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Podcast - Season 1 - Episode 5 - Transcript
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Season 1, Episode 5 Transcript

This episode of the ISAVE That Podcast is made possible by the support from The AVA Foundation, which was created to support AVA's mission: Protect the Patient | Educate the Clinician | Save the Line. The AVA Foundation serves clinicians interested in vascular access, students of healthcare professions as well as patients and their families through funding vascular access, innovation, research and education. For more information, visit www.avafoundationinfo.org.


Eric:  From the Association for Vascular Access. This is the ISAVE That Podcast.
Ramzy: You are in Episode 5, Season 1 of the ISAVE That Podcast. This is Ramzy Nasrallah joined by Eric Seger, the Director of Communications and JAVA Editor-in-Chief. Eric, how you doing man?
Eric:
Good, man. I can't believe it's already approaching the middle of August. I don't know where this year is going. As we seem to say every single episode that we do this, but I'm good. You sound like you're dealing with something wonderful in terms of your sinuses. I'm sure that's going well.
Ramzy:
I have been traveling all summer, which means I've been breathing recycled air and my sinuses finally said uncle. So, I'm trying to get over that. The good news is that I'm going to be on a plane or two planes to Australia tomorrow, so it's more of the same coming my way to my immune system. You mentioned that it's August and that's in any other industry, like where people check out and have some downtime in the summer. Right. But when you work for AVA, August is the month before conference and that's, this is our busy season. What have you been dealing with here as we barrel towards Columbus in September?
Eric:
I'm trying to get a whole lot of content finished and wrapped up. Whether it be for JAVA, we haven't an issue that's going to print in the next week or so. It's due out the beginning of September, so it's ready before conference, you know, so we can have that fresh stuff.
Ramzy:
Biggest issue of the year. Huge issue.
Eric:
Yeah. It's the one that we can't delay at all. Like it's, it's a big one. And then also the, our electronic newsletter Intravascular Quarterly, that's due out in August. So, just trying to get all kind of, you know, cross my t's and my i's, that sort of thing to get that finished up and promoting conference. I'm helping anywhere that I can with marketing and with planning. Cause you know, Tonya, she dominates that as she always has, but she can always use a helping hand here and there. So, that's keeping me plenty busy and, and I'm sure that you're doing the same. Talking about flying all across the country as you always do. What have you been up to other then battling your sinus infection or whatever.
Ramzy:
Across the country and over oceans. It's too much travel. I don't recommend it. A we approach a conference, I get a lot more calls from industry partners and potential industry partners. So, I just found out this morning there's a, there's a company that's just in its inception in Ireland that's going to be at a conference that I met with them in Denmark at WoCoVA and they have created a novel new catheter securement device and it's very difficult to describe on a podcast, but they're going to be at AVA, they're doing two focus groups. They're going to be showing concepts and prototypes to our attendees and I assure you it's not like nothing that they've ever seen before. So I'm excited to see that kind of innovation, these new ideas being brought into the space. In the meantime, aside from industry partners and inventors contacting me, I am charged with writing a General Session speech.

So, I am doing that – 10 minutes on stage in front of, you know, four figure people. That's not a bad thing. I'm also writing an article for Medline about upgrading patient healthcare literacy and standardizing patient treatment expectations. And that ties both into my General Session speech as well as into the most exciting, bedside initiative that AVA has ever undertaken that we're putting a bow on now. That is, and fortunately, I'll again be on a plane that has a desk for, you know, 30 hours. So I've, I've got a lot of time where I can either watch, Forrest Gump again or write stuff. I probably could do a little bit of both. Speaking of conference – we talk about, we always shout out the first time attendees or I do and I think the President will as well at AVA. And not, not the humble brag but neither one of us is going to be a first time attendee. I think this is my 13th AVA, my second as an employee of AVA and Eric, you are now a neophyte. Your, this is your year 2 for it.
Eric:
Right. This is also my second as an employee of AVA, but it's my second AVA ever. So I still consider myself a bit of a newbie. But you know, last year definitely was an experience that being a first time attendee, I kinda felt like my head was spinning a little bit just because there was so much to look at and so much to take in and so many great people to talk to and network with. But then all of a sudden the four days of conference was over. And it was like, where did the time go? So, I think, you know, first time attendees have, have plenty to look forward to. I mean the education that we have in the speakers that we have lined up for this year's conference are pretty extensive and pretty well known, you know, key opinion leaders within the vascular access space.

