Wound Care

Wendy Napolitano

Through this article, Wendy Napolitano outlines the development and impact of the STAR Team, a specialized intravascular access team created to support hospital nursing staff. She highlights the team’s role in reducing CLABSI rates by 80 percent, mentoring new nurses, leading an IV Committee, and enhancing patient-centered care through innovative practices in line selection and safety.

The COVID-19 pandemic transformed the healthcare landscape, highlighting critical areas needing support. During this time, we observed an immense demand for assistance among inpatient nursing teams, especially those with less experience, as they navigated the challenges of increased patient acuity. Initially, our response involved deploying a single critical care nurse to circulate throughout the hospital, offering bedside support, responding to emergencies, and providing troubleshooting assistance. This role aimed to alleviate pressure on inpatient teams and reduce ICU admissions whenever possible.

In the early days, it became evident that assistance with peripheral intravenous (IV) insertions was a recurring need. Recognizing the potential to improve patient outcomes, we took the initiative to expand this role, forming the STAR Team—a Specially Trained and Responsive Team. The STAR Team’s focus included inserting ultrasound-guided peripheral lines to ensure high-quality care and minimize the risk of central line-associated bloodstream infections (CLABSIs). The team’s scope was broadened to incorporate midline catheter insertions to meet patient needs and optimize line selection. This team continues to respond to all inpatient emergencies and can manage patients until they transition to the critical care unit.

As the demand for their services grew, we responded by gradually expanding the team. Initially, we staffed one critical care nurse on each shift (day and night). However, recognizing the increasing needs, we eventually scaled up to two registered nurses per shift. Our current model now includes three dedicated critical care trained nurses on the day shift and two on the night shift, allowing for comprehensive support around the clock.

Over the past four years, the STAR Team has continuously enhanced its capabilities. Today, the team is responsible for all inpatient central line care and maintenance aspects, including ultrasound-guided peripheral IV insertions, midline catheter insertions, dressing changes, and intraosseous insertions in emergencies. To further strengthen patient care, we plan to incorporate peripherally inserted central catheter (PICC) insertions into the team’s skill set. This addition will ensure that patients receive the most appropriate line based on their specific needs and that central lines receive proper initial dressings and care from the onset of insertion.

"The STAR Team’s dedication to patient safety and optimal line selection has transformed care, driving an 80 percent reduction in CLABSI rates and empowering nurses with real-time coaching and expertise."

The impact of the STAR Team has been transformative. Their contributions have driven an 80 percent reduction in CLABSI rates within our hospital. They provide real-time coaching and mentorship, empowering novice nurses to build their bedside skills and confidence. As a result, this team is now well-equipped to manage a wide range of situations with competence and care, making them an invaluable asset to our hospital.

Beyond their clinical work, the STAR Team has established and now leads an IV Committee, which is set to expand across our healthcare system. This committee brings together intravascular access nurses who perform line insertions, fostering a collaborative environment where they can share knowledge, discuss challenges, and standardize best practices. This initiative will contribute to continuous improvement, benefiting our system's patient care.

The commitment to patient-centered care is at the heart of the STAR Team’s mission. A dedication to patient safety and optimal line selection drives every action they take. The STAR Team exemplifies excellence in intravascular access, patient advocacy, and overall patient care through their expertise, mentorship, and unwavering focus on quality.