Benchmarking Helps Drive a Smooth Product Transition

Nearly 1 in 10 healthcare workers suffer from latex allergies—a risk shared by 7.2% of susceptible patients and 4.3% of the general population.¹ At Yale New Haven Health, this urgent reality drove a system-wide transition to external catheters not made with natural rubber latex.

When an adverse event at one of the hospitals in the Yale New Haven Health System (YNHHS) led to an urgent conversion from latex to silicone products, it prompted a closer look at the entire health system. About a year and a half later, all hospitals in the Yale New Haven Health System were preparing to standardize an external catheter not made with natural rubber latex. This time, value analysis nurse and President-elect of the Association of Healthcare Value Analysis Professionals Jodi Katz MSHA, BS, RN, CNML CVAHP, wanted to do it with thought and planning. Working with Medline, Yale New Haven Health collected frontline staff feedback and provided comprehensive education to support the product transition. The collaboration marked a new standard for partnership-driven change.

CHALLENGE

Shifting to a versatile catheter not made with natural rubber latex

The urology providers at YNHHS faced a multifaceted challenge: transitioning away from a latex-based external catheter to improve patient safety, while ensuring that leadership and frontline staff were all on board with the change.

“The move to latex-free is something that the health system has always had as an initiative, but it can be quite complex,” explains Katz. Beyond the allergy concerns, nurses had said they had no problems with the female external catheter they were using. However, they were using their female external catheter off-label on male patients and inappropriately on ambulatory patients. Both misuses posed clinical risks and inefficiencies.

“It was important that they felt comfortable that they had the product when they needed it, they knew how to use it and they knew who to contact if they had questions or concerns.”

—Nancy M. Peterson, MSN, BA, RN, Resource and Education Coordinator, Center for Nursing Excellence, Yale New Haven Health

Planning for the transition to a new external catheter also required that staff feel confident and supported before, during and after the conversion. “It was important that they felt comfortable that they had the product when they needed it, they knew how to use it and they knew who to contact if they had trouble,” says Nancy M. Peterson, MSN, BA, RN, Resource and Education Coordinator, Center for Nursing Excellence, Yale New Haven Health.

ACTIONS

Benchmarking and education lead to collaborative implementation

To avoid another rushed conversion, the first step was benchmarking. They wanted to understand usage patterns, pain points and staff sentiment regarding the existing product. The benchmarking would provide data they could share with hospital nursing leadership. They received 134 surveys back, and what they found was surprising.³

Previous product pre-trial benchmarking survey
Of 134 staff members who filled out the survey:

96% noted leaking with previous product³

68% saw patient skin breakdown with previous product³

80% said they used a pad for securement with previous product³

“The benchmarking made it tangible,” Katz says. “I pulled it up on a slide and said, ‘Here’s what our staff are telling us. You can’t refute this.’” The benchmarking was key to have that evidence. “To show them, ‘You say you love this product, but you really don’t love this product,’” Katz says. It allowed the YNHHS team to start exploring a change.

Evaluating Versette and gathering feedback

A system-wide evaluation of the patented Versette followed, involving five locations and multiple units per hospital for a total of 15 units. “It was a huge undertaking,” comments Lori Matarazzo-Joy RN, BSN, CIC, infection preventionist at YNHHS.

“Once we narrowed down the trial units, we connected with the nursing leaders and their education teams at each of the facilities,” explains Jennifer Beigie, a urology clinical solutions manager at Medline. An important part of the process included diligently selecting patients who were appropriate for Versette. “We wanted to make sure that, not only was the device working efficiently and effectively, but also that we were using it on the right patients,” Beigie says.

The Medline and YNHHS clinicians, plus the health system’s nurse educators, worked closely together to come up with a simple list of survey questions. The goal was to capture honest, informed feedback from the busy staff. To give staff time to adjust to the new product during the trial, they waited a week to ask for feedback. During the second week, Matarazzo-Joy and others started collecting feedback, providing a QR code to send responses to a database, making outcomes easy to measure.

The evaluation lasted approximately three weeks and, at the end, all the remaining Versette trial products were withdrawn from use. “They wanted them back,” recalls Peterson.

OUTCOME

A model for clinical transformation

The Versette trial yielded 189 completed surveys with a 93% acceptance rate, far exceeding the initial goal of 100 surveys and 70% acceptance rate.¹ “When we quickly got to 100 completed surveys, we knew we could blow that out of the water, so we kept going for more,” says Sammia Strazdon, a Medline urology sales specialist on the project.

