Intravasculary Quarterly - February 2019

The e-news publication of the Association for Vascular Access FEBRUARY 2019 | VOLUME IX | ISSUE 1

Intravascular

QUARTERLY

AVA 2019: FULL OF CHANGE, FULL OF PROMISE

Eric Seger, AVA Director of Communications | Editor-in-Chief, Journal of the Association for Vascular Access, Intravascular Quarterly

When I was 8 years old, my father shared with me what I believe to be one of the life’s most prophetic statements: “Change is constant.

And the only constant is change.”

I didn’t think much of it then, but the more things come and go, the more I realize he was onto something. Dad’s statement kept bouncing around in my head during the four days the Association for Vascular Access Board of Directors and its staff spent together during its business meeting last month in Las Vegas, the site of the 2019 AVA Scientific Meeting.

AVA is knee-deep in a pivotal year for its future, and the attitudes, conversations and decision-making that took place in the Caesars Palace Convention Center meeting room reflected that. The team remained busy from early in the morning into the late afternoon each day as we worked through the lengthy list of agenda items that shaped what is on tap for 2019.

We discussed the AVA forecast, Vicarium, the association’s groundbreaking new Industry Partnership Program, clinical assets in the works, outreach opportunities, the Scientific Meeting and much more. It was inspiring to have such buy-in from the Board of Directors and staff members. We all left Nevada with a mile long to-do list!

Everyone is aware that 2019 has great potential – but can only achieve it if we work together. And that includes you, AVA members! We plan to increase the value of your individual membership, but need your help! If you would like to get more involved, please fill out the Volunteer Application on the website or reach out to Director of Outreach Beth Gore at bgore@avainfo.org.

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While we reserved ample time to enjoy the delicious food the City of Lights offers, the discussions about our future and the critical year we have ahead of us stood above all. Conversations on what we discussed earlier that day often spilled over to the dinner table, our tour of The Mob Museum in Downtown Las Vegas and elsewhere.

AVA looks forward to continue growing with you and serving its members, partners and above all, patients with more fervor than ever before. It’s going to be a fun ride in 2019 – change is in the air! We hope you join us!

For more information on the PediSIG and how to join: www.avainfo.org/pedisig

PEDISIG: Making every day count as a pediatric vascular access specialist AVA’s PediSIG is well known for leading the 1 Million Pokes campaign (#1MPokes) developing practice guidelines, putting together quality pediatric pre-meeting workshops and sessions and many other activities.

However, each of the clinicians, researchers and managers within the PediSIG Executive Leadership Council (ELC) are also leading practice innovations within their local areas. Here is a taste of what some of them have been working on to make the pediatric vascular access world a safer place.

Nursing Practice Leader: Pediatric Vascular Access at University of Iowa Stead Family Children’s Hospital Mary Beth Hovda-Davis, MSN, RN, VA-BC™, ELC Chair

In 2008, I began to work parttime as a central line nurse educator. The purpose of the job was primarily to educate our patients and families on how to care for their central lines when they were outside of the hospital. As a bedside nurse, I had zero awareness of the challenges our families face in the home setting. I work with many wonderful home health companies, but as I work in a regional hospital, some of my parents are hours away from any medical center to assist then when complications arise.

We are in the process of implementing a telehealth program that will follow up with the families after discharge to review central line teaching, review going home supplies and review teaching with the home nurse. In recognition that the home environment is vastly different from the hospital one, we have been providing a platform that we can effectively give just in time education and review of cares in the home setting. Through a simple video app, we have been

able to make appointments with the family and then easily be able to assess the patient, answer questions and review cares with the caregivers. While this may not change the world of vascular medicine, parents have enjoyed having a safe place to touch base after discharge.

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#NoBlindSticks Kristine, Nilsen, BS and Stephanie Pitts, MSN, RN, CPN, VA-BC™

Every patient who walks through the door deserves the best care. We know this and work hard to meet this expectation daily. So why are there continuous challenges associated with common vascular access procedures? How do we fix them?

To start, there are still a sizeable number of clinicians not using visualization to place vascular access devices. This could be due to a number of factors including a lack of formal education on vascular access, complexity of ultrasound training (didactic, simulation, practice, support), high costs of ultrasound and required dexterity.8,9 The data shows that clinicians placing peripheral intravenous catheters (PIVs) via traditional methods have lower first stick success rates than those using ultrasound.1,2,3 Not getting the line placed on the first attempt puts patients at risk for complications, delays in treatment, and decreases patient satisfaction scores for the hospital.10,11,12 If clinicians are blind sticking they also lack the ability to visualize the anatomical complexities of veins, nerves, and arteries, leaving patients at increased risk of nerve injury.4 This increased risk should cause concern, because vascular access catheter placements are one of the most commonly performed procedures for patients with an estimated 300 million of these devices placed annually in the United States.5 What’s even more alarming is that up to 90% of PIVs fail before patients complete treatment.6 If up to 90% of PIVs fail before a patient completes treatment, what increased risks are they being subjected to if additional device placements are done without visualization?

A challenge outside visualization is our everchanging population of patients. We now have a categorized group of patients that are considered difficult IV access patients, or DIVAs. DIVAs pose a challenge 4 | IQ | Intravascular Quarterly NEWSLETTER

due to health conditions that make finding access difficult. Some of these health conditions include: obesity, chronic illness, hypovolemia, vasculopathy and intravenous (IV) drug use.7 With changes in our population’s health and increasing evidence supporting the benefits of ultrasound, we need to work to safely expand the use of ultrasound for vascular access. Guidelines from many organizations such as Infusion Nurses Society (INS), Association for Vascular Access (AVA), Emergency Nurses Society (ENA), the Centers for Disease Control (CDC), American College of Emergency Physicians (ACEP), National Institute for Health and Care Excellence (NICE), American Institute of Ultrasound in Medicine (AIUM) and American Society of Anesthesiologists (ASA) are encouraging us to utilize ultrasound.

With the amount of evidence and standards of care in place how do we, the vascular access specialists looking to improve care, make this the standard of care? We start by changing the conversation. Instead of focusing on the reasons why ultrasound may be difficult to implement, we need to be focusing on opportunities where ultrasound can improve outcomes.

For example, if you work on a specialized vascular access team and you are constantly called to the emergency department to place IVs, that could be an opportunity to expand the use of ultrasound into that department. To determine if the opportunity is appropriate, collect information and data from stakeholders. How often are you or your team called in to place lines? Are the nurses in that department open to the idea of learning a new skill? Is there an available ultrasound machine or budget for the department to purchase one? Is the management team open to the opportunity? What type of data is CONTINUED ON PAGE 18

Therapeutic Music Reduces Anxiety During Hospital Bedside Procedures: An Innovative Patient-Centered Practice Ann Fedor, RN, BSN, BS-HA, VA-BC™ and Jonathan Henry, BSN, VA-BC™ Lankenau Medical Center, Main Line Health Vascular Access Team

ABSTRACT The opioid crisis has providers searching for alternative ways to treat pain and anxiety, ultimately reducing pharmacologic interventions. Additionally, there is a nursing initiative for patient-centered care, one of the Quality and Safety Education for Nurses (QSEN) competencies.8 Therapeutic music satisfies both of these needs for some hospitalized patients during stressful procedures.

Therapeutic Music Reduces Anxiety During Hospital Bedside Procedures

Research supports integrating music with painful or stressful bedside procedures as a means to reduce pain and/or anxiety.3,6 As you already know, our roles as vascular access nurses include placing peripherally inserted central catheters (PICCs) and midlines, inserted under similar sterile conditions at the patient’s bedside over approximately 20-30 minutes.

Our patient-centered care/process-improvement project has confirmed the usefulness of playing music for people undergoing these often stressful procedures.

The Problem / “Connecting the Dots”

The opioid epidemic is one of the most talked about problems in today’s society. According to the National Academies of Sciences, Engineering, and Medicine, “over the past 25 years, the United States has experienced a dramatic increase in deaths from opioid overdose, opioid use disorder, and other harms related to prescribing opioid medications for pain management.”2 Organizations like The National Academy of Medicine and The Joint Commission

have tasked health care providers with and offer strategies for utilizing alternative (non-pharmacologic) treatments.

