Lee Steere (RN, CRNI, VA-BC) holds national certification in Certified Registered Nurse Infusion as well as Vascular Access Board Certification. An RN for 21 years, he is the Manager of IV Therapy Services at Hartford Hospital in Harford, CT. He co-chairs the hospital’s Medical-Surgical Clinical Value Analysis Committee and is a member of their HAI Committee.

As an experienced speaker, Steere has presented at regional and national INS and AVA conference meetings. His AVA 2017 presentation on Patient’s 5 Rights was based on his recently published Lean Six Sigma for Intravenous Therapy Optimization: A Hospital Use of Lean Thinking to Improve Occlusion Management/March 2017 JAVA.

There are more intravenous catheters sold per year than there are people in the United States. That averages approximately 10 catheters per patient stay with an estimated annual cost of $9.8 million for intravenous catheter therapy. In a 2020 webinar summarized below, Lee Steere, RN, CRNI, VA‐BC discusses concerns about waste associated with PIVC care. He also presents results of a 2018 study conducted by Hartford Hospital to determine the impact of bundled practices of device insertions using vascular access specialty team (VAST) intravenous trained nurses compared to current practice.¹

Lean Methodology in Healthcare¹:

Lean methodology is taking action to limit waste of processes and procedures which could directly impact time, money, and patient satisfaction within an organization. This process is often neglected within hospital settings due to time constraints and lack of adhering to evidence based best practice. Lean methodology can be used to overcome challenges faced by patients, clinicians, and healthcare facilities and can help justify reducing waste overall in a health organization, especially for PIVCs.

Steere expands upon lean thinking and its applications to reducing PIVC usage per patient stay through project planning, implementing plans, and evaluating outcomes by enacting the basic process of the lean methodology: Plan, Do, Study, Act (PDSA).

Reaching One Peripheral Intravenous Catheter (PIVC) Per Patient Visit With Lean Multimodal Strategy: the PIV5Rights™ Bundle¹

In an effort to reduce the number of catheters used per patient stay, a PIV5R bundle and lean methodology was used in a 15‐month, IRB prospective multimodal comparator study in one 47‐bed medical unit at Hartford Hospital. The aim of the study was to achieve 1 PIVC per patient stay – enacting a call to action to change policy from routine site replacement to removal when clinically indicated by putting PIV insertions into the hands of experts.

The PIV5R bundle involves using right proficiency such as ultrasound guidance (USG) trained nurses that demonstrated first stick success. It also highlighted right insertion and right vein location through the use of USG to place on the forearm with the correct distance from valve. The right supplies and technology should be best of class devices for IV success. Finally, right review and assessment was implemented by thorough disinfection and meticulously assessing for dressing change. The use of this bundle was measured by gathering daily reports of IV supply consumption, therapy delays, time spent training, complication rates, location and type of PIVC and current workforce available.

Comparing the control group to the group that utilized lean methodology and PIV5R resulted in $3,376 of savings per bed per year with a 96% first time stick success rate compared to the rate of 33% in the control group. Fewer restarts on PIVCs resulted in reduced direct costs in addition to less training for bedside RNs. Indirect cost savings involved infection prevention and reduced hospital stays.

Steere declares that within a hospital setting, the problem of excess waste around PIVC is known and it can be fixed through the processes used throughout this study. IV therapy affects almost every patient and institutions should be constantly collecting this data for patient care improvement and financial savings. He is continuing his data collection to address unplanned dressing changes. Trial of a gum mastic liquid adhesive has resulted in a 53% reduction in non-intact dressings as well as cost savings in nursing time and supplies.¹

Interested in more from Lee Steere, RN, CRNI, VA-BC? See his feature on our “3 Questions With…” vlog series here!