Impact of educational leadership and interprofessional learning on vascular access training

Educational leadership supports the effective transfer of knowledge and clinical skills between practitioners. Evaluation of training is imperative to ensure safe and effective transfer of learning into clinical practice. This study explores and critically evaluates the impact of educational leadership on practitioner development and clinical practice, focusing specifically on paediatric vascular access. An educational intervention, consisting of theory and practical simulation of venepuncture and cannulation, followed by interprofessional mentorship and supported practice in the clinical setting, was provided to 18 foundation doctors. Data regarding knowledge and skills before and after the intervention, evaluation of expert facilitation and practitioner development was collected through a three-stage process: before and after the training, and in a short semistructured interview six weeks after the intervention. Overall, practitioners' knowledge and clinical skills were improved, which illustrates the benefits of collaborative learning. Findings also show there is a need for specialist education and training, and that educational leadership needs to be promoted in healthcare settings. There are benefits in having education delivered in collaborative partnerships and by experts and skilled practitioners. This study also highlights that vascular access training within paediatrics varies a widely.

Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ)

BACKGROUND

Peripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality.

METHODS

The Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2-5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott's pi.

RESULTS

Sixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was "pain and tenderness" (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance.

CONCLUSIONS

Our study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.

National evaluation of safety peripheral intravenous catheters in a clinician-led project

Studies have demonstrated that up to 90% of all inpatients require the insertion of some form of an intravenous (IV) access device to facilitate therapy administration, which has also become as an essential aide in diagnostics and monitoring. These devices, particularly peripheral IV cannulas (PIVCs) are not without risks and complications. The NHS is trying to improve the safety and quality of health care by implementing evidence-based practices and one way to reduce the risks of PIVC-related complications is by to choose devices that are fit for purpose. However, there is scarcity of rigorous studies into the clinical acceptability and design of PIVCs. This article presents an excerpt of a national evaluation undertaken by an independent team of NHS senior clinicians from different fields, commissioned by the Department of Health and Social Care into everyday healthcare consumables. The NHS Clinical Evaluation Team's work focused on quality, safety and value to promote efficiency and productivity in the NHS. The success of the team, which delivered more than 30 reports, has paved the way to embedding clinical engagement and collaboration within the NHS. Involving clinicians in procurement will both ensure and assure quality, safety and value for the NHS.

Teaching medical students ultrasound-guided vascular access - which learning method is best?

Introduction

Ultrasound is recommended to guide insertion of peripheral intravenous vascular cannulae (PIVC) where difficulty is experienced. Ultrasound machines are now common-place and junior doctors are often expected to be able to use them. The educational standards for this skill are highly varied, ranging from no education, to self-guided internet-based education, to formal, face-to-face traditional education. In an attempt to decide which educational technique our institution should introduce, a small pilot trial comparing educational techniques was designed.

Methods

Thirty medical students were enrolled and allocated to one of three groups. PIVC placing ability was then observed, tested and graded on vascular access phantoms.

Results

The formal, face-to-face traditional education was rated best by the students, and had the highest success rate in PIVC placement, the improvement statistically significant compared to no education (p = 0.01) and trending towards significance when compared to self-directed internet-based education (p<0.06).

Conclusions

The group receiving traditional face-to-face teaching on ultrasound-guided vascular access, performed significantly better than those not receiving education. As the number of ultrasound machines in clinical areas increases, it is important that education programs to support their safe and appropriate use are developed.

Prepared for Practice? Interns' Experiences of Undergraduate Clinical Skills Training in Ireland

BACKGROUND

Many previous studies on internship have reported a lack of preparedness for the role. More recently in Ireland, medical schools have introduced formal clinical skills training programmes. This study sought to evaluate the impact, if any, of formal skills training in the medical training on intern's preparedness for practice.

METHODS

The study utilized a survey approach followed by focus group discussions. The aim was to identify the skills that were taught and assessed in medical training and the skills that were actually required in their intern year.

RESULTS

Most interns had received skills training in designated skills laboratories. No intern had received training in all skills advised in the European guidelines. Skills taught to all interns were intravenous cannulation, basic life support, and basic suture. Skills required from all interns were intravenous cannulation, phlebotomy, and arterial blood sampling. Removal of peripherally inserted central line (PICC) lines, central lines, and chest drains were commonly requested but not taught. Senior staff underestimated skill abilities and expected failure.

CONCLUSION

These findings identify discordance between the skills taught and the skills required in the job. There is a need for standardization in the clinical skills training to ensure that all interns enter practice with equal competencies. Consideration should be given to experiential learning opportunities such as subintern programmes to consolidate learning and improve preparedness. Improvement in communications with senior clinicians is indicated to ensure that expectations are realistic and reflective of actual training.