Providers are expected to offer integrative modalities.7 Clearly, integrative therapies like music, Reiki and aromatherapy are a significant part of the solution, but we could do more to proactively and consistently offer these nontraditional pain/anxiety management modalities.4 The challenge, as we see it in our immediate work environment, is that we have anxious patients and need to do what we can to avoid pharmacologic interventions. Our therapeutic music project empowers patients to participate in managing their own symptoms, while offering distraction, reducing anxiety, and improving the patient experience. Granted, we didn’t invent this idea, but rather mindfully incorporated it into our practice.

IV nurses see anxious patients all day, every day.

In fact, almost everything we do for our patients involves pain and stress. With any luck, it will be only one stick and finished in just a few minutes.

This is still upsetting for anyone who hate needles.

And who doesn’t? Our sterile procedures take longer and seem to prolong the agony for some in spite of receiving a local anesthetic. Sometimes these lines support the massive amount of infusions while the patient is in the intensive care unit (ICU). Sometimes they are placed just before the patient goes home to CONTINUED ON NEXT PAGE FEBRUARY 2019 | 5

THERAPEUTIC MUSIC REDUCES ANXIETY, CONTINUED FROM PREVIOUS PAGE administer their own infusions. In both scenarios, if the patients are awake, they are usually overwhelmed and apprehensive.

Typically, the masks, hats, and drapes of the actual procedure cause further intimidation for the patient who read about all the terrible things that can happen in the consent they just signed. We got this idea about two years ago, when a patient asked to play her own music during her PICC insertion. The three of us present (the patient, Jon and I) all enjoyed it – such a nice change from daytime TV! That event, and the realization that therapeutic music was already being used all over our health care system in other ways, led to consistently offering music at the bedside with our own practice.

The project and study have been interesting. Here are a few highlights: Of our first 50 patients, the only person that said the music “did not help” to alleviate stress had recently been transferred from a stepdown 6 | IQ | Intravascular Quarterly NEWSLETTER

unit to a higher level of care. Overwhelmed with the move and the implications it held, the patient said she knew the music was playing but “barely heard it.”

Instead, her focused remained on the nagging pain in her abdomen and whether she would need another nasogastric tube.

The remainder of participants have been very positive about the experience. Several were amazed that we had “their” music (old-time country, Frank Sinatra, big band, gospel, jazz, oldies, rap). One man selected classical music and asked me on subsequent visits if I would play it for him again (I did) and if I had come to “put him to sleep again with Mozart.” When I did not have our usual speaker with me, I played music on my cell phone. His response was just as positive as when we offered better audio quality.

On another memorable occasion, I called a longdistance daughter for consent. She was busy CONTINUED ON PAGE 25

What’s Wrong With this picture?

This is Sir Andy Murray. He is a three-time Grand Slam tournament winner, 2012 and 2016 Olympic gold medalist, Davis Cup champion and former No. 1 ranked tennis player in the world.

With 45 singles tournament titles and more than 600 career victories to his name, Andy holds endorsement deals with Under Armor, Jaguar, Head, Standard Life and many more. You get it – Andy is a huge deal in the tennis world.

Unfortunately, earlier in 2019 he announced he may retire in the coming months due to nagging hip pain.

If everything works out, the 31-year old phenom wants Wimbledon in July to be his final tournament.

He is expected to retire with accumulated wealth approaching $165 million.

However, Andy’s preparations for that tournament are currently on hold after he underwent resurfacing surgery on his right hip on Monday. He posted this photo from his hospital room following surgery.

The photo has well north of 300,000 likes on Instagram alone, though it is highly unlikely anyone with working knowledge of how vascular access devices should be inserted and maintained liked anything about what’s pictured above.

To most patients – like Andy – he appears to be showing off some hospital tubes in his arm. But here is what trained vascular access professionals see:

Perhaps we are being picky, but 50 people die every day in America as a result of complications related to hospital tubes like the ones Andy is showing off in this photo.

These are peripheral intravenous catheters (PIV) that have been placed into his body to deliver medicine as part of his surgery to repair his hip. He didn’t go to the hospital to just get a PIV. He got a PIV because of why he was in the hospital.

We are not sure why he has what appears to be two PIVs in the same vein.

Vascular Access is a vital part of the healthcare people receive. It supports your therapy. It helps keep you alive. It can also cause catastrophic problems and even kill you if it isn’t done properly.

• First, Andy is a right-handed tennis pro. That arm is largely responsible for the millions he has earned throughout his career. The clinician who placed the PIV (again, there are two for some reason) should have taken this into consideration and used his left arm.

• Second, blood pressure cuffs can harbor pathogens that lead to infections. The arm without the PIVs should have been used. Had his left arm been cannulated, it would be in CONTINUED ON PAGE 24 FEBRUARY 2019 | 7

COLLABORATING WITH PATIENTS WHO USE DRUGS: DEVELOPING AN IN-HOSPITAL BEHAVIORAL CONTRACT TO PROMOTE PATIENT ACCOUNTABILITY AND SAFETY By: Lori L. Palomino, RN, C, VA-BC™ | TriHealth Vascular Access Team | Cincinnati, OH

INTRODUCTION

Infections are the leading cause of hospital admissions in persons who use intravenous (IV) drugs. They are often serious, requiring long term antimicrobial therapy. This has been studied and documented as far back as 1989.1 IV drug abuse has grown to a crisis level, frequently leading to other serious, potentially fatal medical conditions. It is difficult to monitor these patients for 24 hours during their hospital stay. Visitors have been found to bring in harmful substances and/or needles which jeopardizes patient safety and care.2 There have been several studies and articles addressing PICC placement in the outpatient setting so patients can receive their treatment at home or from an infusion center.

After reading the article “Responsible Compassionate Care: Meeting the Needs of Patients with a History

of Intravenous Drug Abuse” in the 2017 spring issue of the Journal of the Association for Vascular Access, I wanted to explore bringing this same compassionate care to the in patient population.

PROCESS

The authors of the aforementioned article outlined options instead of placing a PICC.3 As you know, this patient population has limited vascular access options with which to start. Placing a peripheral IV each time their current PIV infiltrates or mysteriously “comes out” is not an option. We don’t care for other patients in this manner, so why would we single out people who use drugs?

I met with the Infectious Disease physician at our institution to discuss what we could do to provide the most appropriate intravenous device to complete CONTINUED ON PAGE 12

IN-HOSPITAL BEHAVIORAL CONTRACT SAMPLE

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Improving Outcomes by Prioritizing Patient Education Susan Brown MSN, MSED, VA-BC™ | Chief Nursing Officer, ivWatch

Patient satisfaction remains a hot topic this year, so much so, that nearly every professional in the health care setting must take the patient’s perspective to their own care more seriously than ever before.

Since patient experience is part of the outcomes related to patient care and satisfaction, it’s important for vascular access professionals to identify the areas of their practice that are a potential liability by monitoring clinical and educational activities to identify both anticipated and unexpected risks, where they are succeeding as well as where it’s critical to improve.

A recent survey by the Institute for Healthcare Improvement reported that 21 percent of Americans had a personal experience with a medical error, and 31 percent said they were closely involved in the care of a patient who experienced an error.1 In addition, 8 out of 10 people believe patient safety is the main responsibility of health care providers, hospital leaders and administrators. This data reveals that even though many patients and caregivers have been directly impacted by an error, they still feel medical professionals are responsible for patients’ health and well-being and don’t take an active role in their own care.

Simplifying Patient Education

Although a particular task is routine to you as a trained VAT professional, it’s certainly personal to the patient. Take placing a peripheral intravenous (IV) catheter for example. While only minimally invasive, a patient may not be aware of why they need one or how to communicate an issue if they believe something is wrong.

While there are many excellent tools and techniques vascular access professionals deploy during patient education, few are available at their fingertips and address the patient directly. myIV.com is a patient resource portal dedicated to empowering patients with information on all things IV, simplified. There is

no other website dedicated to informing patients and their loved ones about IV access and the potential risks involved. Its role is to take complicated medical information and explain it in a way that someone without any medical background can comprehend.

