This is precisely the scenario Diane Branham, RN seeks to eradicate. As the Nurse Manager of the CCTSI’s University of Colorado Hospital Clinical Translational Research Center (CTRC), she tasked every staff member with the goal of tracking their success rate for IVs and phlebotomy. To keep things interesting and fun, the staff decided to implement a competition between the Inpatient Unit vs. the Outpatient Clinic. In the 15 months since she started keeping track, the success rate for a first stick for IVs is 90.5% and the success rate for a first try for a phlebotomy is 96.2%.
“These rates are amazing!” says CCTSI’s Director of Operations Janine Higgins, PhD. “Most clinics don’t do this kind of tracking to begin with. And when we look at the literature*, we find clinical success rates in the USA along the lines of 74%.”
Branham chalks up her success to the laser-like focus of her team. “Research is all we do, all day long,” she says. “Each and every day, people who volunteer to participate in clinical research count on and deserve specialized nursing care that ensures exceptional, ethical and safe care, providing high-quality data. And I am proud to say we have a highly motivated staff who provide the best possible care.”
Each staff member tracks his or her success on a daily basis, and the results are reported as a team. Branham says that when she talks with other nursing leaders, she finds they don’t track the success rates. She has known individuals who tracked their success for a year and shared the results in a paper or poster, but then stopped tracking. “I want this competition to continue,” she says. “I want my team to always want to be better.”
Right now, more than 250 active studies are taking place at the adult CTRC. Clinical Research Coordinator Yusra Azhar, MBBS, manages a clinical trial there that involves Lupus patients in a phase 2 double blind placebo controlled study that requires subjects to have a series of infusions over a span of 13 visits. The CTRC nurses help with the infusions. “Lupus patients can be a ‘difficult stick’,” says Azhar. “We tell them to hydrate as much as they can. But it is just part of the disease that makes it difficult. My experience with the CTRC overall has been great.”
Branham’s nurses and research techs use a variety of techniques for patients that may be a challenge. They encourage participants to drink water the day before and morning of the procedure. They keep participants warm, using heated blankets. Also key to success is a high level of communication among the nurses.
“If there is a difficult patient, the nurses might bring along another nurse companion from the CTRC. Every nurse has an expertise; some are more comfortable with the arm, some are more comfortable with the hand veins. Because all of the nurses talk to one another, if they see that a difficult patient is in the clinic, they know they have to be proactive with the next infusion,” Azhar says.
Though all nurses are competent for phlebotomy and starting IVs due to their licensure, all CTRC nurses are required to complete an eight-week orientation where they have to do 50 supervised phlebotomy sticks and 50 supervised IV starts. “When we have someone new, we have to teach them some of this; they won’t be as proficient right away, and our rates will track this,” Branham says. “If a new hire is struggling with this competency, our staff will come and tell me; they will never compromise the care of a participant.”
The University of Colorado Hospital has been helpful as the manager of ancillary healthcare techs is a certified phlebotomy instructor and has provided instruction to some of Branham’s newer staff. She is also pleased to report that the pediatric CTRC is now using her tracking tools in order to chart their success over time.
Branham says she and her team of research nurses are proud to be an integral part of the work that helps advance medicine and the standard of care for future generations. At the end of the day, she says all of her efforts in the CTRC come down to one question, “I think, would I want my mother to come here for phlebotomy and go through this study?”
*Lapostolle et al. 2007