Error Rate Greatest In Hospital
Radiology
Study Cites Communication Failures
By Rob Stein
Washington Post
Wednesday, January 18, 2006; Page A03
Wednesday, January 18, 2006; Page A03
Hope this helps,
Nancy Costa CRNI
----- Original Message -----
From: "Lynn Hadaway" <[EMAIL PROTECTED]>
To: "Kokotis, Kathy" <[EMAIL PROTECTED]>; "Bev and
Tim Royer" <[EMAIL PROTECTED]>; "CAROLYN"
<[EMAIL PROTECTED]>;
<[EMAIL PROTECTED]>
Sent: Monday, January 30, 2006 6:43 PM
Subject: RE: INS standard # 37
> Washington Post reporting that medication errors that harm patients
> are seven times more frequent in the radiological service than in
> other hospital settings. This comes from an analysis by the USP. The
> issue appears to be many communication failures when patients move to
> this dept. So in my opinion, a PICC can and should be done at the
> bedside to reduce the workload and burden on radiology depts while
> they get control of this problem. I learned of this article through
> MedScape but can not get back to that article to give an address.
> Mike Cohen from ISMP is quoted in this article, so there could be
> more information about this from other sources. Lynn
>
> At 3:06 PM -0700 1/30/06, Kokotis, Kathy wrote:
>>I am beginning to believe all PICC lines should be placed in
>>radiology where there are:
>>
>>PICC, Stick and Run teams
>>
>>PICC lines placed with traditional peel-aways
>>
>>PICC lines placed without Ultrasound
>>
>>Radiology does it safer in those instances
>>
>>If I were the patient in any of the above I opt for the radiology
>>placed PICC line
>>
>>Kathy
>>
>>________________________________
>>
>>From: Lynn Hadaway [mailto:[EMAIL PROTECTED]
>>Sent: Mon 1/30/2006 1:23 PM
>>To: Kokotis, Kathy; Bev and Tim Royer; CAROLYN; [EMAIL PROTECTED]
>>Subject: RE: INS standard # 37
>>
>>
>>
>>Well Kathy, I think that you are still comparing apples and oranges
>>when you compare IR inserted PICCs to a nurse-inserted service. I
>>think you are comparing data from multiple studies without going
>>through the strict analysis processes required for a meta-analysis.
>>
>>When we were looking at the published data for the standards, I nor
>>anyone else on the INS standards committee found an article of any
>>kind comparing PICCs inserted with the standard through the
>>introducer to PICCs inserted using MST. You may claim that you can
>>compare data from multiple studies but until it has gone through a
>>true meta-analysis process and the peer-reviewed publications
>>process, it can not be used as a reference in a document such as the
>>standards.
>>
>>I really do not think anyone is arguing that the AC inserted PICCs
>>are better than the ones placed above the AC, so I think we are
>>making a mountain out of a mole hill on this one! Lynn
>>
>>At 11:54 AM -0700 1/30/06, Kokotis, Kathy wrote:
>>>I do not know if anyone read my last paper in the LITE spectrum but
>>>I did address the two papers with looking at complications rates of
>>>MST & US and upper arm placement vs nursing traditional insertions.
>>>How did I do this. IR used upper arm and MST and ultrasound and
>>>nursing used traditional tools. Phlebitis rates, thrombosis rates
>>>were higher for nurisng group significantly.
>>>
>>>If INS does not understand to this day that upper arm basilic
>>>placement has a lower rate of complications and that usage of
>>>portable ultrasound is highly recommended and evidence based in the
>>>AHRQ government safety report than how can I defend practice that is
>>>so out of date. I can defend what we do not easily as INS is not
>>>reading the literature
>>>
>>>My soap box is over. Get with the times. By the way from my
>>>figures 45% of PICC lines are placed in nursing with MST and 100% in
>>>radiology with MST. You do the math. The doctors are right and
>>>more patient focused. Ultrasound is used 15% in nurisng insertions
>>>and doctors use fluoro or ultrasound in 100% of cases. I don't know
>>>about INS but standard of care dictates the usage of US or MST or
>>>all PICC lines should be send to radiology to be placed. What do
>>>you think of that one?