So yeah, I think all first-time attendees to try to get to those, you know, obviously attend the General Sessions like everyone else does, but you know, find speakers that you're interested in hearing fun topics that you're looking forward to learning more about and then going, take good notes and pay attention and do all that kind of stuff and even try to take some time and look at the posters. That's one thing that I did not do enough last year that I hope to this year and just take the 10 or 15 or 30 minutes, however long it takes to read the posters and take in that great data and that conversation and think about how you can bring it back to your own facilities.
Ramzy:
Yeah. It's hard to go to AVA and not leave feeling a lot smarter. Which is a good feeling. You're bombarded with information and I can, I'll treat this like my second AVA since there's a behind the curtain element to what you and I have been exposed to with, with last year and now this year. The level of content and presentation is so robust and scientific now. I'm so proud of what they've put together. By the way, if you haven't registered for the AVA Scientific Meeting coming up in September in Columbus, you can go to avainfo.org/annual and all that information is there for you. If you have any questions for Eric and me and anyone at AVA that you would like to hear on this podcast, either about the conference or about anything regarding vascular access or the organization, you can shoot an email to podcast@avainfo.org or just sneak into our mentions on social media, which we'll rattle those off at the end of the broadcast. But when we return we'll be talking to AVA Scientific Meeting Design Team chairwoman, Marcia Wise about what to expect in Columbus.
Eric:

The Queen! You forgot she's the Queen.

The AVA Foundation provides research grants to develop and evaluate practices, technologies and innovations within Vascular Access that improved clinical outcomes. This funding is competitively awarded and assessed by The Foundation's board across the criteria of significance in innovation, scientific quality and team capability. The Foundation also provides funding to healthcare practitioners for both specialized and higher education in Vascular Access so that they may deliver the highest level of vascular access care. It supports seminars, panels, and education programs to provide updates in Vascular Access practice and stimulate learning. Travel awards scholarships are available to clinicians attending the AVA Annual Scientific Meeting to promote hands on involvement and education. The AVA Foundation strives to promote patient education by funding support for educational videos and consumer literature along with consumer oriented PR and editorial articles. Family and patient education can help ensure that recipients of Vascular Access can understand how to participate in their healthcare. To make a one-time donation or schedule regular donations to the AVA Foundation, please visit www.avafoundationinfo.org. You may earmark your donation for innovation research education or to the overall mission of The AVA Foundation. Together we can drive the changes and improvements necessary to ensure Vascular Access is as safe as possible for the millions of patients who undergo these procedures every day.

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Ramzy:
Joined now by Marcia Wise, who is the chairperson of the D-TEAM, the Design Team for the AVA Scientific Meeting coming up in Columbus, Ohio, this September. We're at WoCoVA in Copenhagen. Marcia, how are you doing?
Marcia:
Well, I'm finally getting over jet lag.
Ramzy:
Great! On the last day of the conference, perfect. Just in time to go back home. Talk a little bit about WoCoVA, what you're doing here and some of the highlights for the people who aren't able to make it to Europe.
Marcia:
Yeah. Well, actually I was an invited speaker to speak about tissue adhesive for Vascular Access, which is exciting, but I've really enjoyed the conference. WoCoVA, not only is the city incredibly beautiful, but we have the conference is very well structured, great content, lots going on. You know, how they pack in so much in three days is just amazing to me. A really engaging speakers and content. I've really enjoyed it.
Ramzy:
Great. Yeah, likewise. That's my impression too. And you just created a great segue way into the AVA Scientific Meeting talking about great content and speakers, which is coming up in September in Columbus. You are leading the Design Team that creates the conference, puts the curriculum together and decides what is presented, how it's presented. Can you share with our listeners exactly what that process has been like for the 2018 conference?