The website’s mission is to explain IV therapy – types of vascular access devices, the typical uses, potential issues, and to help patients recognize symptoms of common complications before they lead to severe injury.

If a patient is aware of the common terms that will be used ahead of a hospital visit, they will likely feel more comfortable asking questions or clarifying advice from their provider. Education empowers patients to improve their health status. When we involve patients in their care, they are more likely to engage in interventions that may increase their chances for positive outcomes.2 Ultimately, setting a patient up to have input into their plan of care will result in increased satisfaction. Providing the patient and their loved ones with information on IV therapy not only increases engagement, but it gives the clinician additional sets of eyes in the room looking out for problems.

Reducing the Burden

Clinicians face many tasks that often put them in the difficult position of having to decide what they will not get done during their shift, also referenced in literature as ‘unfinished care.’ Patient engagement through education may be the task forced off the list and is a detriment not only to the patient, but to the clinician.

A study3 on nurse workloads found that the strongest predictor of nurse outcomes (i.e., emotional exhaustion and job satisfaction) was compromised professional nursing standards due to workload.

Nursing is a caring profession built upon nursepatient relationships and can have negative effects when it’s reduced to ‘task and time’ mechanistic CONTINUED ON NEXT PAGE FEBRUARY 2019 | 9

Subscribe no w on the following pla tforms:

www.avainfo

.org/podcas

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Improving Outcomes, CONTINUED FROM PREVIOUS PAGE approaches. Unfinished care not only increases the probability of adverse events, such as medication errors, but is a source of emotional distress and job satisfaction. myIV.com’s purpose is to reduce the burden of taskchecking of the clinician, by filling the gap through an offering of a pre-packaged and engaging suite of information and resources for all types of patients and caregivers.

Through partnerships with niche organizations, myIV.com provides custom content for anyone from parents of babies born premature (Frequently Asked NICU Questions – HandtoHold.org) to new nurses needing a refresher on Touch-Look-Compare IV site assessment (see next page) recommendations from the Infusion Nurses Society. Content is frequently updated in an effort to provide the most current and accurate information available to patients and caregivers whenever they need it. In addition to definitions of common industry terms, users can download free guides like ‘How to Talk to Your Health 10 | IQ | Intravascular Quarterly NEWSLETTER

Professional’ and a ‘Parents IV Toolkit.’ In addition to printable handouts that clinicians can display on a unit whiteboard, video is another platform available to communicate learning objectives. myIV.com has 3D animation videos explaining types of IV failure and causes of an IV infiltration.

Hospitals and outpatient clinics are often fastmoving and stressful environments, and myIV.com gives patients and providers the tools they need to be champions for quality care. If you are interested in learning more about myIV.com, or how to request any of the information described in this article, please contact info@myiv.com.

REFERENCES

NORC at the University of Chicago and IHI/NPSF Lucian Leape Institute. Americans’ Experiences with Medical Errors and Views on Patient Safety. Cambridge, MA: Institute for Healthcare Improvement and NORC at the University of Chicago; 2017.

1

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Improving Outcomes, CONTINUED FROM PREVIOUS PAGE

1) TOUCH

2) LOOK

3) COMPARE

4) REPEAT

https://degree.astate.edu/articles/nursing/nurses-rolepatient-education.aspx

2

MacPhee, M., Dahinten, V.S. and Havaei, F. (2017) The Impact of Heavy Perceived Nursing Workload on Patient and Nurse Outcomes. Administrative Sciences, 7, 7.

3

https://corp.kaltura.com/resources/webcastingtrends-and-challenges-2017/

4

About the Author

Susan Brown MSN, MSED, VA-BC™ is the chief nursing officer at ivWatch, a leading medical device manufacturer and biosensor technology company focused on improving patient safety and the effectiveness of intravenous therapy. Susan is responsible for clinical research and training programs for the company. Prior to her position at ivWatch, Susan spent 16 years at Children’s Hospital of the King’s Daughter’s (CHKD) specializing in pediatric intensive care and ended her tenure in the position of Director with Patient Care Services. During her time at CHKD, her responsibilities included managing operational and clinical care departments, including departments responsible for patient flow, vascular access, resource pool, and neonatal/pediatric critical care transport.

FEBRUARY 2019 | 11

COLLABORATING WITH PATIENTS WHO USE DRUGS, CONTINUED FROM PAGE 8 the patient’s treatment. We were not naïve to the idea that we would stop a patient from using drugs.

A drug user will use other means, if not their IV line.

Our goal is to prevent them from tampering with their IV device and tubing.

Our first step in this process was to develop a behavioral contract that spells out the patient responsibilities which includes the patient agreeing not to tamper or inject anything into their line or tubing, as well as any family members or visitors. It includes the use of tamper evident tape and if tape has been manipulated, it would be considered a violation of the contract. The contract also lists the consequences associated with violation of any of the requirements. (See page 8) I worked closely with our hospital legal team and risk management to create this document.

The Infectious Disease physician and I then met with the hospital’s Ethics Committee to discuss our concerns regarding options if a patient did not comply and contaminated their line. The Ethics Committee stood behind us and recommended that we check with an Ethics consult to evaluate each case separately if removal of a PICC/Midline was necessary.

After developing the contract, I presented it to the hospital Practice Counsel for approval. With the assistance of a team member on our Policy and Procedure Committee, a nursing policy was created.

(See page 8) We decided that the Vascular Access Team would take ownership of the contract and policy. When the team placed a PICC or Midline, the inserter would obtain consent for insertion and the behavioral contract. Questions arose about what we would do if the patient refused to sign the contract.

Presenting this to our Infectious Disease physician, it was decided that the appropriate line would still be placed, and the use of tamper evident tape placed on all unused injection ports, the same as if they did sign contract. The ordering clinician would be made aware that the patient did not sign the contract and a note documented in the EMR. The same consequences followed as a result of discovered tampering.

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The physician would be notified of any tamper issues and will decide the next course of action.

Prior to rolling out this plan, I created a PowerPoint presentation for our Nursing Forum and helped develop an educational presentation to distribute to all the nurses in our facility. Once we start to implement the contract, we will collect data and start a research project on the results.

SUMMARY

Each patient is entitled to the best care we can provide.

As providers, we need to educate the patients as to their responsibilities and expectations while they are in our care. The temptation to use an existing line may be overwhelming to some patients, but this should not eliminate these people from options available to other patients as long as some safeguards are put in place to protect the line and the clinicians in charge of their care.3 Once we implement the contract, we will also have social services provide the patient with information for drug rehab programs. Our goal is for the patient to complete their treatment in a safe environment.

DISCLOSURES

The author has no conflicts of interest to disclose.

REFERENCES Scheidegger, Claude, Zimmerli Werner. (1989) Infectious Complications in Drug Addicts: Seven-Year Review of 269 Hospitalized Narcotics Abusers in Switzerland. Reviews of Infectious Diseases, 11(3), 486-493.

1

Goel, Noopur, Munshi, Lubna Bashir, and Thyagarajan Braghadheeswar. (2016). Intravenous Drug Abuse by Patients Inside the Hospital: A Cause for Sustained Bacteremia. Case Reports in Infectious Diseases, vol.

2016, Article ID 1738742, 3 pages, 2016. doi: https://doi. org/10.1155/2016/1738742 2

Hawes, Michelle L., and Willegal, Kate M. (2017).

Responsible Compassionate Care: Meeting the Needs of Patients with a History of Intravenous Drug Abuse. Journal of the Association for Vascular Access, 22(1), 31-34. doi: https://doi.org/10.1016/j.java.2016.08.004 3

Offering Patients a Safer Option for Vascular Care

Excerpt from The AWL, a publication of St. Joseph’s Regional Medical Center. Sponsored by the Sisters of Charity of Saint Elizabeth.

Published with permission.

St. Joseph’s Health is the first health system in the United States to develop and implement an alternative, safer option for Femoral Central Line Catheter insertion. The new insertion site, located in the mid-thigh, is the first innovation in vascular access sites since 1961.

“Our culture of innovation at St. Joseph’s Health means that our teams are constantly developing new and better ways to deliver care and improve patient outcomes,” said Mourad Ismail, MD, FCCP, Chief, Critical Care, St. Joseph’s Health.

