No More Repetitive Needlesticks: How CNOs Can Improve Patient Experience

Several new care delivery models are taking over the nursing industry and streamlining daily nursing practices, now including needlestick procedures.

Repetitive needlesticks can be a challenge in hospitals, from both a nurse and patient perspective. A recent survey conducted by the Harris Poll revealed that out of the participants with a recent hospital stay, 59% of patients needed multiple needlestick attempts for IV insertion, and 71% for blood draws, with 11% needing 10 or more sticks to obtain a single blood sample.

Impact on patients

These numbers are representative of a major issue. According to the survey, more than half of Americans report some fear of needles, and a top reason is fear of multiple insertions. The survey also reported that 77% of patients are not aware that they should expect no more than two needlestick attempts from one clinician, no matter what condition they have.

However, IV and blood draw procedures are a necessary part of the hospital stay, and according to Anna Kiger, system chief nurse officer at Sutter Health, they make the patient experience less positive.

“It is one of the most frequent tasks that a nurse or phlebotomist does,” Kiger said, “so if you come for healthcare, it’s a high probability we’re going to stick you at least once, if not more.”

“Whether it’s in the emergency department or later on in the acute care setting, we do need to obtain blood samples from them for a variety of reasons,” Kiger said, “and unfortunately, due to the acuity of their diagnosis and their age, obtaining a clean single needlestick to get the blood can be very difficult.”

According to Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, repetitive needlesticks impact patients in both the short and long term. Not only do needlesticks increase anxiety and pain among patients, but incorrect vascular access practices in general can impact health literacy and lead to potential rehospitalizations or disease progression.

“When patients are more anxious, they’re less likely to understand the procedures that are being explained to them,” Acito said. “Short term, they’re not hearing about their care, about their needs, about their diagnosis, and long term, they’re not hearing about the things they need to do upon discharge.”

Needlestick alternatives

Luckily, alternatives to repetitive needlesticks are on the horizon.

According to Kiger, there is now a device that can provide needleless blood draws.

“This particular technology, which allows a nurse to obtain a direct blood draw through an IV catheter, does eliminate the need for a needlestick,” Kiger said, “and that particular device can be used in the ED or in the inpatient setting.”

“It’s an IV with a tail essentially coming out of it,” Acito said. “The patient should expect one stick when they come into the hospital and they have the IV inserted, unless they need a special test like blood cultures, then this PIVO™ device would be used.”

In patients Kiger has observed, the experience with the device is painless and the blood samples taken with it are of the same quality as those obtained through a needle aspiration.

“If you can remove the needle and obtain a quality blood sample and get to the test result that is required for a physician to make a decision, then I’m all in favor of doing that,” Kiger said, “because it’s one less penetration of the skin, which is our protection from infections, and the patient gets an entirely different experience, a painless experience for most, obtaining blood.”

Acito said they oftentimes employ licensed practical nurses (LPNs) to do the blood draws with the device, which can greatly benefit them as well as the patient.

“This allows [the LPNs] to work at the top of their license, while reinforcing education that has already been provided to the patient, interacting with the patient, providing other needs while they’re in the room,” Acito said.

“Once you put in the IV, if you maintain it well and you choose the site properly, you can use devices that help you find the vein so that there’s a decrease in the number of sticks,” Acito said. “How many blood draws you get is really determined by your diagnosis and the number of tests that need to be run to find [it] or to see if the treatment is working.”

There have already been positive outcomes from using this device as well, according to Acito.

“The positive outcome is that you don’t waste more resources trying to find a vein, [and] trying to stick the patient,” Acito said. “When you walk in, no longer do you have to check this arm and check that arm and find that vein. You already have access.”

The bottom line is that it’s better for the patient, Acito explained, because it decreases exposure to excessive bleeding, bruising, or infection.

“They know when they come in and they get that PIVO™ device because of education from the nurse that this is going to be the site where [they] get [their] medications [and] IV fluids, and it’s also where we’re going to draw [their] blood from,” Acito said.

Training and education

Both nurses and patients need to be educated about needlesticks and vascular access procedures and their alternatives.

CNOs must ensure that nurses receive the proper training on how to make patients feel more comfortable during a needlestick experience.

“I think it’s really important for the nurse to always recall for themselves what it would be like or even a personal experience with having had an IV,” Acito said. “Completely engage the patient, distract them, [and] make sure that the patient is fully educated on what to expect.”

Kiger said the most important thing leaders can do is educate other nursing and hospital leaders about the new technology alternatives that do allow for successful needleless blood draws, like the PIVO™ device.

“First of all, basic education, getting more literature out, getting more published research out, getting the experiences of those who actually use a device like this in clinical practice, and then also getting the patient’s perspective out there,” Kiger said. “Then I think it becomes a matter of showing that over time, this is actually an easier way to draw blood.”