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Driving Zero Complications in VAD Use: A Call to Action
A b s t r a c t s
a n d
ORAL ABSTRACT WINNERS (3-WAY TIE) Central Venous Catheter Insertion by Registered Professional Nurses in the United States: Scope of Practice, Education, Training, and Credentialing Considerations Laura Krick, Jim Lacy, RN, BSN, CRNI, VA-BC, and Nancy Trick, RN, CRNI Abstract: The insertion of acute and long-term central venous catheters (CVCs) by registered professional nurses (RNs) specializing in vascular access, in the United States, has evolved slowly over the last 6 years. The purpose of this presentation is to discuss the driving forces including research, review, validation, education and ability to affect change to public policy, and statutes and regulations governing nursing practice, to expand the scope of practice to include CVC insertion and other advanced procedure skills. A literature review and analysis of current medical and nursing standards, guidelines, and recommendations affecting the insertion, use, care, and maintenance of CVCs was evaluated to identify and justify the opportunity for change. Additional literature and research was conducted to understand the education, training, credentialing, and competency needs of RNs. A core team created an assessment of each state’s board of nursing scope of practice statements. The assessment revealed that 27 states had clear scope of practice statements, which may allow RNs to insert CVCs; 23 states would require additional research, board contact, or request/petition for an advisory or opinion. Individuals within each of the 23 states were identified and the work of addressing state boards where advisory or opinion is required was begun. Results, processes, and identified challenges addressing professional development and practice expansion will be presented. The product of these efforts was the compilation of essential processes, programs, and tools that allow an individual to promote her/his practice level within her/his own environment. Specific examples of individual practice changes will be presented.
Driving Zero Complications in VAD Use: A Call to Action Nancy Trick, RN, CRNI Abstract: Vascular access devices (VADs) are important instruments in the care of critically ill and those with chronic
P o s t e r s
illnesses. While use of evidence-based clinical practice in the day to day management of these devices is intended, actual reported outcomes indicate that we are far from reaching our goal of zero complications. The purpose of this presentation is to consider the tri-directional relationship of catheter associated tip malposition, thrombosis, and infection and address use of combination technologies, getting us as close to zero complications as possible. A literature review and analysis of current standards of practice, guidelines, and recommendations describing a tri-directional relationship between VAD associated tip malposition, thrombosis, and infection was undertaken. The intent of the review and analysis was to better understand clinical practice, which utilizes combination technologies as a consistent model of VAD management. Reported management of single and bi-directional VAD-associated complications was most often reported in the literature and no findings resulted in the correlation of tri-directional management through combination technologies in the management of VADs. A call to action will be issued through this presentation for all clinicians to consider proactive utilization of combination technologies as a single risk-reduction solution for every patient, from insertion of a VAD through completion of therapy, with the aim of driving zero complications in VAD use.
Physician-Based Versus Nurse-Based Medical Registries: Why the Difference? Charles Sherline, BS, MBA Background: There are currently over 20 different practice based registries that are tied to physician practice and procedures. The major reasons these registries exist are to improve patient care and prove enhanced outcomes based on the intervention. With over 3M PICCs inserted by vascular access specialists (VASs) across the US, a practice-based VAS registry is a powerful tool to show quality and outcomes. Methods: There are ZERO registries to capture nurse data of any kind. The physician-based registries capture data on cardiac, vascular, respiratory and many other diseases. In January 2012, a global, web-based PICC registry was launched for VAS. This registry is the first-ever national practice-based registry for nursing of any kind. Quality measures and patient outcomes are reported for national level benchmark creation and vital data will be published. Results: A handful of "forward-thinking” clinicians within vascular access have secured funding and begun to utilize the registry. These institutions embraced the nursing-based registry concept and have begun to see immediate results and implement practice changes. Limitations: Nurses do not see the true value in comparative procedural data like physicians. Nursing is not used to seeking funding from administration. Therefore, acceptance of a VAS registry to capture data is difficult. Conclusion: The mantra of "evidenced-based medicine” largely comes from large data registries and the journal publications from these registries. By participating in a national, practice-specific registry, VASs have the opportunity to prove their