“Through our world-renowned Vascular Access program, we have discovered a safer option for vulnerable patients who require central line catheters for life-saving medications.”

The innovative, central venous catheter insertion is performed by placing a central line to the femoral vein in the midthigh rather than traditional placement in the groin.

This change means that patients have decreased risk of deep vein thrombosis and lower risk of infection.

St. Joseph’s Vascular Access program has a history of innovation beginning with becoming the first hospital

to implement sterile ultrasound-guided peripheral intravenous (IV) insertion, which was awarded the 2016 NJBIZ Healthcare Hero Innovation Award.

St. Joseph’s Matthew Ostroff, APN, board certified in vascular access, approached clinical leadership with this leading-edge idea, illustrating how it can provide improved outcomes for patients.

“This introduction places St. Joseph’s Health’s Vascular Access program on the world stage,” Ostroff said, noting that the Association for Vascular Access (AVA) has included the new program in upcoming educational videos that highlight best practices around the country. Ostroff also has been contacted regularly by hospitals throughout the nation for his protocols to implement the new central line insertion site in their facilities.

For more on the work being done with placing central lines to the femoral vein in the mid-thigh, check out the following articles published in 2018 issues of JAVA: https://doi.org/10.1016/j.java.2018.07.005 https://doi.org/10.1016/j.java.2018.06.004

FEBRUARY 2019 | 13

Announcing the 2019-2020 AVA Board of Directors AVA is excited to announce that the slate of candidates for the 2019 Board of Directors recommended by the AVA Board Development Committee (BDC) has been accepted by the membership.

The BDC is proud to announce the addition of two new members to the Board: Sheila Hale, RN, MSN, CRNI®, VA-BC™ and Jon Bell, RN, MSN, VA-BC™.

Both will serve as Directors-at-Large.

Director-at-Large

Jon Bell

Sheila began her nursing career as an LVN in 1985 and earned her ADN from Austin Community College in Austin, TX in 1993. She received her BSN, 2015 and MSN, Leadership, 2018, from Grand Canyon University, Phoenix, AZ. Sheila has been a nurse for over 30 years and has focused her practice on Vascular Access since 2004. Sheila is a founding member of Central Texas Vascular Access Network (CENTEXVAN) and has held the offices of secretary, president, and is an advisor and web administrator for the network. She has been an AVA member since 2009.

Director-at-Large

Sheila Hale

medicine. These two strands combined to give him an interest in emergency vascular access where he was able to use the sterile procedural techniques and vascular suite training in the ED to assist doctors in placing CVC. He also learned to utilize US guidance for peripheral IVs. Additionally, previously elected Ken Symington, MD, VA-BC™ assumes the role of President, while Lori Kaczmarek, RN, BSN, VA-BC™ steps into the role of President-Elect and Andrea Owens, MSNEd, RN, CRNI® shifts to Presidential Advisor. Russ Nassof, JD, assumes the role of Treasurer and Jocelyn Hill, MN, RN, CVAA, VA-BC™ moves to Secretary.

Jon began in medicine as a paramedic and then transitioned to emergency nursing. After a decade of emergency experience, he became a perioperative nurse while continuing to practice emergency

For more information on the AVA Board of Directors, please visit www.avainfo.org/BOD

2019 Board of directors President

Director-at-Large

AVApresident@avainfo.org

jbell@avainfo.org

President-Elect

Director-at-Large

Director-at-Large

lkaczmarek@avainfo.org

shale@avainfo.org

spitts@avainfo.org

Ken Symington

Lori Kaczmarek

Presidential Advisor

Jon Bell

Sheila Hale

Director-at-Large

Director-at-Large

LORELLE WUERZ lwuerz@avainfo.org

Stephanie Pitts

Director-at-Large

Andrea Owens

Madalyn George-Thiemann

Samantha Crandall

Secretary

Director-at-Large

Director-at-Large

jhill@avainfo.org

tstevens@avainfo.org

cchapman@avainfo.org

Treasurer

Director-at-Large

Director-at-Large

rnassof@avainfo.org

astone@avainfo.org

gconey@avainfo.org

aowens@avainfo.org

Jocelyn Grecia Hill Russell Nassof

mthiemann@avainfo.org

Tonja Stevens AMY STONE

scrandall@avainfo.org

Christie Chapman

Gwendolyn Coney

OUR STAFF CHIEF EXECUTIVE OFFICER

Director of Clinical Education

DIRECTOR OF OUTREACH

ramzy@avainfo.org

jthompson@avainfo.org

bgore@avainfo.org

CHIEF Operations OFFICER

DIRECTOR OF COMMUNICATIONS / JAVA EDITOR-IN-CHIEF

DIRECTOR OF FINANCE

RAMZY NASRALLAH TONYA HUTCHISON thutchison@avainfo.org

DIRECTOR OF AFFILIATES

JUDY THOMPSON

ERIC SEGER

eseger@avainfo.org

CINDY ANDERTON canderton@avainfo.org

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BETH GORE

KATIE TORNOW

ktornow@avainfo.org MEMBER SERVICES COORDINATOR

JENNIFER LIVSEY jlivsey@avainfo.org

STAFF SPOTLIGHT Beth Gore: Director of Outreach My Support System: My husband, Dan, 6 kids (ages 9, 13, 15, 17, 19, 20), three-pound dog, Daisy, extended family, fellow moms of kids with complex disabilities and my faith.

My Favorite Movie: I like specific scenes such as the Independence Day speech, Remember the Titans death crawl scene and numerous scenes from Princess Bride.

My Favorite Quote: “When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, ‘I used everything you gave me’.” ~ Erma Bombeck. My personal mission statement is also a quote, “Speaking for those who cannot speak for themselves.” ~ Proverbs 31:8. I also taught for Dale Carnegie Training for two decades, so I have quite a few favorites from “How to Win Friends and Influence People.”

My Favorite City: Home - Tampa Bay, Florida. Ahh. Palm trees.

My Escape: Deep sleep (rare), traveling and watching medical dramas.

Before you ask, yes, I know they’re not realistic, that’s the point. In less than an hour, the mystery illness is diagnosed and treated (usually by a handsome doctor) and they live happily ever after. It’s quite the deviation from my life-experience of parenting children with complex medical needs.

Thanksgiving 2018

My Roots: I’ve lived all over the US from LA to Chicago, Toledo to Mobile because my Dad was a traveling pastor. We’d live in three cities in one year sometimes, so my sister and I learned to make friends fast. My husband and I have now lived in the Tampa Bay area for over 20 years causing my roots to be deeply entrenched here.

What do you enjoy about working for AVA: I love the people at AVA - the board, staff, volunteers and members who are all passionate about patient safety. It’s easy to spend 8, 10 or 12 hours a day working because it doesn’t feel like work. It feels like purpose.

What do you do at AVA: Patient advocacy is at the heart of everything I do. Whether that’s talking with like-minded organizations or sharing Vicarium with a hospital system, patient safety is first and foremost in my mind.

What are your goals at AVA: My goal is straightforward: to reduce patient complications, morbidity and mortality across the continuum of care. Vascular access has flown below the radar as a patient safety issue for far too long. It’s time.

Vicarium is a vehicle for that where AVA partners with a facility to increase better patient outcomes in a sustainable way. (Contact me at bgore@avainfo.org if you’d like to learn more about getting Vicarium into your facility.)

Beth’s son Manny manning the AVA Booth at the Oley Annual Conference

FEBRUARY 2019 | 15

AVA currently has 52 active networks The Association for Vascular Access is committed to providing an opportunity for members to broaden their knowledge of vascular access and related fields through networking opportunities and education.

AVA Networks offer vascular access professionals the opportunity to network with other professionals in their area of expertise.

Network meetings offer educational sharing opportunities, continuing education credits, dinner meetings and quality dynamic speakers.

Do You Know Where Your Nearest Network Is? w w w. ava i n f o . or g / n e t w or k s

Connecting Talent with Opportunity Search and apply for job opportunities in the vascular access field. On LinkedIn? Save time and import your profile directly to the AVA Career Center.