>>>kathy
>>>
>>>________________________________
>>>
>>>From: [EMAIL PROTECTED] on behalf of Bev and Tim Royer
>>>Sent: Sun 1/29/2006 10:02 AM
>>>To: 'CAROLYN'; [EMAIL PROTECTED]
>>>Subject: RE: INS standard # 37
>>>
>>>
>>>When looking at this standard it is important to note that
>>>Paragraphs II & III A and B which come before paragraph C state:
>> >A "Site selection criteria should be established in
>>>organizational policies and procedures and practice guidelines."
>>>B "Site selection should be determined per manufacturer's labeled
>>>uses(s) and directions for device insertions."
>>>
>>>To me, as a clinician, I am covered under paragraphs A & B if
>>>placing in the upper arm using ultrasound imaging.
>>>
>>>Currently there is very little scientific evidence based practice
>>>published on the topic of comparing antecubital and upper placement
>>>of PICCs. Most manuscripts, address increase in successful PICC
>>>line placement rates in the upper arm using micro-introducer and
>>>ultrasound imaging technology. Only antedotally is it mentioned
>>>that there is a decrease in mechanical phlebitis and an increase in
>>>patient and nursing satisfaction not having the PICC placed in the
>>>region around the antecubital fossa.
>>>
>>>The use of micro-introducers and ultrasound imaging with nursing is
>>>still only a small percent of the total number of PICCs placed by
>>>nursing. There are many facilities and agencies that place PICCs
>>>using the traditional approach of sight and feel and place in the
>>>antecubital fossa regional and report that they have good outcomes.
>>>Nurses are good at what they do.
>>>
>>>Antedotal evidence is OK and is considered but it is not considered
>>>rigorous scientific study. Outcome data analysis carries a little
>>>more weight and should be published more than it is in this area.
>>>However, like everybody else in our field, our time is so involved
>>>in patient care and management that publishing is low on our
>>>priority list. Best would be research in this area involving a more
>>>rigorous scientific study comparing both areas of placement
>>>(antecubital fossa vs upper arm). Again our time is limited at work
>>>and the time involved in getting an approved study through the IRB
>>>at the facilities we work at and the time necessary to carry out the
>>>study is very involved and time consuming. Nursing Research is not
>>>a high priority for many institutions.
>>>
>>>We all need to be tracking our data on PICCs and complications and
>>>have the data published.
>>>
>>>Bottom line here - "The Infusion Nursing Standards of Practice",
>>>revised 2006 edition, cannot put a standard in that is not backed up
>>>by rigorous scientific study even though antedotally we see better
>>>outcomes. It has been published over and over again that nurses can
>>>place PICC lines safely in the antecubital fossa region.
>>>
>>>Timothy Royer, BSN, CRNI
>>>Nurse Manager / Vascular Access / Diagnostic Service
>>>VA Puget Sound Health Care System
>>>Seattle / Tacoma, WA
>>>
>>>Disclaimer - This are my personal beliefs and do not represent the
>>>institution I work at.
>>>
>>>________________________________
>>>
>>>From: [EMAIL PROTECTED]
>>>[mailto:[EMAIL PROTECTED] On Behalf Of CAROLYN
>>>Sent: Sunday, January 29, 2006 7:40 AM
>>>To: [EMAIL PROTECTED]
>>>Subject: INS standard # 37
>>>
>>>
>>># 37 Site Selection - Practice Criteria: II Peripheral-Midline and
>>>III PICC it states:
>>>
>>>Site selection should be routinely initiated in the region of the
>>>antecubital fossa; veins that should be considered for cannulation
>>>are the basilic, median cubital, cephalic, and the brachial.
>>>
>>>When we use ultrasound we are hardly ever placed in the antecubital
>>>fossa because of the larger catheters being required, increase in
>>>antecubital complications because of movement and of course patient
>>>comfort.
>>>
>>>What are the legal implications of this in court by not using the
>>>antecubital for placement? Thanks
>>>
>>>Upgrade Your Email - Click here!
>>><http://promos.hotbar.com/promos/promodll.dll?RunPromo&El=&SG=&RAND=19301&partner=hbtools>
>>>
>>
>>
>>--
>>Lynn Hadaway, M.Ed., RNC, CRNI
>>Lynn Hadaway Associates, Inc.
>>126 Main Street, PO Box 10
>>Milner, GA 30257
>>http://www.hadawayassociates.com
>>office 770-358-7861
>
>
> --
> Lynn Hadaway, M.Ed., RNC, CRNI
> Lynn Hadaway Associates, Inc.
> 126 Main Street, PO Box 10
> Milner, GA 30257
> http://www.hadawayassociates.com
> office 770-358-7861
>
