Becton, Dickinson And Company · NYSE:BDX
Becton, Dickinson And — MACOVA 2020
42 slides from Becton, Dickinson And's conference presentation, April 2020
Slide 1: Presentation disclaimer
These presentations were developed by the respective presenter(s), and the findings, interpretations, and conclusions contained or expressed with them do not necessarily reflect the views of BD. To the extent these presentations relate to specific products, such products should always be used in acc
Slide 2: The broad reach of the vascular access team; A multidisciplinary approach
The broad reach of the vascular access team; A multidisciplinary approach Andrew Barton NIVAS UK Chair Advanced Nurse Practitioner Vascular Access & IV Therapy Lead Frimley Health NHS Foundation Trust
Slide 3: Intravenous & Vascular Access Services
PICC Insertion Team Difficult IV Research & Development Access Patient Home Patient Infusion Safety Intravenous Therapy The broad Leadership & Vascular reach of our Infusion Vascular Access Services Therapy Unit Access Service IV Therapy Leadership Team Practice Central IV Development Access & Train
Slide 4: Intravenous & Vascular Access Services (IVAS) Team
Intravenous & Vascular Access Services (IVAS) Team IVAS associate practitioner IVAS care assistant
Slide 5: Our Service Users
recon Our Service Users Orthopaedic Level one dependency Parenteral Nutrition ‘Ambulatory Gynaecology Critical care IV/Vascular access service Paediatrics ADU Radiol ee Gastroenterology Respiratory Endocrine Endoscopy Frimley Health NSS MACOVA 2020 cnnnammestiiiel
Slide 6: PICC Insertion Team
PICC • 1 Advanced nurse Insertion • Practitioner 3 Clinical Nurse Specialists • Place 150 PICCs per month Team • 2 hospital sites
Slide 7: PICC insertion with navigation and ECG
PICC insertion with navigation and ECG • Same day placements • Confirmed placement in under an hour • Suitable for 95% adult patients • No Malposition’s • Low Waste • Cost saving • NICE recommended
Slide 8: Difficult IV Access Patient
• Paediatric patients Difficult IV • Overweight or obese patients • Elderly patients • Chronically ill Access • Emergency / acute (i.e. skin burn, haematoma, dehydration) Patient • Oncology • Needle Phobic
Slide 9: IVAS team is reactive to patients needs
• IVAS team is reactive to patients needs • Can attend patients within 10mins or be booked in • Attend emergencies • Multiple referral portals
Slide 10: Prioritise vessel health
• Prioritise vessel health • Reduce the number of needle sticks • Improve patient outcomes Copyright – Andrew Barton 2020
Slide 11: 4 Step Approach for DIVA
4 Step Approach for DIVA Frimley Health EAS, MACOVA 2020 —s nly eat
Slide 12: Vein Technology
Vein Technology dh lien ~ Frimley Health IT {}MAS, MACOVA 2020
Slide 13: Longer catheter PIVC
i Longer catheter PIVC cw -. ® en a MACOVA 2020 Frimley Health IT {MAS, NHS Foundation Trust
Slide 14: Patient Safety Leadership
Patient • Work closely with patient safety team • Lead reviewer for all clinical Safety incidents for the Hospital • Respond to complaints • Co-ordinate serious incident Leadership investigations • Respond to national alerts • Learn from incidents and update Hospital wide practice
Slide 15: Day 6 photographs
Frimley Health Day 6 photographs us
Slide 16: Day 15
Frimley Health Committed To Excellence | Wor her Facing The Future
Slide 17: Extravasation diagnosed
EXTRTAVSATION DIAGNOSED = 5% Dextrose 40mmol K+ Osmolarity 409, pH 4.2 Over the 8 days the patient was an inpatient he had been treated for high calcium and low potassium with 6 litres of 5% dextrose with 40mmols potassium via a peripheral cannula in the right arm.