Post an ad for an available vascular access position -find the| Intravascular best talent! Quarterly NEWSLETTER 16 | IQ

Start your search at:

jobs.avainfo.org

TeamSTEPPS and Closed-Loop Communication Samantha Crandall, MSN, RN, CPHQ, CPPS

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was created by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense’s Patient Safety Program. TeamSTEPPS provides higher quality and safer care by helping build teams that optimize information, people, and resources, increase team awareness, resolve conflict and eliminate barriers to patient safety. This program provides multiple tools, all free to the public on AHRQ’s website.

I’d like to start a TeamSTEPPS series and teach some tools that are easily adopted in daily practice, and tools that you can start to apply today to ensure safer care for your patients.

Closed-Loop Communication

“Roger,” “Wilco,” “Over” and “Out” are all examples of closed loop communication (CLC) used in early voice radio communication. When one was unable to see the person receiving the message, the need for ensuring the transmitted message was actually received was critical. For those who are curious: • Roger—stands for the letter “R”, which was often difficult to understand over the radio—meant “message received.”

• Wilco—meant “will comply” with what you said.

• Over—meant “I am done—now you can talk.”

• Out—meant “I am done.”

Every transmission had a reply, and if there was no reply, you assumed your transmission was not received and repeated it. Designed to ensure transmission and reception of information in an environment where communication was often confused and pressured, the entire system is something we can surely relate to in health care!

The Joint Commission has identified communication failures as the third-most common cause of sentinel events. Closed-Loop Communication is a tool that can be utilized to improve our reliability by helping us communicate more clearly, and the best part is that it isn’t a foreign concept to any of us! When I go to In-N-Out and order a double-double and fries, they don’t simply answer back, “Got it” or “I heard you.” The point of CLC is to let the sender know you heard them and understood them. The staff, in this scenario, repeat back exactly what I said, “You want a double-double and fries.” - simply acknowledging: “I’m human, you’re human, did you say it right? Did I hear you right?” Closed-Loop Communication attributes to the massive volume of orders that leaves fast food restaurants and their low rate of error.

CLC has been shown to reduce error rates by removing ambiguity from instructions and allowing questions if the instruction was not heard or clearly understood. It also allows others in close proximity to also be aware of proposed course of action.

CONTINUED ON PAGE 27

FEBRUARY 2019 | 17

#NOBLINDSTICKS, CONTINUED FROM PAGE 4 currently being collected in the department on first stick success, etc.?

Once you’ve gathered the appropriate data, analyze it and work with the appropriate stakeholders to decide whether ultrasound implementation is an option for that department. If approved, begin planning how it will roll out – who should be involved, what steps will be taken to educate the group, how they will practice placements, what type of education should they receive, is there a training department that can be involved, etc.

Once implementation has occurred the team should continue to track outcomes and progress. Have the number of attempts per patients decreased since implementation? Has the number of times they call your team for support decreased? Have supply costs decreased due to higher first stick success rates?

Tracking outcomes allows you to monitor the progress of the implementation along with the sustainability over time. Refresher training may be beneficial every few months just to ensure skills stay up to par and to support any new team members.

This type of opportunity can likely be found throughout hospitals, primary care centers, infusion clinics and many other places. There are so many opportunities to educate and remove challenges associated with vascular access. We can be the driver of change, we just need to share our expertise! Remember, we want to safely expand the use of ultrasound to benefit the patient and the clinician. Every stick matters, so let’s get the world committed to #NoBlindSticks.

REFERENCES Egan G, Healy D, Oneill H, Clarke-Moloney M, Grace PA, Walsh SR. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis.

Emergency Medicine Journal. 2012;30(7):521-526. doi:10.1136/emermed-2012-201652.

1

Desai K, Vinograd AM, Abbadessa MKF, Chen AE. Longevity and Complication Rates of Ultrasound Guided Versus Traditional Peripheral Intravenous Catheters in a Pediatric Emergency Department. Journal of the Association for Vascular Access. 2018;23(3):149-154. doi:10.1016/j. java.2018.06.002.

2

18 | IQ | Intravascular Quarterly NEWSLETTER

Feinsmith S, Huebinger R, Pitts M, Baran E, Haas S. Outcomes of a Simplified Ultrasound-Guided Intravenous Training Course for Emergency Nurses. Journal of Emergency Nursing. 2018;44(2). doi:10.1016/j.jen.2017.10.001.

3

Boeson M, Hranchook A, Stoller J. Peripheral Nerve Injury from Intravenous Cannulation: A Case Report.

AANA Journal 2000 4

Moore, C. (2014). Ultrasound first, second, and last for vascular access. J Ultrasound Med. 33:1135-1142.

5

Alexandrou, E, Ray-Barruel, G., Carr, P., Frost, S., Inwood, S., Higgins, N., et al. (2018). Use of short peripheral intravenous catheters: Characteristics, management, and outcomes worldwide. J of Hospital Medicine. DOI 10.12788/jhm.3039 6

Emergency Nurses Association (ENA) (2015). Clinical Practice Guideline: Difficult intravenous access. Emergency Nurses Association.

7

Infusion Nurses Society Position Paper (2013).

Recommendations for Improving Safety Practices With Short Peripheral Catheters.

8

O’Grady NP, Alexander M, Burns LA, et al. (2011).

Guidelines for the Prevention of Intravascular CatheterRelated Infections. Centers for Disease Control and Prevention (CDC).

9

March, N., et al. (2018). Expert versus generalist inserters for peripheral intravenous catheter insertion: a pilot randomized controlled trial. Trials. 19:564. doi. org/10.1186/s13063-0118-2946-3 10

Walsh G. Difficult Peripheral Venous Access: Recognizing and Managing the Patient at Risk. Journal of the Association for Vascular Access. 2008;13(4):198-203. doi:10.2309/ java.13-4-7.

11

Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization.Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD006962.

DOI:10.1002/14651858.CD006962.pub2.

12

Vascular Access: My Why Madalyn George-Thiemann, MSN, RN, CNS

AVA, AVA, how I love thee! Let me count the ways you have impacted me!

AVA is professional, innovative, practice-based, enthusiastic, accountable, passionate and compassionate, which is why I was drawn to it many years ago.

I first became acquainted with vascular access specialists in my practice as a staff nurse on a pediatric floor. Children, especially infants, can be difficult to access. I spent many hours in treatment rooms with inexperienced practitioners poking and poking until the child looked like a human pincushion. Once the hospital put the “IV team” in place, these experts consistently saved my tiny patients from the horror of multiple unsuccessful IV starts.

In 1990, a little guy with total parenteral nutrition (TPN) dependence due to short bowel syndrome came home with me. Keeping his central access patent was a matter of life and death. Due to infection, dislodgement and other complications, he required multiple line placements. After many years of surgical line placements, we were told his line would be placed by a department called Interventional Radiology.

Unaware what this department did, I soon learned and came to respect and trust these professionals who saved my son a trip to the operating room and the implications that came along with it. After many

line replacements, my son’s access became difficult and these expert physicians and nurses went above and beyond to get into his veins and assure his “life line.”

When my son and I were asked to speak at the annual AVA Scientific Meeting several years ago, I was overwhelmed with the level of passion, compassion and commitment of the professionals I met. Top on their list of priorities was the patient – that sealed it for me! They were speaking my language! After many years in the nursing profession preaching family- and patient-centered care, it was so refreshing!

When I was asked to be a member of the AVA Board of Directors in the capacity of patient advocate, it humbled and honored me to say yes. I completed a year on the BOD in December and have learned much about the workings of the organization and its mission. I can attest to the fact that the patient remains the most important aspect of all that they do to further the practice of vascular access.

I am a pediatric hospice nurse. My little patients require vascular access for chemotherapy, pain control antibiotics and various other infusions. They depend on impeccable care and maintenance of their lines at all times. I depend on the guidance of the experts to assure that my practice is top-notch. AVA is providing that expert guidance.

Well, that should convince you that yes, I LOVE AVA!