Marcia:
The D-TEAM is a fun experience and I've really enjoyed being a committee member as well as chairing this year. It's a very scientific process that goes on in a very short period of time. So we spend three or four months requesting information from people that might want to present. So, there's a call for presentations and then the committee, which I think it's about 15 or so people, we all met in Columbus and, there is a very – led by Megan Schofield – a very organized process of going through all the abstracts and picking those that we think would make great content. And then there's a very organized process of plugging them in and it's an amazing experience. What occurs in two days. I mean, two days! Long days, but, a lot of banter back and forth. What's the best content and how do we make sure that our audience, we're meeting all of the AVA membership through that organization through our conference.

And it's just an incredible experience. We're going to have a great program this year as we always do, but you know, every year you think it's going to get a little bit better, a little bit better. And we've got some kind of interesting new things we're going to do. We're going to have this lunch and learn kind of debate on the last day. And that's going to be, you know, we picked a topic that we think is pretty controversial and we're going to have sort of a debate on the pros and cons of this topic.
Ramzy:
What is this topic?
Marcia:
Well it's about antimicrobial catheters. And do they really make a difference?
Ramzy:
Pros, cons. Reasons to believe, reasons not to, OK.
Marcia:
And AVATAR is sort of leading that session with all of their work in research. I think it's going to be an exciting one. And then we've got some other really, you know, interesting topics going on. Our keynote and I think we've talked quite a bit about him, Marcus Engel, he's going to be incredible I think. And you know, we're really focusing on the patient advocacy side and such as WoCoVA here and we're kind of in sync with this a patient first. And we do need to continue to believe that there's a patient on the end of this line that we're placing. And focusing around how do we bring that patient into our world. I think this is – he was a patient and he had some pretty bad things happen to him as a young man and how he's going to share with us how, you know, patient care from his caregivers, got him through his ordeal and the impact that that made. Then we've of course got the topics around all the controversies, the MAGIC guidelines, GAVeCeLT Guidelines, algorithms versus algorithms. So that'll be fun. Just really some interesting things. Intraosseous, we're covering, peripheral catheters and securement will be a hot topic as it is here. It's interesting to see us move a little bit away from the traditional PICC line thing and move into some other categories: dialysis, multidisciplinary, patient-focused and we have some great physician speakers as well as nursing educators speaking this year. Then Columbus itself, it's just fun place.
Ramzy:
It is a fun place. Disclosure: I'm from there. I have nothing but kind things to say about Central Ohio.
Marcia:
I've told a lot of people, they go, why Columbus? And I said, you know, I don't think you would top of mind think about that from a conference standpoint. But once I was there, I was very impressed. I had been in National Harbor a few years back and that's, it's reminiscent of that, the little boardwalk around the area there and all the, yeah, all the shops and the conference center itself is just incredible. The shrink wrap off of it. Yeah, it's beautiful. Everybody's going to love it. Lots of place for people to gather and network and talk.
Ramzy:
I don't think people realize the city. Do you know, it's like the 14th largest city in the country.
Marcia:
I didn't know that!
Ramzy:
I mean, having been from there, I'm like, that was kind of a cow town, but I lived there in the 80s so it's come a long way. They benefited from me leaving.
Marcia:
Well, I think it kind of got redone right a few years back or something. 
Ramzy:
It's the confluence of academia and business coming together and converging on Columbus that developed it into what you'll see in September is really a vibrant, eclectic and really thriving place to have a convention and you know, even live. One last question before we get back to WoCoVA: If you could think of a couple of reasons to go from a scientific standpoint based on the curriculum we've put together. I'm thinking about going to Columbus for the AVA meeting because of...
Marcia:
Well I think the technology is changing so quickly and I don't know how in a staff situation in a hospital you can stay up with that. You've got to get to these conferences and uh, just the networking experience alone, but then the scientific content that you can pick up and take back to your organizations is incredible. And you know, if our practice is moving so quickly that I don't know how anybody keeps up anymore without going to one of these every year. Because every year there is, you know, 90% of it's relatively new. You can't just go one or five years. You've got pretty much go every year or every other year at least to keep up.
Ramzy:
It's like you ate once and now you're nourished forever. You need to keep eating.
Marcia:
Well and I think we've done a really good blend of those that are, you know, there's a lot of new people coming in to Vascular Access cause it's such a hot specialty right now and so much going on and so challenging and people are very passionate. Our challenge always on the D-TEAM is to have enough content for those advanced practitioners that have been doing this for awhile as well as the new people coming in that are just learning how to use ultrasound, etc. And I think we've worked real hard on the D-TEAM this year to keep that balance. So we have stuff for people that are new versus people that have been around for a while.