2012
j
Vol 17 No 4
j
JAVA
j
189
a n d
ORAL ABSTRACT WINNERS (3-WAY TIE) Central Venous Catheter Insertion by Registered Professional Nurses in the United States: Scope of Practice, Education, Training, and Credentialing Considerations Laura Krick, Jim Lacy, RN, BSN, CRNI, VA-BC, and Nancy Trick, RN, CRNI Abstract: The insertion of acute and long-term central venous catheters (CVCs) by registered professional nurses (RNs) specializing in vascular access, in the United States, has evolved slowly over the last 6 years. The purpose of this presentation is to discuss the driving forces including research, review, validation, education and ability to affect change to public policy, and statutes and regulations governing nursing practice, to expand the scope of practice to include CVC insertion and other advanced procedure skills. A literature review and analysis of current medical and nursing standards, guidelines, and recommendations affecting the insertion, use, care, and maintenance of CVCs was evaluated to identify and justify the opportunity for change. Additional literature and research was conducted to understand the education, training, credentialing, and competency needs of RNs. A core team created an assessment of each state’s board of nursing scope of practice statements. The assessment revealed that 27 states had clear scope of practice statements, which may allow RNs to insert CVCs; 23 states would require additional research, board contact, or request/petition for an advisory or opinion. Individuals within each of the 23 states were identified and the work of addressing state boards where advisory or opinion is required was begun. Results, processes, and identified challenges addressing professional development and practice expansion will be presented. The product of these efforts was the compilation of essential processes, programs, and tools that allow an individual to promote her/his practice level within her/his own environment. Specific examples of individual practice changes will be presented.
Driving Zero Complications in VAD Use: A Call to Action Nancy Trick, RN, CRNI Abstract: Vascular access devices (VADs) are important instruments in the care of critically ill and those with chronic
P o s t e r s
illnesses. While use of evidence-based clinical practice in the day to day management of these devices is intended, actual reported outcomes indicate that we are far from reaching our goal of zero complications. The purpose of this presentation is to consider the tri-directional relationship of catheter associated tip malposition, thrombosis, and infection and address use of combination technologies, getting us as close to zero complications as possible. A literature review and analysis of current standards of practice, guidelines, and recommendations describing a tri-directional relationship between VAD associated tip malposition, thrombosis, and infection was undertaken. The intent of the review and analysis was to better understand clinical practice, which utilizes combination technologies as a consistent model of VAD management. Reported management of single and bi-directional VAD-associated complications was most often reported in the literature and no findings resulted in the correlation of tri-directional management through combination technologies in the management of VADs. A call to action will be issued through this presentation for all clinicians to consider proactive utilization of combination technologies as a single risk-reduction solution for every patient, from insertion of a VAD through completion of therapy, with the aim of driving zero complications in VAD use.
Physician-Based Versus Nurse-Based Medical Registries: Why the Difference? Charles Sherline, BS, MBA Background: There are currently over 20 different practice based registries that are tied to physician practice and procedures. The major reasons these registries exist are to improve patient care and prove enhanced outcomes based on the intervention. With over 3M PICCs inserted by vascular access specialists (VASs) across the US, a practice-based VAS registry is a powerful tool to show quality and outcomes. Methods: There are ZERO registries to capture nurse data of any kind. The physician-based registries capture data on cardiac, vascular, respiratory and many other diseases. In January 2012, a global, web-based PICC registry was launched for VAS. This registry is the first-ever national practice-based registry for nursing of any kind. Quality measures and patient outcomes are reported for national level benchmark creation and vital data will be published. Results: A handful of "forward-thinking” clinicians within vascular access have secured funding and begun to utilize the registry. These institutions embraced the nursing-based registry concept and have begun to see immediate results and implement practice changes. Limitations: Nurses do not see the true value in comparative procedural data like physicians. Nursing is not used to seeking funding from administration. Therefore, acceptance of a VAS registry to capture data is difficult. Conclusion: The mantra of "evidenced-based medicine” largely comes from large data registries and the journal publications from these registries. By participating in a national, practice-specific registry, VASs have the opportunity to prove their
2012
j
Vol 17 No 4
j
JAVA
j
189