FEBRUARY 2019 | 19

NETWORK NEWS

INDIVAN is a new AVA network and held its first meeting in August 2018 INDIVAN held its inaugural meeting at Rick’s Boatyard on the Eagle Creek Resevoir in Indianapolis where Indiana native Chellie DeVries, MPH, CIC, VA-BC™ provided an inspiring presentation titled, “Addressing the Dressing: Improving Vascular Access Dressing Disruption” and sponsored by Eloquest Healthcare and Ethicon. We had approximately 64 attendees who have a variety of experience. Vascular Access Specialists, Infection Prevention nurses, Quality Improvement Nurses, industry representation, Nursing Instructors and several Key Opinion Leaders in the specialty of Vascular Access from all over Indiana attended. They came from Ft. Wayne, Columbus, Bloomington, Bedford, Muncie and Gary, to name a few. The enthusiasm was contagious!

INDIVAN Board and Cindy

Team from Parkview in Ft. Wayne

Fall Meeting with great turnout and great venue!

In November 2018, we had another fantastic educational event with Dr. Pitou Devgon reviewing approaches to blood draws and sponsored by Velano Vascular. There was great info as to why we cannot get blood samples from PIVs and the research they have done to overcome that. We had a few nursing and medical students as well as some Emergency Nurses to supplement the attendance. AVA CEO Ramzy Nasrallah also attended. We are grateful Marian University allowed us to use their lecture hall!

will have three speakers in addition to a vendor fair and lunch is provided. Look for more information to come!

Our next meeting is March 27, 2019, from 9 a.m. to 2:30 p.m. at William K. Nasser, MD Healthcare Education and Simulation Center in Indianapolis. We

Please join us and help us to shine a light on protecting the patient, educating the clinician and saving the line!

20 | IQ | Intravascular Quarterly NEWSLETTER

INDIVAN Board, Ramzy Nasrallah and Pitou Devgon

NETWORK NEWS

Diana Melton, MSHA, RN, CRNI, VA-BC™ | FLAVAN President

FLAVAN begins the New Year with a big welcome to our newest Board member, Caitlin Soldati! Caitlin was elected as 2019 Secretary and we are super excited to have her. Other Board members include President Diana Melton and Treasurer Rhonda Peyton.

FLAVAN wrapped up 2018 with a total of 13 educational scholarships (yes, 13) for our members who attended the annual Scientific Meeting in Columbus in September. Amber McFerren, RN, VABC™ topped the list as the recipient of our 2018 scholarship. She took the challenge to another level, as seen in her “My AVA Experience” presentation to the members during our Dec. 13 meeting in Orlando.

We’re planning our 2019 schedule and invite you to pay a visit to Florida and network with us. For FLAVAN news and upcoming events, visit our website and like us on Facebook!

FEBRUARY 2019 | 21

NETWORK NEWS 2018 was a tremendous year of growth for OKVAN, Oklahoma’s Vascular Access Network. The new officers for 2018: Tori Amsler (President), Shanelle Stensaas (Vice President), Lorna Pickett (Treasurer) and Amy Deimel (Secretary). Each brought with them an energy, focus and enthusiasm as they worked hard to boost membership and community engagement.

Our goals were to increase awareness of our network, build membership, develop stronger ties with local industry representatives and promote high quality vascular access within our state. Overall, it was a successful year! We were able to gain 90% more members than the previous year, raise network funds to provide scholarships for AVA Annual Scientific Meeting attendance and develop a more robust social media and contact list to spread the word of our network. We hope to continue this momentum in 2019 and look forward to building a thriving network.

OKVAN POSITIVE OUTCOMES

22 | IQ | Intravascular Quarterly NEWSLETTER

NETWORK NEWS

On Friday, November 16, 2018, AVACNY held their 10th Annual Teaching Day Symposium at the Craftsman Inn and Conference Center in Syracuse NY. With over 125 attendees and 25 sponsors, the event was a huge success! Nurses came from all over New York State, despite the heavy snowstorm, to attend the event.

Speakers covered a variety of topics, including evidence-based medicine, new securement options, home infusion therapies and vascular access changes in practice.

The following speakers presented this year: People Still Do That? Clinical Convention vs. EvidenceBased Medicine — Presented by Renee’ Odehnal, MS, BSN, RN, CRNI®, VA-BC™

opportunities for education, to expand our network of healthcare providers, to encourage certification through Vascular Access Certification Corporation (VACC), and to promote membership for the National Association of Vascular Access (AVA).

Some of our accomplishments this year included partnering with the NYS Department of Health to help educate on best practices, held our first VACC Review Class at Hotel Syracuse, held a dinner symposium for proactive catheter care management and hosted two programs for IgCN certification, all very well attended. 2019 brings many new opportunities to discuss new trending technologies, advanced practices for our scope of practice and current infusion therapies for the alternative care setting.

Tissue Adhesive: A New Tool for your Vascular Access Toolbox — Presented by Marcia Wise, RN, VA-BC™ Specialty Home Infusion: IG Administration & Protocols — Presented by Robin Belle, RN, IgCN, LNC Impact Assessment of Securement Devices on CLABSI — Presented by Mark Rowe, MNSc, RNP, VA-BC™ Vascular Access Change in Practice — Presented by Kathy Kokotis, RN, BS, MBA The President of AVACNY, Jan Elliott BS, RN, VABC™, CRNI®, opened and closed the Symposium and introduced our amazing speakers.

AVACNY: www.avainfo.org/group/avacny

In 2019, our network goals are to continue to offer

VACC: www.vacert.org

AVA National: www.avainfo.org

FEBRUARY 2019 | 23

WHAT’S WRONG WITH THIS PICTURE?, CONTINUED FROM PAGE 7 the right place on his right arm. Inflated blood pressure cuffs also interrupt and diminish blood flow. This can impair drug delivery infused below and the combined cannulas also decrease blood flow. All can contribute to deep vein thrombosis (DVT).

• Third, Andy has hairy arms. They should have been clipped prior to cannulation.

• Fourth, there is blood visible in one of his cannulas, which needs to be flushed. It is also secured with tape. There are better options for securing PIVs. PIVs get dislodged at an alarming rate.

• Fifth, the dressings - and tape - are clearly not occlusive and should be changed.

• Sixth, stopcocks could be removed immediately following surgery. They do not disinfect ports and are known to increase intraluminal infection risk.

Both PIVs were placed in the forearm and do not terminate in an area of flexion, like Andy’s elbow or wrist - so the site selection, albeit on a professional athlete’s dominant arm - appears to be sound. When PIVs are placed in the hand or terminate in the wrist, any bending risks pistoning the catheter which could lead to phlebitis, dislodgment, embolism, infiltration and infection.

These devices - their insertion, care and maintenance - are the most common invasive procedures in all of healthcare. Hundreds of millions of them get placed every year around the world. You’ve probably had at least one in your life.

clinicians perform insertions, care and maintenance.

That’s not OK. The Association for Vascular Access would like to change that.

We are committed to protecting patients through advocacy and education by helping them understand and define what is normal with their PIVs and other access devices. AVA also educates clinicians on important aspects of vascular access like site and device selection. The AVA Foundation helps fund research, scholarships and initiatives that elevate the standard of catheter care and the competence of the people who administer them.

Vascular Access requires dedication and understanding. Andy went to the hospital for hip surgery, not to get a PIV - but he could have ended up staying much longer (and possibly never leaving) because of it.

Fifty people die every day in American hospitals because of complications resulting from their vascular access devices. Andy did not become part of that statistic, but thousands of others do every year. We need to do better, not just for the rich and famous - but for all of us.

This is Andy Murray. He is a patient, just like all of us.

To learn more or to join AVA, please visit www. joinAVAnow.com For more discussion on Andy Murray’s IV care, check out Season 2, Episode 2 of the ISAVE That Podcast on iTunes, Spotify, SoundCloud and Stitcher.

Andy, a multi-millionaire and celebrity, shared photos of his PIVs and probably had no idea just how suboptimal his vascular access care was. The hundreds of thousands of fans who liked the photo probably had no idea either.

This is happening every day in hospitals and clinics everywhere, in part because vascular access is not adequately covered in nursing or medical school. This specialty and vital component of healthcare delivery is generally learned on-the-job by watching other 24 | IQ | Intravascular Quarterly NEWSLETTER

(Andy Murray has no relationship with AVA or the AVA Foundation, but he can always ask)

THERAPEUTIC MUSIC REDUCES ANXIETY, CONTINUED FROM PAGE 6 and stressed about making arrangements to come see her elderly mother, who was now sedated and intubated, and in critical condition in the SICU. When I suggested we could play music for her mom during the PICC procedure, she was genuinely relieved and happy. Her mother, having been a concert pianist, connected with classical music.

