New clinical evidence for the use of PICCs in pregnancy.

A new retrospective case series was performed that included all pregnant and postpartum women who received peripherally inserted central catheters (PICCs) at a single institution between 2006 and 2014.

Similar outcomes rates were reported to non-pregnant women populations.

Safety of peripherally inserted central catheters during pregnancy: a retrospective studyLaura Jacques, Megan Foeller, Rahmouna Farez, Kristina Kaljo, Melodee Nugent, Pippa Simpson & Timothy Klatt

The Journal of Maternal-Fetal & Neonatal Medicine

Received 06 Jan 2017, Accepted 22 Mar 2017, Published online: 16 Apr 2017

Fluoroquinolones Are Too Risky for Common Infections

The Food and Drug Administration (FDA) is advising against prescribing fluoroquinolones, a group of antibiotics that includes drugs such as Cipro and Levaquin, to treat three common illnesses —bronchitis, sinus infections, and urinary tract infections. 

The agency issued the new recommendations after a safety review revealed that fluoroquinolones can cause disabling and potentially permanent side effects that affect the tendons, muscles, joints, nerves, and central nervous system.

The new FDA ruling calling for restricted use of fluoroquinolones affects five prescription antibiotics: ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), ofloxacin (Floxin), and gemifloxacin (Factive). All are also available as generics.

Read more here;

http://www.consumerreports.org/drugs/fluoroquinolones-are-too-risky-for-common-infections/

Why we need to be familiar with our specialty evidence; read regularly.

I just got off the phone with a colleague from North Carolina. I always enjoy his phone conversations. We had a robust discussion about many issues relating to vascular access, but one of the common threads of our conversation was the lack of self-education and keeping up to date in our specialty field. Despite having large professional bodies specifically educating to vascular access and infusion therapy, with organization such as AVA and INS, we still see clinicians who are unaware of the current evidence, and the standards of practice, within their specialty field.

Really? How can this be? I have seen for a fact that this is commonplace; I was speaking at a local chapter in Colorado last month and asked the room ‘who has read the new (2016) standards of practice (SOP)’. Probably 6-8 hands that went up in a room of ~25-30 people. So I prompted them again with another question; ‘of those who have read the SOP, how many had aligned their hospital policies with the new SOP to ensure they were practicing within the recommendations of the standards?’ Maybe 1 or 2 put their hands up. Wow! I was a little taken aback, as these clinicians are the forefront of vascular access and infusion therapy practice, many with credentialing letters after their names, and yet they are unaware or not reading the developing evidence that guides their clinical practices within their facilities and institutions.

Guidelines, recommendations and standards of practice all have differing cause and effects; and meaning. Car companies can make a recommendation that you use oil in your car, but if you chose not to do so, then your car will eventually stop functioning for a number of obvious reasons. Guidelines are similar; they guide clinicians in clinical practice through evidence and assisting them to make appropriate decisions based upon a certain level of evidence. Standards of practice is what we practice to that is also guided by regulation and peer-reviewed evidence. A standard is also something we held accountable for in a court of law. This is where this such a differing between the 3. Not to say a guideline isn’t peer-reviewed, but it’s looked upon in a slightly different manner. But the SOP, which is the go-to reference for those working in infusion therapy or vascular access, rely on this document to make appropriate clinical recommendations and decision-making process based upon the various levels of evidence and be held accountable in our actions for following these standards.

Standards are also put in place to reduce harm to patients. With todays ever increasing scrutiny of adverse events, patient satisfaction and quality improvement, we have to ensure that our clinicians are made aware and educated on changes that effect them while they are performing their roles and providing healthcare.

Why do we care about this? Because what we do has significant impact on our patient outcomes and we are judged on what and how we perform. Pleading ignorance to the evidence and standards will not support you in a court of law, even if you are deemed a competent clinician.

So, what is the importance of EBM and EBP? How does this relate to my clinical practices? Effective performance is a requirement to provide a standard of care. It will NOT stop you from getting sued… BUT should improve the quality of care clinicians provide and should decrease the chance of litigation (however, not guaranteed).

Read folks – this is the reason why we need to maintain our ongoing learning; to improve ourselves, and others, in our professional working world. We need it, our patients need it, our institutions need it. Better knowledge is better decision-making and performance, which in turn has better outcomes – for everyone.

And here is a great article from Harvard Business Review on mentoring;

https://hbr.org/2017/02/what-the-best-mentors-do?utm_campaign=hbr&utm_source=twitter&utm_medium=social

Want to understand everything about what a systematic review is? Go visit Cochrane UK to find out..

Thanks to a team of creative colleagues from Cochrane Consumers and Communication, I want to share a video resource which answers this question clearly and simply for people who may not be familiar with the concept of systematic reviews: what they are, how researchers prepare them, and why they’re an important part of making informed decisions about health – for everyone. #vascularaccess #FOAMva

http://uk.cochrane.org/news/what-are-systematic-reviews

If you like this, then you will also enjoy this article on stakeholder involvement in systematic reviews..

https://researchinvolvement.biomedcentral.com/articles/10.1186/s40900-017-0060-4

I really liked this – pertinent in vascular access clinicians lives when trying to change things for the better..

Often, we find ourselves or other clinicians come across barriers and obstructions to promoting and encouraging best clinical practices, especially in the vascular access realm. It may have even happened to us – trying to make important changes, based on strong clinical evidence, guidelines and recommendations – to be frequently informed that higher powers, not familiar with the best evidence, do not consider the change relevant or even important.. Often, this is purely a lack of exposure to issues at hand – despite clear evidence supporting potential required change.

It is often very frustrating, and the inevitable feeling of being unable to make change for the better is quite often the reason why people just give up. ‘I’m done’. ‘I’ve had enough of beating my head against the wall’. ‘No-one listens’. ‘I given them the evidence but it is not highly regarded’. We all can acknowledge this is frequently something we come across, at all levels, however, when the patient is the central focus in our world, it becomes a lot more pertinent. Patients lives are often at stake. Poor, or should I say LACK, of the patients specific needs and requirements put them on the backfoot, especially if an inappropriate device is considered, or even placed, increasing obvious risk of complication, increased morbidity and mortality and procedural risks with inexperienced practitioners.

Striving to improve clinical practices and patient outcomes is the underpinning role of all healthcare practitioners, but what if they just aren’t interested in the change? Do not give up the fight. Patients deserve optimal care and pushing this is something that all clinicians and hospital executive/administrators need to ensure is happening in healthcare institutions around the country (and the world).

This image, which was posted recently on LinkedIn really highlights the need to continue to fight to improve all aspects of healthcare. It can be taken in numerous contexts when read and applied to any situation, even from end educational perspective, but to me, this is why we strive for excellence in vascular access practices.. Never give up, continue to fight and push for best practices always – even if we have to change our pathway of change process.. Patients deserve it – because we will all be patients one day, I’m very sure of it!

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