Using an ultrasound transducer may look easy, but it is a highly specialized skill, and to use a transducer requires education, accountability, and competency checks to occur regularly.
To have safe, effective ultrasound transducer use, users should have specialty-specific education and training, supervised practice, and the means to maintain the level of competency for which they are responsible.
Using an ultrasound transducer may look easy, but it is a highly specialized skill, and, to use a transducer requires education, accountability, and competency checks to occur regularly.
In this second segment of a 4-part interview, Nancy Moureau, RN, PhD, CRNI, CPUI, VA-BC, an expert in the field of vascular access practice, owner and CEO of PICC Excellence, and a member of Infection Control Today®’s (ICT®)’s editorial board, continues her discussion with on the safety of point-of-care ultrasoundwith ICT®.
The first segment is here.
Infection Control Today® (ICT®): What other factors have contributed to your concerns about the safety of point-of-care ultrasound?
Nancy Moureau, RN, PhD, CRNI, CPUI, VA-BC: There are many variables involved with maintaining safety when using ultrasound in clinical applications. Those variables include the differences between medical education and nursing training, and the ability of nurses to access education, rather than just on-the-job training.
I have serious concerns about the “see 1, do 1, teach 1” approach to medical instruction. This leads to an approach where the clinician sees someone else using ultrasound to place an intravenous device, thinks that it looks easy, and starts using it. Then, while trying to train themselves, they perform multiple placement attempts and, in the process, stick the patient over and over. It is not acceptable to claim a 100% success rate with up to 10 attempts, yet we’ve seen that published in the literature.
We can improve on this situation by providing anyone who will use an ultrasound unit with specialty-specific education and training, supervised practice, and the means to maintain the level of competency for which they are responsible. This type of education should be included among the policies and procedures for clinicians using ultrasound for all vascular access devices.
ICT®: What do you think can be done to ensure that ultrasound practitioners follow the correct procedures?
NM: Everything goes back to education. Everything goes back to policies on training. We can help each other, but most of the time clinicians really don’t want oversight. They don’t want somebody observing them. Yet the policies within our hospitals need to include some sort of competency assessment.
Hospitals currently have credentialing programs. They may make sure that people receive training initially, but there’s frequently no follow-up. Maintaining an 80% success rate with ultrasound-guided peripheral catheter insertions, or with any peripheral or central catheter insertions, should be a minimum level. If an inserter does not maintain 80% with 1 to 2 attempts, then they need to be reeducated. They need to have access to phantoms and other types of devices that enable them to practice and improve. Simulation suites that provide an opportunity for a competency assessment can also be helpful—and certainly preferable to performing a placement on a patient or having intermittent observed insertions.
Clinicians who do not perform insertions regularly can easily fall out of practice, putting patient safety at risk. To ensure that ultrasound practitioners and clinicians follow the correct procedures, some observation and competency assessment needs to be part of the policy, along with audits of performance.
ICT®: Why are health care workers not doing what they know they need to do? Does it all come down to education? Or do clinicians need someone who’s overlooking everything to make sure that all appropriate procedures are performed?
NM: Clinicians need to accept some level of accountability. The common response is that we’re so busy trying to take care of our tasks, trying to assess patients, trying to administer medications, trying to do this and this and this, that we can’t follow correct procedures. But, yes, they can—and it’s part of their professional role and job to safeguard patients. There needs to be some level of accountability.
Everybody wants to use best practices, but sometimes it’s hard to keep that up day in and day out. They do naked probe insertions. They forget to disinfect. We all need to be reminded of best practices, which is a great function of research, conferences, and talks within the hospital on infection prevention.
Higher levels of observation promote accountability and better practices. But do we need to have an infection preventionist in every department? No, I don’t think so; but there need to be some integration of checks and balances.