In this case, the music indirectly helped someone many miles away from where it was actually being played. As you might expect, even patients that cannot converse (aphasia, dementia) also respond positively to hearing music while we work. And, the nurses in the room like it too!

Supportive Organization

The American Society for Pain Management sets standards and promotes nursing practices for pain and stress management. Their position is that pain relief is a basic human right, and their goal is to equip nurses with as many strategies as possible to provide appropriate and individualized pain management modalities.1

Conclusion

Providing music as a means to manage patient anxiety or perceived pain is more than just another nice thing to do. There is abundant evidence to support using therapeutic music for patients undergoing stressful

procedures. Implementing music has been wellreceived by patients and families at our institution. It is a low cost, highly portable, and effective modality in helping patients cope with situational stress.

One caveat about music-streaming apps, you might want to consider upgrading to an ad-free version to prevent disruptions in music sessions!

References

American Society for Pain Management Nursing website.

(2018). http://www.aspmn.org 1

Confronting pain management and the opioid epidemic.

(2018). Retrieved from http://resources.nationalacademies. org/infographics/AcademyOpioid/index.html 2

Ghetti, C. M. (2013). Effect of music therapy with emotional-approach coping on pre-procedural anxiety in cardiac catheterization: A randomized controlled trial.

Journal of Music Therapy, 50(2), 93-122.

3

Howland, R. H. (2016). Hey Mister Tambourine Man, Play a Drug for Me: Music as Medication. Journal of Psychosocial Nursing and Mental Health Services, 12, 23-27. https://doi. org/10.3928/02793695-20161208-05 4

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2014). Policy & Politics (7th ed.). Saint Louis, MO: Elsevier.

5

Swedberg Yinger, O. (2015). A systematic review of music-based interventions for procedural support. Journal of Music Therapy, 52(1), 1-77. https://doi.org/10.1093/ jmt/thv/004 6

The Joint Commission jointcommission.org 7

website.

(2017).

www.

The Quality and Safety Education for Nurses website.

(2018). http://qsen.org/competencies/pre-licensure-ksas/ 8

FEBRUARY 2019 | 25

Welcome

to our Newest

Dru Strohmenger -- Canton, Ohio Melody Bourgeois -- Weare, NH Lisa Green -- Queen Creek, Arizona Wendy Prescott -- Alexandria, Virginia Beth Gross -- Cave Creek, Arizona Julia Hill -- Los Angeles, California Shannon Westenberger -- Sheboygan, WI Deborah Guthrie -- Springboro, Ohio Vance Clement -- Fayetteville, Arkansas Kristin Benasich -- New York, New York Jennifer Aguero -- Tampa, Florida Timothy Rochelle -- Morgan, Texas Elizabeth Gallagher -- Lake Zurich, Illinois Kerry Ryan -- Richmond, Virginia Loretta Dorn -- Volo, Illinois Vickie Starosta -- Brookfield, Illinois John Attebury -- Eldorado, Illinois Karin Derr -- Bend, Oregon Rob Renander -- Livermore, Maine Jeffrey Rowe -- Proctorville, Ohio Elizabeth Bruce -- Arlington, Texas Molly Carlson -- Lincoln, Nebraska Tom Hunter -- Franklin, Indiana Gregory Settles -- Conway, Arkansas Joe Burkett -- Addison, Texas Jennifer Stone -- Goose Creek, SC Nick Ashenburg -- San Francisco, California Rachel Black -- Limington, Maine Christine Vereb -- Irwin, Pennsylvania Janelle Smith -- Tebbetts, Missouri Stephanie Bergeron -- Prior Lake, Minnesota Karen Polinski -- Upton, Massachusetts Chris Booms -- Sacramento, California Kevin Readel -- Yukon, Oklahoma John Domingo -- San Antonio, Texas Nicholas DeRita -- Abingdon, Maryland Jason Bryant -- Wendell, North Carolina Donald Walk -- Westford, Massachusetts Marilyn Ritenour -- Portland, Oregon Brandon Watts -- Redding, California Michelle Elder -- Ann Arbor, Michigan Daniel Dispenza -- Carol Stream, Illinois Sarah Augros Johnson -- Santa Clara, CA

Jennifer Johnson -- King City, Oregon Colleen Hanrahan -- Charlotte, NC Kimberly Moffett -- Russell, Massachusetts Kendra Schultz -- Maplewood, Minnesota Patrick Carlton -- Bel Air, Maryland Jennifer Oskam -- Colorado Springs, CO Grace Rodriguez -- Miami, Florida Nicole Rose -- Ypsilanti, Michigan Megan Rowlett -- Elkridge, Maryland Lillian Clegg -- Plantation, Florida Jessica Jones-Driscoll -- McMurray, PA Tonya Setzer-Ayscue -- Henderson, NC Shonda Harden -- Milledgeville, Georgia Susan Pettyjohn -- Mount Sidney, Virginia Natalee Olah -- Arlington, Virginia Cristina Grasu -- Northridge, California Paula Combs -- Brighton, Colorado Kathryn Rider -- Castro Valley, California Jody Gunderson -- Cave Creek, Arizona Conor Bailie -- Scottsdale, Arizona Monica Lawson -- Seattle, Washington Linda Romano -- Peabody, Massachusetts Leanne Ruegg -- Kuluin, Queensland, Australia Jill Michel -- Oceanside, California Tracy Thompson -- Smithfield, NC Chelsea Bone -- New Albany, Indiana Kevin Frye -- North Ridgeville, Ohio Kassandra Spiller -- Murphysboro, Illinois Elizabeth Hill -- DuQuoin, Illinois Ashley Henderson -- DuQuoin, Illinois Diane Pyatt -- Grand Tower, Illinois Riley Wahl -- Bandon, Oregon Sarah Ellis -- Haywards Heath, West Sussex, UK Jodi Caggiano -- Garden Grove, California Regine Turmel-Bristow -- Pembroke Pines, Florida Lawrence Caton -- Yreka, California Michelle Stewart -- Danville, Indiana Kimberly Rust -- Rosemount, Minnesota Juliana Hartman -- Aurora, Ohio Angela Davis -- Winston-Salem, NC Patricia Griffith -- Buchanan, New York

26 | IQ | Intravascular Quarterly NEWSLETTER

Members (Joined November 1, 2018 - January 31, 2019)

Ruth Carrico -- Louisville, Kentucky Kevi Harpring -- Rushville, Indiana carla hudson -- Santiago, Santiago, Chile Nancy Malinosky -- Waynesboro, PA Bianca Estelle -- London, London, UK Karen Buchs -- Carleton, Michigan Tricia Julian -- Fairmont, West Virginia Mark Cathcart -- Indianapolis, Indiana Robert Buck -- Las Vegas, Nevada Kathryn RĂƒÂ­os -- Leawood, Kansas Michael Tal -- Tel Aviv, Israel, Assuta Medical Center Walter Turner -- Austin, Arkansas Margaret Hawn -- San Jose, California Kelly Parker -- Clermont, Florida Susan Gniewek -- Ann Arbor, Michigan Chris Goodwin -- Altamonte Springs, Florida Kenny Bacle -- Princeton, Texas Kyle Bruno -- Rancho Cucamonga, California Judy Jennings -- Beckley, West Virginia Andrea Borling -- Flagstaff, Arizona Jacqueline Reyman -- Hoosick Falls, MY Maegan Peterson -- Annapolis, Maryland Brenda Gaidiessmith -- Cupertino, California Barbara Indyk -- White Oak, Pennsylvania Bradford Wanta -- Waunakee, Wisconsin Barbara Wiles -- Greenville, South Carolina Claudia V Ortega -- Chicago, Illinois Amanda Budak -- Charleston, South Carolina Mary Ann Dark -- Gregory, Michigan Tamara Sullivan -- Santa Rosa, California Glenn Kellum -- Whitestown, Indiana Nicole Mauceri -- Montville, New Jersey Kimberly McClain -- Livonia, Michigan Donna Bozga -- Chicago, Illinois Cathy Peterffy -- Milan, Michigan Tino Elisara -- San Bruno, California Mark Lichterfeld -- San Antonio, Texas Audrey Lambert -- Nixa, Missouri Jill Lyman -- Sterling, Colorado Chris Morgan -- Oak Hill, Florida Krista Frasier -- West Babylon, New York Hayley Krause -- Indianapolis, Indiana

TeamSTEPPS AND Communication, CONTINUED FROM PAGE 17 TIPS/TRICKS

• Make eye contact when you can—utilize nonverbal as well as verbal communication • Clearly identify the person to whom you are speaking Now that we understand what closed loop communication is, let’s discuss when to use it!

