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cheryl ferraro
cheryl ferraro's picture
Policy and Procedure Problems

How would you feel if your place of employment were untimely in having policy and procedure for IV therapy and Central line care revised or even not having a policy available at all.  What if you are the only CRNI in your facility and offer input regarding the new standards of care and the input is not used.

Say there is an IV policy that expired in July of 2013 and was revised quickly prior to a JACHO visit.  This expired policy that was renewed now has outdated standards and wrong information.  What do you do?

  If there is no policy on CVADs and you write one based on best practices and that policy is passed around to other practicianers for input and the policy you wrote has now changed. Is there anything that can be done in a situation like the one Im describing?

Most companies are using Mosby software or some sort of software for there procedures so if you need to know how to do something you are referred to that software package so they dont have to have  a procedure manuel anymore.

lynncrni
Using published procedure

Using published procedure resources is totally acceptable IF they are current and meet the national standards and guidelines from a variety of applicable organizations. These resources usually do not include policies - the nonmodifiable, nonnegotiable rules specific for your organizaiton, staff, and patient population. You and your colleagues can not unilaterally write and begin using a document. These documents have to go through the appropiate committee(s) and be accepted. Without policies AND procedures, you and your facility has an increased liability for negative outcomes. These documents are used to guide decision making for each patient, so they are vital for your work. Have you spoken to risk management or infection prevention about the lack of these policies? Taken the problem up your chain of command to the CNO? Use these resources to get this problem addressed. 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

jill nolte
that is a little scary

I would feel unprotected, that's what.  Policy should not be random based on the opinion of the strongest personality in the place.  I've used a Lippincott online for nursing policy, it was outdated but it was possible to insert hyperlinks to update and/or modify.  Mosby's probably has the same. 

Sorry you have to deal with that.

cheryl ferraro
cheryl ferraro's picture
policy and nursing interventions

Hi Lynn

Id like your opinion on a similar issue but first  let me say,   The policy has been before committees. The clinical practice committee and the Professional Practice Council.  Ive  noticed policies have come out and I have not seen it come through the clinical practice committee.  Some seem to bypass our nursing committee straight to the other committee.  In truth I am so frustrated I am about to move on after 32 years of service.  I think when we went from hard copies to digital some things got left behind and then ended up lost.   One other thing Ive discovered is Normal Saline flush are not scanned.  To me no one is held accountable.  Same issue it went from an MAR to a BCMA and got stuck in a traffice jam on the information highway.

So my question to you, Do you think when a policy is written on CVADs alteplase should be a part of it?  Ive had a nurse express if that was put in the policy then everything that can go wrong should be included.  I feel the alteplase is a floor nurse respnsibility to assess that the cvad needs clotbusting and be expected to act on that intervention after discussing with the doctor and getting an order.   Other things that could go wrong usually require a nurse with special training not just a staff nurse who is competent in caring for CVADs.   When ever the policy gets out of the information highway traffic jam  it may have no mention of treatment with alteplase.  Sometimes I think there are too many cooks stirring the soup!

As always thanks for your valuable input

Cheryl Ferraro RN, CRNI

lynncrni
I would prefer to have a

I would prefer to have a separate policy and procedure addressing CVAD lumen occlusion. Long before you choose the solution to instill in the lumen, you must look at the history of the problem, the clinical presentation and patient factors, to determine the most likely cause of the occlusion. Then choose the most appropriate solution to treat it. tPA can not be used for every situation. This should not be lumped into a CVAD P & P on routine assessment, dressing changes, etc. I think a med-surg staff nurse will focus on the fact that she cannot get a blood return and/or cannot infuse and then immediately attempt tPA without these assessment piece. So I believe this assessment and management of lumen occlusion should be in the hands of infusion specialists. 

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

JackDCD
Nothing you can do!

Merry Christmas IV-Therapy

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