Number of FTEs per patients

[jeahav]

I am interested in knowing the staffing patterns used in other hospitals with IV teams; specifically, how many staff are needed per patient population. Our IV team functions on the day and evening shifts and provides coverage primarily for the inpatient setting; however, because we have a closed practice system (all staff including MDs are employees of the healthcare organization) we also cover the PACU, ASU, ED, ICU, and ambulatory settings when there are difficult sticks. This past year we have gone well over budget and we are now being asked to revise the staffing plan; however, I am having difficulty finding out information from other places about how they staff. Any guidance or sharing of information would be greatly appreciated.

[Daytonite, BSN, RN]

The V.A. IV team I worked on was a 24-hour service with 7 FTEs. We worked six 12 hour shifts and one 8 hour shift in a 80 hour pay period. The 8 hour person was scheduled to work from 12 noon to 8pm. Staffing was 2 on from 8am to 12pm, 3 on from 12pm to 8pm, and 1 on from 8pm to 8am. We made rounds and inspected all patient IVs (including the ones in the ICUs) twice a day and documented our observations. IVs were changed as needed and every 72 hours. We placed PICC lines and repaired hickmans and central lines. Staff nurses seldom even tried to start their own IVs. We also took medical students with us on rounds and helped them learn skills. We were a 120 bed acute hospital.

[Chuckie]

We have a 200 bed hospital with ED, L&D, ATU, Outpatient surgery and Oncology Chemo. All these units take care of all their IV's. Our team is only responsible for starts and restarts. All central line care, dressings, lab draws and and declotting are done on the floors. IV team assess picc line placement however refuse to do very many. We have radiologists and radiological nurses responsible for most of the picc lines. IV team only do starts and restarts on the floors. We have 2 on days one mid shift 10-6 and one evening and night. Weekends is one less on days. They are the only department in the hospital that are allowed long breaks and lunches. The refuse to do any calls. between 1100 and 1300 because the are taking lunch. They do nothing but IV starts and restarts. They wait outside the room until all patient care is taken care of, then go in the room to start the IV.

[jeahav]

Thanks so much for the good information. We are also about 200 beds (180) so we are talking about a comparable size. Do you have any sense of the numbers of starts/restarts that you are doing in a specified period of time? (per day/week/month)?

We have a 200 bed hospital with ED, L&D, ATU, Outpatient surgery and Oncology Chemo. All these units take care of all their IV's. Our team is only responsible for starts and restarts. All central line care, dressings, lab draws and and declotting are done on the floors. IV team assess picc line placement however refuse to do very many. We have radiologists and radiological nurses responsible for most of the picc lines. IV team only do starts and restarts on the floors. We have 2 on days one mid shift 10-6 and one evening and night. Weekends is one less on days. They are the only department in the hospital that are allowed long breaks and lunches. The refuse to do any calls. between 1100 and 1300 because the are taking lunch. They do nothing but IV starts and restarts. They wait outside the room until all patient care is taken care of, then go in the room to start the IV.

[jeahav]

Your information is most helpful. We are struggling with determining appropriate staffing and it is difficult to find any good information on this from the literature so, I thought I would ask around.

The V.A. IV team I worked on was a 24-hour service with 7 FTEs. We worked six 12 hour shifts and one 8 hour shift in a 80 hour pay period. The 8 hour person was scheduled to work from 12 noon to 8pm. Staffing was 2 on from 8am to 12pm, 3 on from 12pm to 8pm, and 1 on from 8pm to 8am. We made rounds and inspected all patient IVs (including the ones in the ICUs) twice a day and documented our observations. IVs were changed as needed and every 72 hours. We placed PICC lines and repaired hickmans and central lines. Staff nurses seldom even tried to start their own IVs. We also took medical students with us on rounds and helped them learn skills. We were a 120 bed acute hospital.

[Daytonite, BSN, RN]

Do you have any sense of the numbers of starts/restarts that you are doing in a specified period of time? (per day/week/month)?

About 12% of IV's go bad and need changing within 24 hours.

37% go bad and need changing within 48 hours.

50% are changed after 72 hours.

The other 1% are IVs that remain in longer than 72 hours for one reason or another.

We have a documentation sheet on each patient with an IV or central line. Our IV team keeps the sheet in a notebook(s) each therapist carries with them. Team members answer pages as a first priority. The IV's that are 72 hours old are flagged by the night therapist and those IVs are changed in between the pages. The goal is to get all the routine changes done by the end of the day shift, but it doesn't always happen that way due to being short staffed or just an unusually odd day. Also, every patients IV is looked at and documented on twice a day. Once on days, once on evenings so everyone's IV is seen by the IV team staff twice a day and any problems can be addressed then and then. When a patient's IV is discontinued the documentation sheet is put into the nursing section of their chart on the unit. IV team members are assigned certain units each day in which to do their IV rounds, answer pages from those units and do the routine site changes for those patients. Over time we have learned which units tend to be "IV heavy" and need more attention and so we make assignments as equal as possible.

These are figures from 4 years of data.

I forgot to mention that we also do all central line and PICC dressing changes twice a week. The sheets of those patients are flagged for attention on the day the dressing change is due.

A full service IV team gets a lot of pages to "check IVs out". Nursing staffs depend on them since they can easily call them and have any problem taken care of. ICU and ER nurses are really the only staff nurses who will change or start an IV. Our goal is to respond to a call within 10 minutes, but we sometimes have a backup of calls, so the therapist has to prioritize and let the staff nurses know when they will get to the IVs they have been paged about.