• When giving verbal instructions • When written communication is not possible • When delegating tasks Using CLC helps us mitigate risk associated with mishearing and misspeaking (e.g. An RN hears, “Transfuse two units” when the MD actually said, “Transfer to the unit”). Health care is fraught with opportunity to mishear what someone is saying.

Often we deal with sound alike letters that increase our risk (eg. F/S/X, M/N, B/C/D/E/G/P/T/V/Z).

When repeating back information, make it your practice to clarify using the NATO Phonetic Alphabet.

The actual words you choose don’t need to be from the table, but the concept is important. For example, you can use “Sam” instead of “Sierra” or “Dog” instead of “Delta.” If I were to spell my last name (Crandall), for example, I might say, “C-Cat, R-Romeo, A–Apple, N-No, D-Dog, A-Apple, L-Llama, L-Llama.” Try to stay away from tricky words (e.g. don’t say, “P as in phone”).

In addition to ensuring sound alike letters don’t hinder a successful communication, it’s also important that we pay close attention to numbers. Mishearing numbers can be even riskier than letters because unlike letters which you can sometimes catch due to the context of the word, numbers are generally individually variable without relation to the others around them.

Examples of critical times in which we interface with numbers and would want to use numerical clarification include: medication doses, entering a patient’s address, or providing a room number.

What numbers sound alike?

Biggest risk is the teens: 14 sounds like 40 15 sounds like 50 16 sounds like 60 17 sounds like 70 18 sounds like 80 19 sounds like 90 But others can be misheard, so it is best to get in the habit of using individual numbers when it’s important.

Examples of CLC: A team leader wants to ensure messages are received and understood: Sender: “Give Vasopressin 40 units IV now.”

Receiver: “I’m giving Vasopressin 40 units, that’s four zero units, IV now.”

Sender: “That’s correct.”

CONTINUED ON NEXT PAGE FEBRUARY 2019 | 27

TeamSTEPPS AND Communication, CONTINUED FROM PREVIOUS PAGE Closed-Loop Communication is a relatively simple tool, but it is not always easy to use. When you begin to use it, you may experience some resistance from those who you ask to repeat-back what they have heard. This is not unexpected, as they may not understand why you are making this request.

Respectfully explain to them the reason you are using this tool is to ensure you are both on the same page, and to prevent an error from miscommunication.

Many communication errors can be avoided by using this simple tool. Choose today to communicate more safely by using Closed-Loop Communication.

Do I? Verify critical communication by repeating it back to sender?

Request verification if not provided?

Use CLC whenever I am unsure of the communication?

Look for opportunities to use CLC in your workspace?

If your healthcare institution does not have TeamSTEPPS training, you can always attend a training session provided by the American Hospital Association.

Commit to Make the Change This is a skill you can begin using today!

• Look for opportunities where CLC can be incorporated in your department.

• Decide to use CLC one time during your shift.

• Listen for when others use it and take note of its effectiveness.

• Thank your coworker for using CLC.

28 | IQ | Intravascular Quarterly NEWSLETTER

PEDISIG, CONTINUED FROM PAGE 3 Lisa Sheehan, RN, MSN, VA-BC™ and Dana Etzel-Hardman, BSN, MSN, MBA, CPN

The UPMC Children’s Hospital of Pittsburgh vascular access team and value analysis team collaborated to help reduce pediatric CLABSI events.

Following extensive assessment of the current state of central

line practice, a combined roll out of a humanfactors designed central line dressing change kit was combined with required education and individual skill assessment for all nurses on central line care and maintenance to achieve a 60% reduction in CLABSI events.

Amanda Ullman, PhD, RN, BN, GC PICU, MAppSci Associate Professor: Alliance for Vascular Access Teaching and Research (AVATAR) at Griffith University (Australia)

We have so many great projects going, all working to transform the way we provide care to children needing vascular access. One I am proud of is a study where we are tracking children with central venous access devices (CVADs) through their entire experience, from all different perspectives (the child, the parents, the clinicians and

the cost). This includes the child’s experience from critical care, through acute care, and into the home.

We want to be able to better understand the impact that CVADs have in the lives of children with complex health conditions, how we can best support them and their families and prevent harm. This study will help us focus our future innovations on things that really matter and justify the value of technological advancements.

Call for Manuscripts We invite you to submit original manuscripts in the field of Vascular Access. We are interested in receiving manuscripts on clinical practice, education and research related to vascular access including articles on vascular access manufacturing and technology, and vascular access care and maintenance issues in hospitals, home settings, hospice, and alternative care facilities.

We also invite submissions to our Patient/Consumer Perspective column where we ask you to share personal stories or “lessons learned” about caring for, living with or having a vascular access device. In about 1000 words and in conversational style, present your story. You can submit on behalf of someone or encourage them to write it themselves.

For complete instructions see:

Information for Authors at www.avajournal.com Or contact the JAVA Editor at JAVAEditor@avainfo.org FEBRUARY 2019 | 29

1,200

00

30 | IQ | Intravascular Quarterly NEWSLETTER

Advertise to the Market You’ve Been Looking For . . .

Advertising space available on AVAinfo.org The Second Edition of the ‘Chart of Pediatric CVC Maintenance Bundles’ IS AVAILABLE AT AVAINFO.ORG/STORE

GET YOURS TODAY! Printed full color with gloss UV coating 13” x 19” size Package of 5 Members: $40 Non-members: $50 Shipping included FEBRUARY 2019 | 31

Do you like what you read here?

Would you like to be part of this publication?

Do you have something interesting, informative or new going on in your place of practice? Have you cared for a special or interesting patient? Do you or your colleagues have new or innovative ways of doing things? Have you been to or presented to any meetings or conferences?

We invite you to submit For publication Writing a submission does not mean that you have to write the next great American novel.

It is more about presenting pertinent information in a brief, fun and creative way.

Please submit to eseger@avainfo.org

Submission dates are: February 1 deadline for submissions for February issue May 1 deadline for submissions for May issue August 1 deadline for submissions for August issue November 1 deadline for submissions for November issue

Visit our website www.avainfo.org

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@associationforvascularaccess www.pinterest.com/associationforvascularaccess/

Association For Vascular Access www.linkedin.com/company/association-for-vascular-access/

Association For Vascular Access www.youtube.com/channel/UCP3i3q44bvmVdjjUclt9esw

F O R C O M M E N T S OR S U G G E S T I O N S , P L E A S E S U B M I T T O AVA @ avainfo . org Disclaimer: AVA (Association for Vascular Access) is a professional organization of vascular access professionals dedicated to improving vascular access practice and patient outcomes through education and other means. AVA publishes this periodic electronic newsletter for our membership and other interested parties for information purposes only. AVA distributes this electronic newsletter with the understanding that AVA is not engaged in rendering medical or professional service through the distribution of the IQ publication. AVA is not giving advice and does not subscribe to guarantee the accuracy or efficacy of the information provided. Privacy Policy and Unsubscribe Information -AVA maintains strict rules of confidence with regards to your email address and all other personal contact information. We will not, under any circumstances, sell, transfer, or provide your email address to any third party for any reason. Email lists are compiled on an opt-in basis by AVA for the sole purpose of distributing the E-VAN newsletter. AVA does not condone or participate in the distribution of unsolicited email. If you feel that you have received an email transmission from AVA in error, please contact AVA at info@avainfo.org and ask to be removed from the list. All removal requests are addressed promptly.

32 | IQ | Intravascular Quarterly NEWSLETTER