Slide 18: Learning
Learning • Implement pump checklist and fluid chart • Double check initial starting infusion rate • All infusions via a pump if longer than an hour or a vesicant • Check pump infusion pressure setting • Weekend IV and vascular access support needed • Include incident in annual IV updates
Slide 19: IV Therapy Leadership
• We work closely with infection IV control and attend monthly hospital infection control committee meetings Therapy • Interventional nutrition group • Parenteral nutrition • Safer medication committee Leadership • Audit IV medication errors • Govern injectable medications policy and review fitness
Slide 20: Patient outcomes
Patient outcomes • No insertion infections • 2017-19 No CVC/PICC related blood stream infections • Low patient harms • 1 CVC retained wire • 1 CVC air embolism
Slide 21: Clinical Procurement
Clinical Procurement • Have supported our IVAS team to grow and provide the most up to date technology and materials • Gate keepers to product standardisation • Procurement Clinical Nurse Specialists • Values high standards of care alongside cost savings • Clinical product evaluation co-ordination •
Slide 22: Standardised protocol's
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Slide 23: Central IV Access Service
Central IV • The IVAS service can place all Access vascular access devices as required Service
Slide 24: Advanced Vascular Access Services
Advanced Vascular Access Services
Slide 25: Nurse led PORT insertion service
Nurse led PORT insertion service Placing with ECG
Slide 26: Specialist IV Access
Specialist • Renal IV Access • Paediatrics • Satellite USS PIVC services IV Access • Individualised IV needs
Slide 27: Paediatrics
Paediatrics • Device selection should be appropriate for first insertion • Vessel health should be considered including tip location and vessel diameter • Technology guided insertion • 4 step approach • Good device after care & maintenance is essential • Paediatric nurses and doctors have been train
Slide 28: Specialist IV services
Specialist IV services • Ultrasound stations • IVAS link nurses • Phlebotomy USS • Community support – GP referrals
Slide 29: Policy & Governance Leadership
• Cross site vascular Policy & access guidelines • Injectable medicines Governance policy • Complications guidelines Leadership • Fluid administration guidelines • Extravasation policy
Slide 30: Policies
Policies cea. Premley Health EG El Listone ms Care of your Vascular Access Device PICC Line Peripheral Inserted Central Catheter A guide for patients carers and community nurses nara PCC hubs ‘ower nyectabl, ey Health foundation Trust icing The Future contrast via a power PIC( Are you Injection? Che
Slide 31: Practice Development & Training
• IV therapy administration Practice course • Venepuncture and cannulation course Development • International vascular access academy & Training • Decisions making tools • Care bundles • Documentation
Slide 32: Choosing the safest vascular access device
Difficult Vein Access Use Vein Location Technology Ultrasound Veins below 5mm Infrared Veins up to 7mm Vein Stimulation Enlarges and stabilise peripheral arm veins Consider local/topical anaesthetic Copyright – Andrew Barton 2020 CHOOSING THE SAFEST VASCULAR ACCESS DEVICE
Slide 33: Care bundles
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Slide 34: Care bundles
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Slide 35: Documentation
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Slide 36: Infusion Therapy Unit
• Same day IV therapy • Iron Infusion • Blood transfusion Infusion • • • Venesections Antibiotics Frusemide Therapy • • • IV fluids MS Immunology -IVIG Unit • Drop in cannulation and venepuncture • Outpatient vascular access
Slide 37: IVAS unit
IVAS unit • Infusion unit • 10 chairs • 9 infusion nurses • Specialist IV infusions • OPAT • Nurse led • Non-medical prescribers
Slide 38: Home Infusion Therapy
Home • Nurse led with support from microbiology • Home IV antibiotics Infusion • Weekly nurse led clinic • Patient self administration • GP referrals Therapy • Pathway practice • Integrated care systems
Slide 39: Research & Development
• Veinsite – infrared vein location Research technology • SecurAcath • SyrEase & • Sherlock 3CG • CHG Dressings • Portocator Development • Veinplicity • PORT placement with ECG • Community IVAS • New catheter securement device Cath Latch
Slide 40: Building a vascular access team
Building a vascular access team • How will a team benefit your organisation • What will the team offer • Who will help make it happen • How will it be funded • What will the service offer • How will outcomes be measured
Slide 41: Current focus in IVAS clinical practice
Current focus in IVAS clinical practice • Partnership working, taking care out of the acute hospital bed • IV therapy delivered in hubs and day units • Reliable IV devices that are cost effective, safe and robust • Reduce the risk of catheter related blood stream infections • Reduce the risk of exit
Slide 42: Thank you MACOVA
Thank you MACOVA