Just posting this for some insight/opinions. Our facility has been asked to teach another hospitals Iv team to place PICCS. We ( the team) have numerous concerns about this not the least of which is that the other facility uses completely different equipment than we do. Different US, different PICCS. They are coming to us so we don't even have access to the supplies they are going to use. The powers that be don't seem to think this is a hurdle. They have 7 people on their team & the supposed expectations that all of them can be trained within 2 months! We are a small team and are only planning teaching 1 person at a time. Our PICC volume is variable, some days we don't have any, other days we have 6. Am I out of line thinking that this is a BAD idea? We don't know if they have asked the supplier of their PICCS for education. We don't know if they have policies in place. They don't use 3cg or any type of navigation system. Am I supposed to stop using my 3cg & subject my patients to non essential cars to accommodate this new team? Interested in what everyone else thinks. It's not that we don't want to help them. We can show them our policies, paperwork, etc, but we feel they should be with dedicated trainer who can follow up with them if they need assistance. Thanks for your input.
Sorry, meant cxrs not cars ;)
It is my opinion this is a REALLY bad idea. How many piccs a year are they expecting to place? How many inserters are they hoping to have on staff? How many insertions per year will each person have to maintain competency? How are they selecting devices? Are ANY of these new inserters interested in vascular access or are they going to be "piccers"? I have a zillion more questions like this.
Most definitely I would NOT stop using 3cg for training this team. That equipment and those lines were purchased by your hospital for the benefit of your patients - for gentle, reliable insertions. In my opinion it would be a travesty to give your patients less than your very best, and to waste the money.
I hope in the future there will be minimum standards for PICC inserters. Too many hospitals don't seem to understand what it is we do and this "each one teach one" nonsense has to stop.
Vascular Access Specialists vs PICCers: This is my analogy, feel free to use it. Imagine you are tasked with installing the grounds for a beautiful new country club. Would you hire a landscaper or a lawnmower? The landscaper understands soil, sunlight and weather patterns, nutrition and moisture, indigenous pests, common plant diseases, etc. etc. etc. The lawnmower maintains what the landscaper designs. Would you hire the lawnmower to design and install your new country club lawn and gardens? Probably not.
The idea of nurses from another hospital coming to your hospital to learn PICC insertion is filled with challenges. I would not say it is totally a bad idea, however there are many aspects that you did not mention. You can NOT jump right in to clinical practice as the first step. What is the experience level of the learners? First they need to gain knowledge thru attending an insertion class or completing a computer or online based educational process (most all PICC manufacturers offer this). This would include anatomy and physiology, infection prevention, all equipment and supplies required (this is where they would learn about the differences in catheters, kits, US, and ECG, etc. as all inserters should be exposed to the entire spectrum of devices), routine nursing care, and complication prevention and management. After this step, then they would have a period of lab practice with anatomical models to learn how to set up and use all devices and become familliar with all the steps. Then they would move to supervised clinical practice with a qualified preceptor. Are these nurses going to be allowed to actually insert PICCs on your patients? Whose liability insurance is covering them - their hospital, your hospital or their individual policy? Does your risk management dept know about this plan? I would certanly make sure they were in on the planning. Who is going to document their competency? How many successful insertions are required to deem each one competent? How do you define "successful"? completely successful insertion with correct tip location? Or making the venipuncture and some catheter advanvement only? I have been educating in this arena for about 35 years and this is all that I would require in the planning stages.
There are 2 resources you will need. First is the INS Standards of Practice and the standard on competency. Ensure that what you are planning is going to meet that standard.
The second is the SHEA Compendium from 2014. Download here Compendium of Strategies to Prevent HAIs. Download the CLABSI chapter. This document contains a section on Implementation and is divided into 3 sections - engage, educate, execute, and evaluate. I wrote the section on educate and evaluate. There is a great deal of information in there about competency.
As I see it, the 2 major issues are a complete learning process that leads to documented competency for each learner. And the liability issues for each hospital and individual.
Good luck with this process! Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I liked your analogy Jill. I said roughly the same thing! Still not sold on this idea. We want to do right by this new team and be as prepared as possible. Thank you Lynn. Gives us more of an idea of what we need to do this and what questions to ask. I would still they rather have a company trainer who would go to their facility and train them there but I think it is a done deal. We'll see if any of those points Lynn brought up have been addressed by the higher ups.
One other thought. The hospital learning this insertion must have policies and procedures written and approved before the learners can return and start doing procedures. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861