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Saline Flushes - My Old As Dirt Question

Updated | Posted

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

Saline Flushes - How are they managed?

  1. 1. Where do you store your saline flushes?

    • 3
      Medication Dispense Cabinet (e.g. Omnicell, Pyxis)
    • 52
      Supply Area
    • 4
      Other - Please comment
  2. 2. Do you scan your saline flushes during administration?

    • 8
      Yes
    • 48
      No - Go to question 3
    • 3
      Other - Please comment
  3. 3. If you don't scan your flushes, how do you document use?

    • 5
      EMR - other than MAR
    • 40
      We don't document them.
    • 14
      Other - Please comment
  4. 4. Have saline flushes been a source of revenue loss to your knowledge?

    • 4
      Yes
    • 35
      Not that I am aware of.
    • 20
      Unsure

59 members have participated

Good Morning,

Georgia, about a year ago, I have now heard changed our salines from a medication to a device. TJC supports this as a device. Now comes the process of changing our salines from a scanned med, to a documented part of supplies. Looking for additional points of view on this to present to the task force. It is funny because last week when I Googled for this topic I found my own posts from 2011 where my previous hospital was loosing 1/2 a million a year in unscanned flushes.

Some topics never die.

Thank you for any input you can provide.

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

Bumping this for a few more responses. Thank you to everyone who is taking time to fill out the survey.

If the physician place an order for the flush we scan it if no order we don’t scan but do document an IV flush as part of assessment in EMR. We are trying to get moved from our pharmacy to logistics then won’t be considered a med at all and will not require scanning at all

Edited by registerednutrn

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

26 minutes ago, registerednutrn said:

If the physician place an order for the flush we scan it if no order we don’t scan but do document an IV flush as part of assessment in EMR. We are trying to get moved from our pharmacy to logistics then won’t be considered a med at all and will not require scanning at all

Thanks for this feedback. I will let you know how ours pans out. We meet in two weeks and I am trying to bring back persepctives from other facilities to help support our next steps. At this point it looks like we will be going to charging for flushes as part of "supply". So if you give an IV med you would charge for two flushes automatically (one for pre and post flush). We would have to look at other procedures however, like PICC line blood draws where you may need a lot more. I am pushing for them to stay in the Omnicell for safety and our accreditation folks have confirmed if deemed a medical device they can safely be in a nurses pocket or a locked WOW!, but we still need to keep them out of patients rooms so they can't use it access a line with something we didn't prescribe.

Swellz

Specializes in oncology, MS/tele/stepdown. Has 6 years experience.

5 hours ago, registerednutrn said:

If the physician place an order for the flush we scan it if no order we don’t scan but do document an IV flush as part of assessment in EMR.

Same where I work. There is an order for flushes q12 that would require scanning, but it is rarely put in.

ER-

Seems like an order automatically enters. It goes on the MAR. I ignore them.

BlueShoes12, BSN, RN

Specializes in PACU, Stepdown, Trauma.

When I worked on the floor, flushes were scanned, typically as a q12 hour order. There was the option to scan a PRN flush whenever an IV was given, but only a couple people actually used it. Now, I work in a PACU with paper charting, and we do not document flushes given. Flushes are kept in locked drawers on both units.

Cloud9RN, BSN

Specializes in Rehab. Has 12 years experience.

I always scan saline flushes. It's always in our E-MAR PRN and it will be counted/reflected in the medication intake and output... We kept our saline flushes in the Medroom.

salineflush.JPG

salineflush.JPG

Edited by Cloud9RN

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

Thank you so much for all the responses!

DowntheRiver

Specializes in Urgent Care, Oncology. Has 7 years experience.

We document our flushes when we flush a port/PICC as part of the procedure.

For IVs, when we d/c the IV we document that we flushed with 10 mL NS.

However, we don't document the flushes we use between meds for IV pushes or the flushes we use to make IV pushes.

OliveOyl91, CNA, RN

Specializes in Orthopedics, Trauma.

The only time I scan a flush is when it pops up on the MAR as a scheduled PICC or central line maintenance.

lregister

Specializes in LD, MOBA, TRAUMa. Has 14 years experience.

We don’t scan routine Saline flushes. I guess it’s one of the last remaining things us nurses can be trusted to use and not Have to document in 14 places. 😂

When we document our IV assessment, we do document that the site flushes.
Heparin flushes are kept in the omnicell and scanned at bedside to patient’s record.

This seems crazy to me. Are they being scanned some places purely to charge the patient for them? Maybe it's because I work at a nonprofit, but we don't scan anything for patients, supply wise. They aren't being charged for chucks, purewicks, or toothbrushes either. If I have to change a canister in someone's room, I just grab one and change it. Do you have to scan that kind of stuff at some hospitals?

Lipoma, BSN, RN

Specializes in CEN | ER | Urgent Care. Has 3 years experience.

I might get flamed for this... but on admission, the Hospitalist orders 3cc saline flushes at 6am...if I'm going into the room for any reason then I will scan, document, and flush the IV. I might've even flushed that IV 10 times before they go from ER to Inpatient. If it's for capturing cost, then we should be scanning per flush and not per order.

If there is no reason for me to enter that patient's room...then I document "not given".

It's a waste of my time. Why is it even ordered if there are orders for continuous IV infusion???

Edited by Lipoma

gonzo1, ASN, RN

Specializes in ED, ICU, PSYCH, PP, CEN. Has 18 years experience.

Up to about a year ago we had to get flushes from Pyxis and were supposed to scan all of them when used. In our ICU there just isn't time for this. Flushes are now left on counter in med room and we just scan the ones ordered for specific times like for PICCs every 12 hours. Some nights we go through 300-500 flushes in our 8 bed ICU, most of which are not charged as they are not scanned. I have pointed out to management that we lose a lot of revenue because nothing we use is scanned or entered for charges, like foleys, central line kits, you name it. They said they just don't care. So I quit trying to promote better tracking. I will say it makes life much easier not having to account for stuff. I guess they are getting the charges from documentation of things done.

I can't complain cause our hospital is really nice to work at and they have supplied us with all the PPE we could ever want during the "Rona"

Don’t know what happens in the back end but here is the problem.

I can see that scanning everything is important for documentation/charge purposes. I would hope facilities factor in costs of additional flushes and other supplies considering the patients situation. Then the next crew comes in or admins have to consider raising prices for whatever reason. One Einstein will see previous documentation and say that flushes used are not factored in black and white and therefore should be in black and white, and therefore comes up to be scanned to justify raising prices. Next will be, wait, just one flush to be scanned?