Ramzy:
It's great tracks just based on where you are in your career and your proficiency. A beginner, intermediate, advanced, Marcia.
Marcia:
No, Marcia is out! I'm in the cadaver lab already.
Ramzy:
She's famously said, even after she leaves and retires, Marcia will return to an AVA Scientific Meeting in the cadaver lab. She is Marcia Wise, the chairperson of the D-TEAM and so much more. Thanks for taking some time out today.
Marcia:
Thanks Ramzy.
Eric:
After a quick break, I'll chat with Vascular Access and Home Infusion Specialist, Elizabeth Dow as well as Jenn Charron, the Vice President for Clinical Services for the National Home Infusion Association about the current state of home infusion and where it sits in the continuum of Vascular Access care.

Eric:
And it is my distinct honor to be joined today by Beth Dow board certified Vascular Access and Infusion Specialist as well as Jenn Charron, who is the Vice President for Clinical Services at the National Home Infusion Association to chat a little bit about infusion and certification within that area of Vascular Access. How are you ladies doing today?
Beth:
Doing great.
Jenn:
Doing well, thanks for asking.
Eric:
I heard you guys are dealing with some swampy conditions over there on the east coast in Boston and New Hampshire. It's been similar to that in Ohio. I think we're all just kinda pushing and waiting for fall to get here to maybe get some cooler temperatures.
Jenn:
Yeah, I'm not going to wish for fall to come quickly, because then comes winter.
Eric:
That's true. With all the nor'easters last year. I don't think you guys want anymore. So, we can just dive right in here. I know you guys have done some great work within both personally and then Jenn, we, we've had you on the podcast before to discuss the NHIA collaboration with AVA. I know that you guys have some main points about with the clinicians bearing the responsibility maybe to to maintain the practice standards and keep pac, with best practice advances. Beth you have any thoughts you want to dive into that and kick us off?
Beth:
Dive in I shall! Yes, thank you so much, Eric, I appreciate that. Looking at where we're going as far as home infusion, it definitely is relevant opening up the number of patients we have week to week, month to month, year to year is just exponentially growing. And I was talking with Jenn earlier and we were in agreement that there is a little bit of a gap here as far as practice standards and clinical education goes for clients who are receiving care at home and also clinicians who are providing care at home. It really is an area that came round, and I think that right now looking to the established areas, we've got primarily NHIA, thank you very much Jenn. We've also got AVA and we've got INS and those are our three really big pillars that we have to look to. We've got ONS. But as far as the home care population goes, I don't see them being really active currently.
Beth:
But you know, maybe that will change. Hopefully, we can look at the three main ones that we haven't kind of put together a little bit more of a patient-centric and home care clinician-centric group of education. And that would really be very helpful to all parties involved because right now there is no practice standards specific to home care infusion. And that's a gap. There's definitely one for acute care. We look to people who are in acute care to trickle down into the sub acute areas. But lots of times that doesn't necessarily really happen. And we also know that as we look at marketing and we look to financial flows and we look to industry for education quite, quite frequently. That's where a lot of our education comes from. Clinician educators coming out and teaching us about new products and new techniques, but that doesn't usually happen in a tertiary market. It doesn't happen outside of acute care or doctor's offices because traditionally home care does not qualify really as a purchaser.
Beth:
So that education is really missing. It's really sort of a lost market. That being said employers, even in the home care area, when they want to be able to provide education to their staff, they don't always have access to those resources either because they're not going to be a big purchaser. So you know, industry just, you know, it's hard for them to take all of that, all of that time, all of that money, all those hours and bring it to a place that's definitely not going to return for them. So looking at having a standard of practice or having a certification that individual clinicians can reach towards, that would bring them continuing education and the best practice standards specific to home care where they have to be really autonomous, they have to have progressive knowledge, they have to be really on top of their assessments and feel comfortable and confident in their skills because there's no one else there. They're in a home. It sounds silly when I say it's home care. You know, you're in a home, but that's it. You have yourself and you have the bag that you brought into the home with you and there's nothing else there. So if something goes wrong, you're really on your own. So having clinicians that are closer to entry level, doing this job is really probably not what we want. We probably want to be able to establish a higher standard and be able to empower individual clinicians to aspire to that higher standard prior to leaving the more structured and stable acute care environment.