Staff feedback was overwhelmingly positive, with many expressing appreciation for the product’s comfort, versatility and ease of use. In addition, 91% reported that there was minimal to no leakage.¹

189 Completed surveys¹

93% Acceptance rate¹

91% Reporting minimal to no leakage¹

One nurse commented on the ability to shape Versette into three distinct ways to meet different body shapes: “From my observation, I think that product is life-changing for so many of our patients, especially the male patients with retractable anatomy.”¹ It’s a feature of Versette that Peterson calls “brilliant” and the nurses loved.

Katz shared the response from a bariatric patient during the trial period: “He said he was dry, he was comfortable and he felt that he finally had some dignity.”

For those nurses who were unsure about the switch, Strazdon says she told them, “’We’ll work through it.’ And I feel like a lot of the time, they just wanted to be heard, especially because they have a lot of changes that come down to them,” she says.

“We were all working toward the same goal, and we all deployed a lot of resources to achieve that.”

— Jennifer Beigie, Urology clinical solutions manager at Medline

“We were all working toward the same goal, and we all deployed a lot of resources to achieve that,” Beigie says, adding that the clinical partnership is especially helpful for external catheters. “They’re a very clinical device and need a lot of support for a successful conversion and implementation.”

Supporting the transition with education and trust

“The thing that took us over that finish line to get that great feedback was that we were able to support them clinically at the bedside with application and troubleshooting,” Beigie notes. With the overwhelmingly positive feedback—and leadership on board—the next phase was to convert the whole system to Versette.

“Nurses need the information, they need to know the conversion is coming.

—Nancy M. Peterson, MSN, BA, RN, Resource and Education Coordinator, Center for Nursing Excellence, Yale New Haven Health

It started with meetings with stakeholders related to Versette, including infection prevention, nursing leadership, materials management and wound care. “We went over their questions and made sure we worked through any issues they had,” Strazdon says. Together, the team also created an SBAR and dates for each educational session. Overall, the education and communication was central to the success of the transition.

Before, during and after implementation, the multi-layered strategy included:

• In-person training
• Road show-style informational booths
• Virtual Q&A sessions
• Just-in-time education
• Biweekly office hours for ongoing support
• Decision trees
• Post go-live education

Katz appreciated the attention to detail when it came to the education. “We knew exactly the days we were going to have education, the hours and who from Medline would be there, and they were very respectful of our policies and procedures,” she says.

Ensuring every staff member knew about the transition was important. “Nurses need the information, they need to know the conversion is coming,” Peterson explains. “To help, we created pre-communication that it was coming, that they knew when the education was happening and when they were going to see the product on the shelf.”

Another way they did this was road-show style. Katz and the Medline team visited all seven hospital’s inpatient campuses in the system over a seven-day period. “We sat outside the cafeterias and talked to the nurses to say, ‘Hey, this product is coming. What are your questions. Let us know.’ And we would sit there and just talk to people and let them touch and feel the product before it was live,” Strazdon describes.

“We would sit there and just talk to people and let them touch and feel the product before it was live.”

—Sammia Strazdon, Medline clinical lead

In addition, nurse leaders discussed the transition at every huddle the week before implementation. During conversion week, the Medline team was on site with hands-on classes. Then just-in-time education and bedside troubleshooting helped give staff confidence that they’d have support through the transition.

There was a learning curve involved that the Medline and YNHHS team worked through together. “We really just try to educate everybody,” Peterson says. “The biggest things were making sure that they knew that there were different shapes that you could put it in, how to keep it secure, which patients were appropriate for use, and that the material is the same foam that’s on the skin dressings that we’re using.”

“I can walk them through the things they’re doing really well and then the areas of opportunity,” Strazdon adds. For instance, Peterson says some nurses noted that Versette seemed rough, but Versette has the added comfort technology of ComfortPlus Foam.

Clinical and cost benefits

Versette addressed issues such as skin irritation and leakage. It also eliminated the need for additional pads to hold the previous product in place, contributing to cost savings. “We’re going to save money not only with changing the product to a better one, but also using less of those pads,” Matarazzo-Joy says.

