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Allegheny Health Network to drop IV teams

| Saturday, May 17, 2014, 9:00 p.m.

Needle-phobics call it sheer agony, the wait time in the hospital before a nurse sticks a hypodermic needle through the skin and into a vein.

Allegheny Health Network promises to shorten that delay in five of its hospitals by dissolving teams of intravenous therapy nurses, who specialize in inserting IV lines, and reassigning many of their duties to floor nurses.

A nursing association worries that the change, which has been adopted by many hospitals across the country, might lead to higher infection rates as less-specialized nurses insert IV lines.

“I don't know how this is going to increase efficiency if you have people who aren't experienced” with IVs, said Mary Alexander, CEO of the Massachusetts-based Infusion Nurses Society.

AHN spokesman Dan Laurent said the company could lay off some IV nurses and reassign others, but he would not say how many would be affected at Allegheny General, Allegheny Valley and affiliated hospitals.

Alexander said IV nurse teams often control hospital costs because their specialization and experience allow them to work quickly. They tend to use fewer needles because they make few pricks, saving expenses for supplies and keeping patients more comfortable, Alexander said.

“The knowledge and skill that we get in nursing school is very limited with the specialty practice of infusion nursing. They're expected to learn it on the job after graduation. That does not always happen in a carefully planned, controlled manner,” said Lynn Hadaway, a Georgia-based registered nurse and consultant who leads a task force for the nonprofit INS.

AHN nursing supervisors said they are forming smaller “vascular-access teams” to handle difficult IV procedures while floor nurses will take over more straightforward insertions.

Every registered nurse accepting IV duties will undergo training and demonstrate proficiency before inserting an IV in any patient, said Jocelyn Benes Stickle, a registered nurse and AHN vice president for clinical transformation. If a nurse fails twice to insert an IV into a patient, she said, an especially skilled nurse will take over.

“No one wants to wait for one person who's trying to see 50 patients in order to get an IV. It's much better that more people are trained and proficient at doing this, and able to provide the care to the patient,” said Joy Peters, the chief nursing officer at Jefferson Regional Medical Center in Jefferson Hills.

AHN's Jefferson and West Penn Hospital in Bloomfield have relied on floor nurses for years to perform IV insertions. Peters said Jefferson has not had any bloodstream infections associated with peripheral IVs since it adopted the approach 15 years ago. She called it “extremely successful.”

Nursing supervisors said they decided to expand the approach to the other five AHN hospitals — including Forbes Hospital in Monroeville, Canonsburg General Hospital and St. Vincent Health System in Erie — since they became subsidiaries of Downtown-based insurer Highmark in 2013. They said the shift from conventional IV teams should be completed by June.

Company officials would not characterize the shift as a cost-cutting maneuver, saying it would improve patient care and efficiency.

“Let's face it: We're all asked to do more with less. Nurses aren't any exception to that,” said Betsy Snook, CEO of the Pennsylvania State Nurses Association in Harrisburg. She said nurses “have always been able to start IVs” and are well trained in school to do so.

Snook said conventional IV nurse teams gained popularity in the 1980s and early '90s as care became more specialized. She said the teams have declined over the past decade, with many hospitals returning IV nurses to more generalized patient care units, although exact numbers were not available.

UPMC uses teams of IV nurses in some cases, depending on the needs of individual hospitals, spokeswoman Stephanie Stanley said in a statement.

In Westmoreland County, floor nurses at Excela Health hospitals handle most IV insertions for low-risk patients. Small, specialized IV teams tackle more complicated cases, spokeswoman Robin Jennings said.

“If you gave that (IV) responsibility back to the nurse at the bedside, she's going to start many more IVs than she would be if she had an IV team,” Snook said. “She's going to become as fully skilled at it.”

Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or asmeltz@tribweb.com.

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