Jenn:
Yeah. I think there's so many points there that I can absolutely agree with that. Part of joining NHIA was this love for home infusion nursing and feeling like we just don't fit into a lot of the molds that we have out there. And to your point, we're kind of, you know, picking, you know, a little bit from here a little bit from there and really trying to then interpret some of those things to be specific to the home environment. So beyond upping our clinical practice and ensuring that we're meeting standards don't have a lot of data associated with outcomes in the home environment. That's something that NHIA is really starting to look at. We're starting a data initiative coming up this fall. But again, that, that whole piece of it is lacking in our, in our industry.
Jenn:
And I think coming from that, you have not, I don't think the level of respect for what a home infusion nurse is required to do and does on a daily basis is really understood by the industry. And to your point about certification, these are nurses, that are doing biologics. Sometimes they're doing wound care, they're taking care of people with massive infections, long term care patients who need TPN for life. And these are very complex stations that are living in their home. And the standards, to your point are something that we're calling from many areas, many of it work. But I think there's a lot to be said for collaborating with our associations can build that standard of practice.
Eric:
That's a lot of great points and I think it's awesome that NHIA has started to collaborate the data that you mentioned Jenn. What are you guys' thoughts about how to get industry to understand more about home infusion and what the specialists in that field do.
Jenn:
Yeah. You know, it's interesting too because it's not talked about either and colleges. It's not even usually brought up as something that nurses are taught that is a field. And so I think we typically go from, you know, nursing education, I get my nursing degree, I go into acute care, skilled facility and then you kind of move out and you need that stage. But we need to let people know how awesome it is to be a home infusion nurse as well. It's amazing the level of care that you can provide and the satisfaction you get as a clinician working with these patients.
Eric:
Beth, I'm sure you don't have any thoughts on that.
Beth:
Well, if you let me open the door on that. I can probably talk to you straight through next Thursday. In this area in home infusion, there is no other area other than home infusion, mobile infusion, mobile Vascular Access, whatever term you want to use to call what it is that we do. There is no other area where you're going to find a matched level of autonomy. And also, that is job satisfaction including patient closure. And when I say patient closure, I mean seeing something through to the end. And in knowing what happens to your patient and making sure that at the end of the day you have a happy ending one way or the other, you're actually making something work for your client in a way that no one else can. And that is something really, really special that you're not going to find in other areas of really any clinical practice.
Beth:
I've been a nurse gypsy for a long time and I've kind of been all over the place with my career. This is the only thing that's held me for almost 12 years now, which is kind of saying a lot because I tend to hop around quite a bit and and I've been held here, which is, which is impressive. It's not often that you get to spend an amount of time with a client in a setting where you're able to see what their lifestyle is. You're able to generate a plan of care that matches that lifestyle, inclusive with their family and their goals, and then see it through and navigate the healthcare system the way those people need it done for them. And to Jenn's point, I mean it's not just the infusion. You know you've got people with massive gaping wounds and negative pressure. You've got people with massive sepsis, you've got all kinds of autonomic issues that we've got people with you know, pemphigus and you've got people with disreflexia. Then you've got all kinds of different stuff where you have to navigate those things in order to make that person's life livable for them. And when you're in the home setting, you're actually able to do that. Lots of times, home care nurses find things, home infusion nurses, home care nurses, find issues that have been overlooked for years and years and years by traditional healthcare because patients are screened for 5, 10, maybe 15 minutes in a room, in a doctor's office on a table and they're not ever assessed in their home, native environment and deficits that are picked up by people in the home care field is really needs to be researched more. And I'm glad to hear that Jenn and her group are doing more research because I think we're going to find that a lot of improvement in a lot of the navigation and coordination that happens between the silos we have in healthcare. Are undercovered when we look to home infusion and we look to the specialties that go on in the home.
