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Alma,
Where do you work? I could not remember. Trying to put a face with a name sort of thing. I'm getting old.
Heather Nichols RN BSN CRNI
Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Alma Kooistra" <[EMAIL PROTECTED]> 8/2/2006 8:41 PM >>> Amen.
Alma Kooistra RN, CRNI ----Original Message Follows---- From: "Bev and Tim Royer" <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] Subject: RE: VAD Committee Date: Wed, 2 Aug 2006 05:58:12 -0700 Nadine, All I have to say is way to go and thanks to all your hard work in developing and maintenance excellence in practice. Tim -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Nadine Nakazawa Sent: Tuesday, August 01, 2006 10:47 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: VAD Committee Our hospital VAD Committee was started in 1983 by the Oncology Cliinical Nurse Specialist at that time. The members were nurses from oncology and hematology units initially, and eventually BMT. By the end of the 1980's the committee fell apart because the chair at that time was working only part-time and going to graduate school. I started the PICC program in 1990 but our volume in the early years was relatively low. By 1993 it became apparent that there was a huge need for PICC line and vascular access education, and someone to write PICC and CVC related policies and procedures. I took over the VAD Committee at that time, and invited members from infection control, the ICUs, outpatient oncology infusion, med-surg, dialysis, home care, home pharmacy, a rep from the Crisis Nurses (they go around and help out with all kinds of procedures: inserting difficult IV's, declotting CVCs, removing CVCs or PICCs, moderate sedation, etc), and the clinical research unit, and the general med-surg educator (head educator who oversees the unit educators). Up to that time, there were different CVC related procedures in the ICUs, med-surg, oncology, outpatien t oncology, and home care. It was confusing for patients because their care was different depending on which unit or outpatient area they were in, and it was confusing for nurses who floated to different areas of the hospital. It took me THREE years and monthly meetings to get all these areas to agree to a single CVC Maintenance Care procedure that covered ALL central line care for inpatients, outpatients, and in home care. We developed a single custom CVC dressing kit that could be used on ANY central line from a triple lumen CVC, to a dialysis catheter, tunneled catheter, port or PICC line. I started with a 2 hour inservice on care and maintenance of PICC lines in 1992, and it evolved over the next few years into an all day class that was given quarterly through our Center for Education and Professional Development. That way the CE Center advertised the classes, took registration, provided classroom space, AV equipment, set up morning and lunch food, and gave out the CE certificates. All I had to do was show up and teach. I have been a member of the VAD Committee since its inception in 1983 and the chair since 1993. We do not have physician representation on our committee, but we do have an NP from the IR dept on our committee. We've also added the nurse manager of Radiology to the committee. We meet monthly, although I've been doing so much outside lecturing at conferences, etc, that we've only met about half the time. Through the years email has evolved and become a major means of communication about issues and problems that can't wait for the monthly or bimonthly meetings. We discuss the following: 1) Write and revise the following procedures: CVC Maintenance Care Procedure, CVC Removal Procedure, CVC Repair Procedure, PICC Insertion Procedure, P ICC Removal Procedure, PICC Repair Procedure, Declotting CVCs Procedure, Dissolving Drug Precipitates Procedure, Therapeutic Phlebotomy Procedure, Accessing and Deaccessing Implanted Port Procedure. 2) We evaluate different products and decide which PICC line to use, which needleless connector to use, which antiseptic to use, whether to use Biopatch, what to put in our custom CVC dressing kit, etc. Basically any and all products that have to do with VADs. Obviously I have a lot of influence on these products, and I am the one to contact the vendors and invite them to present their products. I also do all the research (eg, calling other hospitals, reading the articles, attending conferences, "talking" on the listserv(!), etc. I hand out pertinent articles and materials when deemed necessary. If a small trial on different nursing units is needed, I get committee members to take responsibility for getting inservices done, getting the evaluations completed and tabulated, etc. I get the potential products introduced into Materials Council (on which I am an active member). 3) Discuss different issues and problems and discuss ways to resolve them. In the past year we have revised most of the CVC and PICC procedures, implemented changes in these procedures, introduced PowerPICC, Biopatch, a new needleless connector, and moved to NS flush/locks on all CVADs and PICCs. We are still struggling with this decision and get periodic emails with complaints. 4) Other classes: I organized and brought together experts for an all day CRBSI course in June. It was a full class and got excellent evaluations. I'm looking to repeat this course next Spring (that's how far in advance the CE Center plans their courses). For those of you attending AVA, you will get to hear Dr. Ellen Jo Baron, Stanford's Director of Microbiology Lab. She will give an excellent presentation on peripheral blood and catheter blood cultures. I also run the PICC Program so there is a lot of overlap. Our volume continues to increase, and we've introduced a new ultrasound machine, a new navigation system, a new computer documentation system, a new data collection system, etc. When new procedures or products are introduced, I usually am the one to attend the Education Council meetings, Practice Council Meetings, Procedure Committee, and if necessary Pharmacy & Therapeutics Committee, and Research or Quality Council. Some of the PICC team members (there are 6 of us) have certain responsibilites like tracking and ordering PICC supplies, organizing the PICC carts, helping with data input, etc, but they don't seem much interested in committee work or teaching. I also teach a b asic PICC Insertion class that follows the VAD Nursing management course one week later, and an advanced PICC insertion using ultrasound course a week after that. I insist that nurses who take my PICC courses take all 3 courses so that I can insure that they receive all the information that they need to successfully run a PICC program. I believe that a successful PICC program is much more than just insertions. Most of you on this listserv already do what I've described above, or have a team that acomplishes these things. It includes staff education on care and maintenance, and complication management. Most hospitals cannot afford an IV or PICC team that does all the CVAD and PICC problem solving and dressing changes. This means that staff education needs to occur from nursing orientation (new hire or new grad) to inservices on new products and revised procedures, but also general up to date vascular access education. Believe me, I do not have a perfect situation but it is a system that has evolved over time and I now have a lot of credibiity in my hospital. It took years to get any recognition but the PICC program is now taken for granted as a necessary and important service. It took 14 years to get a cost center for the PICC program, a desk, phone and computer for me, and 15 years to get 3.8 FTEs for this program. Nowadays with lots of great models out there it shouldn't take so long. We've always had a PICC team, but most of the team members did not do PICCs every day. However, since the mid-1990's the nurses assigned to do PICCs for that day were assigned to just do PICCs. The extra PICC nurse often got pulled to cover short staffing issues in our main unit, but by year 14 that was no longer the case. It all depends on your volume. I just asked if I could change my round-table p resentation to talking about setting up a VAD Committee at the AVA Conference. If I get the "go ahead" and you're coming to AVA, and you want more info, come to my session. Nadine Nakazawa, RN PICC Program Coordinator Stanford Hospital >From: "Tom and Louise Oak" <[EMAIL PROTECTED]> >To: "Glenn and Dayna Holt" <[EMAIL PROTECTED]>, [EMAIL PROTECTED] >Subject: Re: Question for Nadine Nakazawa >Date: Tue, 01 Aug 2006 17:44:59 -0400 > >Nadine >Could you share that information with me as well? > >Thanks in advance > >Louise Oak RN, CINA(c) >Vascular Access Nurse >Sault Area Hospital >X4399
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BEGIN:VCARD VERSION:2.1 X-GWTYPE:USER FN:Nichols, Heather TEL;WORK:562-3530 ORG:;IV specialist EMAIL;WORK;PREF;NGW:[EMAIL PROTECTED] N:Nichols;Heather TITLE:RN END:VCARD