This product has been used with barrier creams by the clinical teams. Katz sat with the wound care nurses to get their concerns or comments on Versette, and they didn’t have any. “Staff will express their dissatisfaction with a product through various channels, but I haven’t received any communication along those lines,” Katz says. “Any concerns that have been raised have been addressed and acted upon in collaboration with the Medline urology team in as close to real time as possible.”

“Staff will express their dissatisfaction with a product through various channels, but I haven’t received any communication along those lines.”

—Jodi Katz, MSHA, BSN RN CNML CVAHP, value analysis nurse at Yale New Haven Health

To guide appropriate product use, the team developed a decision tree, which was embedded into Epic, Yale’s electronic health record system. This helped standardize ordering and ensure compliance with clinical protocols. One key change they had to make to the ordering was to reflect that Versette isn’t just a female external catheter, that it’s also appropriate for males with retracted anatomy.

The Medline team had an existing decision tree—when to use an external catheter—and gave it to the YNHHS team to customize. “After infection prevention and skin health reviewed it, we made some tweaks,” Katz explains. “It’s still early on, but having that decision tree has been impactful.” One unexpected outcome, says Katz: “One of the units told us they weren’t using as many Versette as they did the other product.” When asked why, Katz was told it was because they were following the decision tree.

Continuous improvement and ongoing communication

Post-implementation, the team sustained momentum with regular office hours, ongoing education and plans for quarterly benchmarking. “We’re working now to set up a regular cadence calendar of education, to keep on top of it,” Katz says.

The initiative also laid the groundwork for future studies on CAUTI reduction and proper utilization of external catheters. “I’m going to be doing a longer-term study to see if I have a reduction in CAUTI,” Matarazzo-Joy explains.

“There’s been constant communication on every level,” Strazdon notes. “Now we’re talking about doing a class for the patient care technicians.”

Blueprint for success

“One of the biggest keys to success when you’re doing a conversion is following a consistent process and making sure you don’t skip steps or go around people,” Peterson says.

In a nutshell, Katz agrees: “We had the plan, we followed the plan, we enacted the plan, we had success.” But that success was not just about product performance—it was about partnership, planning and presence. The collaborative effort between the YNHHS team and Medline created a model for other health systems to emulate.

“We had the plan, we followed the plan, we enacted the plan, we had success.”

—Jodi Katz, MSHA, BSN RN CNML CVAHP, value analysis nurse at Yale New Haven Health

Working side by side, the Yale New Haven Health and Medline clinical teams built a strong relationship that allowed the plan to run smoothly. And when there were bumps, the teams approached them together. “I feel very blessed and fortunate that I’ve been able to work with a team that was so open and so communicative and so honest,” Strazdon says of her YNHHS counterparts.

The feeling was mutual. “I cannot speak highly enough about the collaboration,” says Katz. “Medline has truly been an industry partner with me as a value analysis professional. We walk hand in hand,” Katz added. “You need to build your relationships because everything is built on that,” Katz stresses.

Beigie agrees. “We were always invited to the table, so everybody heard the same messaging, everybody knew the new device was coming, and it just speaks volumes to the way that the Yale New Haven Health team communicated internally as well as with us.”

“You need to build your relationships because everything is built on that.”

—Jodi Katz, MSHA, BSN RN CNML CVAHP, value analysis nurse at Yale New Haven Health

Strazdon credits Medline’s dedication to achieving a smooth transition to the whole team: product support specialists, clinical support and boots on the ground. “I’m forever grateful for the amount of resources that are available to us at Medline, especially for an implementation of this size.”

“We really showed up in full force,” agrees Matt Meredick, clinical division manager at Medline. “You know, actions speak louder than words, and that mattered to them—seeing the level of support we brought.”

Another positive outcome was that staff have seen that their opinions are valued. “We’ve been telling people we can’t fix something if we don’t know about it. So they’re getting more comfortable bringing up issues,” Peterson comments.

Bottom line, says Matarazzo-Joy: “They were so excited to have that product back.” With the partnership in place, the Yale New Haven Health team plans to use their experience as a model for future change management. “It really paved the path, so we’ve marched this through as the standard now,” Katz says.

Yale New Haven Health’s transition to Versette catheters, not made with natural rubber latex, demonstrates how benchmarking, education and a strong partnership can drive successful and sustainable clinical change. The collaborative approach—marked by transparent communication, hands-on support and ongoing education—created a blueprint for future initiatives.