Factors associated with variability in management of vascular access ports

Abstract

Guidelines and clinical practice recommendations vary on the management of vascular access ports. Traditionally, patient, health system and healthcare professional's factors have been interrelated in studies of clinical practice variability. Understanding variation in the management of vascular access ports and to identify the influence of these factors in the compliance with the most common recommendations of vascular access guidelines, is an important first step for designing targeted improvement interventions. We analysed data from a survey sent to all Spanish outpatient clinics. Overall, 185 units at Spanish outpatients clinics out of a total of 256 completed the survey. Geographical region and unit size are the most common associated factors in the management of vascular access ports and there is a low level of compliance with many of the recommendations given by guidelines. Large outpatient chemotherapy units have been related to higher monitoring of the recommendations. Clinical practice and provided care to patients with vascular access ports are influenced by region and structural and organisational differences in the outpatient chemotherapy units. It is important to identify additional factors that may explain the variability.

Inertia in nursing care of hospitalised patients with urinary incontinence

“…Currently, failing to achieve the objectives defined by the clinical practice guides cannot only be related to the effectiveness of the procedures mentioned in them or the adherence of professionals and patients to them (Saxer, de Bie, Dassen, & Halfens, ). It is necessary to analyse and consider the negative variability in care (Chaillet & Dumont, ; Fernández‐de‐Maya & Richart‐Martínez, ), together with inertia actions which, as automatic behaviours lacking reasoning and clinical judgement, determine professional actions in situations and contexts, removed from the available scientific evidence (Sadeghi‐Bazargani, Tabrizi, & Azami‐Aghdash, ).…”

Intraspinal Drug Delivery Reservoir Refill Procedure by Non-Physician Clinicians

“…A large Spanish study that explored factors associated with practice variability in vascular access device management, a long-term, implanted medical device that requires accessing via a port with a non-coring needle, a procedure that is similar to the reservoir refill procedure, found that geographic location and practice site size were factors that influenced practice variability. The study found that large chemotherapy units were more likely to observe clinical practice recommendations (Fernández- de-Maya & Richart-Martinez, 2015). Our results were consistent with the Fernández-de-Maya and Richart-Martinez (2015) findings in that most participants performed less than 10 procedures per week, which may represent small pump practice sites and only half of the total sample used CPG in practice.…”

“…The study found that large chemotherapy units were more likely to observe clinical practice recommendations (Fernández- de-Maya & Richart-Martinez, 2015). Our results were consistent with the Fernández-de-Maya and Richart-Martinez (2015) findings in that most participants performed less than 10 procedures per week, which may represent small pump practice sites and only half of the total sample used CPG in practice. However, use of CPGs increased significantly in practice compared to training (p < .0003).…”