Jenn:
There's another point I wanted to make – Liz talked a lot about home care agencies and in a home infusion. In our market we've done some surveys to our members and more than 50% of the nursing visits that are provided to home infusion patients are actually done by home health or visiting nurse agencies. So, working together is something that we do every day, right. Between a home health company and home infusion. That's very typical. But the resources vary for education, to Liz's point, vary greatly between home health agencies. So, large agencies that do a lot of home infusion, they might have a lot of resources for education, but you see a lot of, I would say I think of it a little bit of dabbling in the home infusion market where you may only have one or two nurses that can do infusion. That's not really specialized and I feel like that again is another area that AVA and NHIA could collaborate to develop educational programming for that group. That'll up the level of care that we're providing patients across the continuum in a, in a really different way.
Eric:
That's definitely something that should be on the table moving forward. And we're starting the conversation right now. I think the collaboration between AVA and NHIA is a key component of that to break down the silos that, that Beth mentioned. But on a more local level what are your guys' thoughts on sort of breaking down those barriers and, instituting the clinical learning and growth and how that's best accomplished?
Beth:
I really think it comes down to individual clinician needing to have the autonomy and the self-respect to be able to say, 'I need more education. If We really stop and think about it. The most basic part of what you're going to do with infusion, is start peripheral IV, pretty, pretty basic and culturally nurses take that as kind of a blase thing, 'Oh no big deal. Go ahead, put the 22 in somebody and make sure you wash your hands first.' Sometimes we don't even use sterile technique and we do that, which should be, but sometimes we don't. That's considered very basic, very entry level and we teach that to young nurses, but if we go and we look at other areas of healthcare, is there any other area where we would say, yeah, sure, go ahead. Why don't you try that endoscope? Nowhere else would we do that. Nowhere else would be say it would be entry level to invade that body system.
Beth:  Even though it's peripheral and it's on the outside, but you're still going to do some of the vascular system like that. That's a risk of sepsis, that's huge. Even with the peripheral IV. So, it's something really that I think we need to stop and look at the way we teach and train all of our healthcare clinicians from the get go, like just right from the word start that, if we're going to be intravascular at all, if we're going to be into the vein at all, we really need to stop and think about what we're doing. And I really don't think it should be the type of thing that is entry level. I really think you should have somebody who has a little bit of a respect for what it is that they're doing and they understand what the repercussions are of doing something wrong.
Jenn:
I just want to make a couple comments on that. Personal responsibility for your own practice is huge. And thinking the things that we do in infusion as basic in a big mistake. Care and maintenance, just a central line dressing change, that people think, 'You know, I'm just, you know, I do this every day' and we're not as paying attention to what we're doing as we should. NHIA, for the first time, had a basic course for home infusion and really all it was was information about dressing changes, lab draws, peripheral insertion, preventing complications. And we had hands on training with the nurses got to practice doing a dressing change. And I can't tell you how many people said to me, 'Oh, gosh, I've done this a million times. You know, it's just so easy.' And one clinician in particular is like, 'let's just do it. You're here, let's just do it.' And what happened was she did the dressing change and did not cover the statlock leaving a wide open area, for contamination in the central line! And it's not because people are trying to do something wrong, it's because we're not paying attention in our own practice and ensuring that we're meeting every guideline available
Beth:
It happens every single day. Every single day I see something like this that needs to be remediated. Not a day in my practice goes by where I don't see something where I have to correct that. Educate the patient and say, listen, if you see this, it's wrong. It needs to be done that way. Do you need an air-occlusive dressing and explain what air-occlusive is you need, you know, going step by step and educating the patient as the patient is the clinician is really critical. And then going back and remediating that person who made the mistake and it comes down to individual clinicians becoming kind of blase in their practice. And you know, when you start to get boring and work starts to become ho hum and here we go. Gonna get on a donkey trail and go to work again. It's time to switch. It's time to leave. It's time to find something else to do because you, you're not going to help anyone if you're taking for great the work that you do and you're not excited about it and it's interesting to you and you're not committed to and you're not focused a hundred percent on what it is that you're doing, you shouldn't be doing it.
Eric:
Most definitely. I really appreciate the time from both of you. I think this has been a really constructive conversation and something that our members and those that listen to this podcast are going to kind of stand out to them as far as like, I need to do this, I need to do more than this. I need to educate myself. I need to continue my, getting these credits and consider a certification in these areas. So, they are Beth Dow and Jenn Charron. Thank you ladies so much. I really appreciate it.
Jenn:
Thank you.
Beth:
Thank you, Eric. Thanks, Jenn.