
Inventory control
Stocking shelves
IV Push
5 minutes
Daily rounds
120 minutes
(Baldwin 1988 311)
Other (explain)
Total
Kathy's data does include the references for it. Please note that this is more than 20 years old. Has practice changed in any way that would alter these numbers? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
we need some new productivity numbers
This is all I can find that is published and it is twenty years old
I think that is a sad scenario
Kathy Kokotis RN BS MBA
Bard Access Systems