The goals of the protocol were not initially realized and the outcome demonstrated that IV catheter placements still required high number of unplanned restarts. The number of unscheduled restarts was largely caused by the poor holding power of tape securement, the traditional method of holding IV catheters in place. That led, in turn, to high unplanned-restart rates even when the previous 72-hour protocol was in place. The 96-hour protocol only exacerbated the problem.

With that in mind Health First Inc. began evaluating numerous IV securing methods, procedures, and securing devices which yielded no significant change with related complications. Health First Inc. then evaluated a new and unique catheter securement device (StatLock IV Ultra by Venetec International, San Diego, CA) that dramatically reduced complications, restarts and restart costs.

Catheter securement device is
the key
Prior to implementing the new device to replace tape, the IV team at Holmes Regional Medical Center regularly tracked its restart rate and related costs. It found:

•Under the 72-hour protocol, only 8-to-15 percent of Holmes’ catheter sites lasted the entire term without an unscheduled restart.

•When the 96-hour protocol was instituted, the rate worsened significantly, with nearly all placements needing to be restarted at some point during the 96-hour span.

StatLock by Venetec

From a financial standpoint, the new protocol was unsustainable when tape securement was used. Material costs for the unplanned restarts ran about $4-5/IV. Labor costs, while harder to quantify, clearly rose under the new protocol, as well. Unplanned restarts take an average of 30 minutes to 40 minutes to execute – about twice as much time as the 15 minutes to 20 minutes Holmes Regional Medical Center nurses spend on a scheduled IV placement. This is because the unscheduled restarts require immediate collection of various supplies and reaching a patient who may be on a distant floor of the hospital – as opposed to the efficient sweep of the floor with all materials and an IV cart that is possible with planned IV starts and restarts.

The efficient use of nursing time was negatively impacted and costs rose, with FTEs, salary dollars, and overtime pay increasing related to unplanned restarts in part a result of ineffectiveness of tape in achieving a 96-hour dwell time.

By the end of fiscal year 2003 during the tape securement phase, for example, nurses had started 9 percent more IVs than budgeted and spent 20 percent more salary dollars than had been budgeted, even with a skilled IV team placing the catheters.

To address the situation, the Department of Contract and Supply Chain Administration and the IV team evaluated an alternative securement method: the StatLock device. Numerous studies had documented the device’s ability to substantially reduce restarts, costs, and catheter-related complications.

In conjunction with the system-wide Product Standards Committee, it was agreed that StatLock would be tested during a one-month period, with the clinical trial taking place at both the Holmes Regional Medical Center and Cape Canaveral hospitals. Primary reliance would be on data gathered at Holmes Regional, which had historical data with which to compare the trial results.

In the first phase of the trial, data was gathered on 67 tape-secured IVs. Of those, 47 required unplanned restarts during the 96-hour period, a 70 percent restart rate. Long-term data demonstrated that tape securement normally yielded even higher unplanned restart rates: from 80 percent to 85 percent.

The second trial phase tested the StatLock device. To put the device through a rigorous trial, it was tested on a respiratory floor where IVs had an especially high failure rate. A large percentage of subjects were chronic respiratory patients on prednisone. Many of these patients had thin skin that caused taped IVs to pivot and leak. Despite this hurdle, the overall unplanned restart rate for the alternate securement device was 21 percent, a 70 percent improvement over the tape phase. This impressive performance was consistent with the extensive research literature on its use.

When the data was presented to the Product Standards Committee, the committee agreed that the trial had clearly demonstrated the device’s superiority as a securement method as well as its suitability for the new protocol. However cost remained a consideration. The material cost for the StatLock device was about $3 per IV placement, which would substantially increase material costs if the device was used for all IVs. (This calculation does not include consideration of the cost of restarts, because every avoided restart essentially pays for about two units of the device.). The committee recognized it could reduce the cost of using the device by about half if the device was utilized only on patients who were anticipated to stay in the hospital for at least two days.

StatLock IV Ultra was approved for system-wide use on peripheral IVs. The committee’s approval resulted in positive outcomes. The cost for the device was clearly acceptable by the savings the device produced. These savings included:

•A significant per capita reduction in I.V. start kits used for restarts, resulting from a much lower restart rate.

•Lower labor costs were a result of the reduced number of unplanned restarts. IV Team Salary costs at Holmes Regional Medical Center tended to vary with IV placement volume. That is, when volume rose, so did costs – by about the same percentage of increase. Since StatLock was implemented in December 2003, the trend has reversed.

For example, from October 2003 to August 2004 with global use of the new catheter securement device, the I.V. team was able to perform 16 percent more procedures than budgeted, while salary costs decreased to 4 percent below budget. The I.V. team salary dollars have remained favorable to budget every month since its adoption, even though the number of IV placements has been over budget every month in that same time frame.