By Susan Cantrell, ELS

Communication is perhaps the most important component of a successful relationship. Communication is sort of like dancing: It’s two or more people working closely together to achieve smooth progression, trying not to step on each other’s toes along the way.

Communication between the materials managers and critical-care nurses is vital. Only by consulting with the people who use the products can materials managers meet the users’ needs. Highlighting the need for communication between materials managers and critical-care nurses, Linda Bell, RN, MSN, Clinical Practice Specialist at the American Association of Critical-Care Nurses (AACN), Aliso Viejo, CA, urges materials managers to "Talk to the nurses. The best relationship to build is a bridge to practicing nurses," said Bell. "Talk to them, because these are the people that can help with the pros and cons of the particular products under consideration. Nurses are very much needed on product committees. If I were thinking from a materials management standpoint, I would be thinking ‘how can I best protect my staff? What are the qualities of the products that I need to discuss with my infection control people so that there is a criteria set for these products?’

 Ballard Trach Care Closed
 Suction System

Product Development

Communication also plays a vital role in developing products used by critical-care nurses. Tim Dye, General Manager for Critical Care and Temperature Management, Kimberly Clark Health Care, Roswell, GA, said, "We start out with the clinical need in mind; that helps us to improve and develop new products, hopefully to improve practices, and then ultimately help to improve patient outcome. That’s our objective, especially in the critical-care arena."

Kimberly Clark’s Trach Care-72, a closed suction catheter that removes secretions from the airways of ventilated patients, was developed in response to a need communicated by clinicians such as critical-care nurses. Dye explained how it happened: "Studies have shown that, to help reduce infections such as ventilator-associated pneumonia, it is helpful to minimize the number of times the circuit is opened and to keep the circuit closed as long as possible. Any time the circuit is opened, it’s an opportunity to introduce harmful organisms into the patient’s airway. Our traditional product, the Trach Care catheter, is for use up to 24 hours; however, we had been hearing from clinicians who were asking, ‘Hey, can you help us to keep the circuit closed longer?’ So, we responded by developing a new design that could be used for up to 3 days; it’s called Trach Care-72 because it’s good for use up to 72 hours. This product enables the circuit to remain closed for a longer period of time, while also allowing more effective cleaning of the catheter; so, it results in a reduction in the level of bacteria colony-forming units (CFU) that have grown on the tip of the catheter after 3 days. In fact, The Trach Care-72 catheter has less colonization of the catheter tip at 72 hours than the traditional Trach Care catheter has at 24 hours."

Education

"Inservicing and education are a couple of our communication keys," said Dye. "Inservicing is employed to ensure that clinicians who will use the product have a good understanding of the need it addresses and that the users are trained until they feel comfortable using it. Then they can communicate to materials management and administration the need and the viability of a certain product."

Dye noted, "We also have a number of strong educational programs for clinicians that earn participants continuing education units (CEUs), such as the ones we did through the AACN on closed suction systems. Another CEU program is on cardiac multifunction electrodes, or defibrillation pads. These educational programs help healthcare workers to continue their education and maintain their license while helping them to understand the specific areas in which Kimberly Clark is involved. Multiple people ultimately are involved in purchasing decisions, and the CEU programs help clinical personnel to understand the need for and the use of our products within the facility."

Clinical needs vs. cost

"The Trach Care-72 also is a good example of how we try to balance a clinical need with the need for cost-effectiveness. It’s not as if everyone’s floating in a lot of dollars. One way that it helps in being cost-effective is by helping to lower infection rates and improve outcomes. The other way is that it can be used three times longer but it costs only about two times more than the traditional product." The multifunction electrodes are another example of attending to clinical needs cost-effectively. Dye said, "The defib pads can be standardized so that only one supplier is needed. There are a lot of defibrillator manufacturers, but they all have different connectors. We have those connectors available so that they don’t have to buy from multiple suppliers. We can save the facility money by standardizing to one pad provided by one manufacturer. In most instances we’ve found that we can help users to save money on the cost of the pads by reducing the level of inventory that needs to be carried and by eliminating the need for multiple purchase orders."

Certainly cost is no longer a concern relegated to the bookkeeping department. Bell emphasized, "Cost is a concern for all of us. When I first started working 33 years ago, the word ‘cost’ never came out of anybody’s mouth. You never thought about how much it cost to treat the patient. You just used what you had and did what you knew needed to be done. Somewhere at the other end, a bill for the patient and a paycheck for me were generated." Demonstrating how nurses are actively involved in seeking out cost-effective products, Bell said, "One of the sessions we have scheduled at the National Teaching Institute and Critical Care Exposition (May 15-20, Orlando, FL) is how to evaluate equipment and how to do a clinical trial on equipment." Bell also notes a comment by Judy Verger at the University of Pennsylvania, who is the list owner for a Yahoo group for practicing nurses in critical care (AMPACC), that "Probably one third of the conversation is related to product and equipment experience. You can’t look at just the equipment either, you have to look at the cost of disposables that go with the equipment and what could be reused or recycled on them. This is a whole area of materials management that nursing was just giving thought to 15 years ago, but now it’s the first thing."

Worker and patient safety

Another issue that has done an about-face in the past few years is cross-transmission of bacteria. Bell explained, "We used to worry about protecting the patients from us, and now we worry equally about protecting ourselves from the patients, which is a huge transition."

Vendors are educated on the problem and sometimes develop products with this concern in mind. Dye believes that "Trach Care-72 is a great example of a product designed to help protect both healthcare worker and the patient. On an intubated patient, the endotracheal tube down their airway is a straight pathway for bacteria or other bugs to get into the lower airway, where they can cause pneumonia or other infections. And if the patient coughs or if their secretions otherwise come in contact with the HCW, they’ll be exposed to the patient’s bugs; so keeping the circuit closed helps to protect both the patient and caregiver by helping to prevent cross-contamination."

Dye summed it all up by saying, "It’s always a balance of meeting the clinical need, working toward delivering quality of care, improving outcomes, and doing that in a cost-effective way."

Although Bell works full-time for AACN as a clinical nurse specialist, she still practices one weekend a month at a local hospital. It isn’t a requirement to keep her license active. "Knowing the current environment in critical care helps me to make decisions here at AACN. And, there’s something so satisfying about working with patients." Again, the importance of communication is highlighted: "The best part of nursing is the interaction you have with the patients and their families. It’s part of the trajectory of learning. I’m so fortunate to have arrived here."

Good communication may be more about listening than talking. That’s hard sometimes, because egos and agendas tend to get in the way. To be productive and effective, it’s important to remember the purpose, the goal, and not to take well-intended direction personally when it doesn’t go your way.

Even professional ballroom dancers, people who truly understand what working together closely for the good of the unit means, sometimes trip up even while trying their best not to. At an international dance competition I once saw a beautifully clad and highly skilled couple fall and, still clasped together, roll across the floor like a crayon that had slipped out of a child’s hand. How did those pros handle it? With grace and aplomb. No one stormed off pointing fingers. They got up, dusted themselves off, and continued elegantly on their way. Toward their goal. Together.