At Texas Health Presbyterian Hospital Dallas, nurses have turned a nationwide shortage of IV bags — which began after Hurricane Maria struck Puerto Rico a year ago this month — into a way to provide a wonderful benefit: much more personal care and time with patients.
Many of the intravenous bags are made and filled with solutions in Puerto Rico, so the hurricane affected the supply of both the larger IV products normally used to administer saline solution and the smaller, “piggyback” bags often used for medications needed in smaller doses.
Lacking the normal supply of solution and bags, nurses needed a new workflow to include more IV pushes, meaning the nurses push the medications directly into the main IV lines by hand with syringes. This is instead of using the normal process of placing IV bag mixtures on “smart” IV pumps, which deliver the medications automatically without the need for the nurse to stay at the bedside.
The surprising result of going back to the “old way of giving medications,” as one nurse put it, was not an increase in workload but more quality time with patients that the nurses described as “very personal, wonderful time,” said Dr. Cole Edmonson, chief nursing officer at Texas Health Presbyterian Hospital Dallas. He added that the large number of tasks required of nurses is one of the reasons the automated IV pumps, called smart pumps, were introduced and are commonly used in hospitals and outpatient centers around the country.
“Nurses can spend a significant amount of time on non-nursing tasks — hunting and gathering equipment, communicating/coordinating between departments and on documentation, leaving less time for actual patient care and presence with patients and families,” said Edmonson. “So anything that gives nurses back time to spend with patients, being present and in the moment is truly welcomed in this age of technology and digital equipment.”
The change also strengthened the partnership between nursing and pharmacy, said Randell Ball, vice president and system pharmacy officer.
“When THR was forced to rapidly respond to the acute shortage of IV bags, pharmacy and nursing leadership quickly came together to discuss options,” he said. “When discussing the need to move to syringe-based dosing, the pharmacy partnered with nursing leadership to identify those medications that could be safely provided in syringes of 30ml or less and could be safely given by IV push over five minutes or less.”
While the system also saved some money with the syringe method, which leaves less waste of tubing and bags, “the real benefit has been the increased interaction between our nurses and our patients, which refocuses us on the reason we do what we do — providing best care to our patients,” Ball said.
Once nurses started using the manual push method, one of the time savers was that they didn’t have to wrestle with cords and tubing to connect and power up the automated pumps. There were fewer beeping machines in the room, allowing patients to more comfortably rest and relax. And what time was spent administering the medication, was time spent one-on-one — nurse and patient.
Clinical nurse Tessa Kennedy, BSN, R.N., at Texas Health Dallas wasn’t sure about the new workflow at first.
“Initially, I expected the change in process was going to take more time, as we were so accustomed to using a pump and IV bag,” she said. “What I actually found was it gave me more time with my patients, getting to know them, to provide education and simply have a conversation while doing the IV push.”
Another nurse, who had limited experience with IV pushes for antibiotics, asked to make the short-term solution to the shortage permanent because she loved the additional time, conversations and learning more about her patients, Edmonson said.
Leaders and caregivers worried at first that the safeguards normally in place when they used smart pumps might create risk and issues for patients, leaving open the possibility of incorrect dosing. Additional concerns were that patients might see the process as cumbersome and yet another thing they had to go through and that busy nurses might see it as more time-consuming.
Very quickly, it proved to be just the opposite and the perceived drawbacks melted away, Edmonson said. “In fact, no issues emerged because the nurses’ clinical reasoning, competence and advocacy along with their partnership with pharmacy, circumvented any problems.”
Patients also like the change. During clinical leader rounding by nurse leaders, patients said they truly enjoyed their increased time with nurses. Several said getting to know their nurses and having more personal time improved their experience.
Some medications will always be administered through IV pumps, especially those that are slowly administered for long periods of time, he said. “It wouldn’t make sense to have a nurse do a manual push for two hours.”
But medications that have short dosing times (usually two minutes or less) are now evaluated to see if a manual push might be the better way. “Before the shortage last year, we would have gone straight to the pump. Now we’re asking, ‘What’s best for the patient and nurse?’ ” Edmonson said.
“Out of a terrible tragedy (Hurricane Maria) and in the most respectful way to everyone impacted, we found some unexpected collateral benefit to our patients’ and nurses’ experience,” he said.
