#WeNurses - Tuesday 17th November 2015 8pm (GMT Standard Time) Peripheral venous catheters - The evidence

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This chat is guest hosted by @CochraneUK @SarahChapman30

Re-siting peripheral venous catheters: have you ditched the routine?

CochraneUK have recently released a new blogging series “Evidence for Everyday Nursing” #EEnursing, and one of their first articles in this series looks at a Cochrane review which found no evidence to support routinely re-siting peripheral venous catheters. A link to the blog can be found here - and is a must read before this #WeNurses discussion. 

This WeNurses discussion will be exploring this blog and the questions it asks around the Cochrane review.  In collaboration with @UKCochraneCentr #WeNurses will be discussing the following questions:

  • What do you do when it comes to managing peripheral venous catheters (PVCs)? 
  • Do you change PVCs routinely or only when there are clinical signs that this is necessary?
  • Whatare your thoughts on the evidence presented in the Cochrane Review?
  • Doyou feel you should stop routine changing of PVCs?
  • Doyou feel that this is something that you could bring to your practice area?
  • Will you personally change your practice in light of this evidence?

For this discussion we will be joined by Sarah Chapman:


About our guest 

@SarahChapman30 is a former nurse who now works for @ukcochranecentr, where she tweets about Cochrane Evidence and writes weekly blogs for Evidently Cochrane with the aim of making Cochrane reviews and other evidence more accessible to health practitioners and patients.





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 Chat Summary

 

Who joined the chat?

We had 63 contributers to the chat, sharing over 400 tweets, the majority nurses from different specialties and nursing students. It was great that we were also joined by a radiographer, giving us a view from another area of practice, and by Professors of Nursing Claire Rickard and Joan Webster, authors of the Cochrane review. Most were in the UK but we had contributions from Australia too, where Joan is Nursing Director for Research in at the Royal Brisbane and Women’s Hospital and Claire leads the AVATAR (Alliance for Vascular Access Teaching And Research) Group. The word cloud at the top was generated by the chat.

What determined routine PVC replacement policies?

Claire Rickard told us that routine re-siting of PVCs was changed from 24 to 48 hours in the 1980s, based on expert opinion only, and that the Centers for Disease Control changed its recommendation from 48 hourly to every 72-96 hours in the 1990s, based on cohort studies with 2500 people. There are data from many more patients in randomized controlled trials of clinically indicated replacement. Epic3 guidelines are clear that clinically-indicated is the way to go but Claire said many guidelines have not been updated since new evidence came out.

Routine replacement still dominates

Many said that their local policy is to change them at 72 hours. There were some caveats. One said that it could be left longer if access is particularly difficult; another that replacement at 72 hours is usual and that although review to see if the PVC can remain in place is encouraged this doesn’t tend to happen. Adult nursing student Darren said “my placement area tend to change them after 4 days, regardless of need”. Another student, Lee, reported that changing at 72 hours was the norm in his placements, “unless difficult access, then monitor and record”. We were all horrified to hear that in one place the routine replacement policy has been retained ‘so junior doctors can get enough practice!’

But clinical indicators are the drivers for some

Micahel told us that “in the community a pragmatic approach is often adopted using VIP scale”. One contributor expressed concern about the accuracy of recording of VIP (Validated Infusion Phlebitis) scores and another cited this as one of the reasons for impending policy change, but this system was mentioned by several. “All care workers should know signs that should be reported”, commented Anne-Marie.


In paediatrics, re-siting when clinically indicated seems to be the norm and the idea of doing unnecessary procedures rightly regarded as unacceptable. As Claire asked, “why is that seen as safe but not in adults?”Radiographer Janice said she changes the PVC if she is unhappy with it, irrespective of time in situ, noting that some CT exams require high flow rates and that that they have to be mindful of IV contrast extravasation. Her practice is to flush with saline after the exam and check with the ward if the cannula can be left in. “As a cannulating radiographer it is a priority that I work with my nursing colleagues to ensure best practice”.

Could it lead to complacency, one asked? Someone else thought it could, but this would be outweighed when balanced against the risks, and could be mitigated by training. The UK-based venepuncture and cannulation training folk, @vipvctraining, said their teaching is firmly based on the guidelines and they advocate replacing when clinically indicated.

According to Joan Webster, it’s “pretty simple really; if the site is red, swollen etc, take the device out. This may be after 10 hours or ten days …”

How long could a PVC remain in situ?

Claire says they are licensed by regulatory authorities for 30 days use and that she has used them for around 20 days. She also notes that most fail by 72 hours. “If they make it to 72 hours, let’s not ruin it!”

What about the patient?

Happily, there was plenty of discussion about consideration for the patient. Several pointed out that it’s important not to site, or re-site, PVCs unless there is a clinical need to do so, and to remove them as soon as no longer required. Comments included that they are painful, that anaesthetic creams can be ineffective and that cannulation skills are variable. Joan Webster said that returning patients who have taken part in their trials now refuse to have their PVCs changed routinely! We liked this! “Patient power! No routine replacement thank you very much!” Patients and carers, it was noted, can be powerful advocates in achieving the implementation of evidence.

The argument should be over

We have good evidence that replacing PVCs when clinically-indicated does not put patients at increased risk of complications of IV therapy and and saves money. So are there any reasons NOT to do this? “Wouldn’t that be poor practice?” asked Charlotte. It seems that there are obstacles to change.

Sometimes tradition trumps evidence…

Kaye said that their policy (in New South Wales) is to replace routinely at 72 hours because blood stream infection (BSI) is a concern. Yet the evidence doesn’t support this. Cochrane author Claire noted that there were half the BSIs in clinically indicated PVCs and that we don’t know whether making holes in skin 72 hourly causes BSI.  Craig thinks that re-siting PVCs ‘just in case’ puts patients at risk.

It seems that culture is an obstacle to change here, with Kaye noting that “their argument is that translation into practice is difficult”.  Depressingly, when asked if this is just a triumph of tradition/culture/habit over evidence, Kaye says “Absolutely! It has always won!” “The weight of tradition and experience of BSI outweighs the evidence for clinical replacement.”

Trusts not trusting?

While Trust policy should be evidence-based, it isn’t always. Several people thought Trusts would be reluctant to change their policies, despite the weight of evidence. Might there be concerns about accusations of neglect? Policies, it’s felt, are not easy to change and it was suggested that it would take a brave Trust to change their policy. Why should this be so, when all the evidence is in favour of clinically-indicated replacement? It was good to hear news of one Trust that has just done this, resulting in “30% less cannula insertions and no increase in VIP scores”.

Evidence into action: what will you do now?

There was a strong sense that the evidence necessitated action where practice isn’t following it, with talk of  professional responsibility to raise concerns and to challenge current practice that has been shown not to be based on the best available evidence. It was agreed that staff are bound by policy but that policy should be challenged. Several people finished the chat determined to take action. Here are some of the intentions and suggestions:

  • “Print off the epic3 Guidelines and take them to the Trust to help argue the case”
  • “If you want to take something away, you have to give something in return. Implement a new PVC removal daily checklist”
  • “If policy doesn’t follow best evidence then identify gatekeepers to change if unsure. Be the patients’ advocate always”
  • “Evidence must be disseminated to IPC teams and policy revisited”
  • “Key to PVC insertion and care is training, education and good audit cycle. So infection control and IVTeams can play a part”
  • “Will share the chat summary with future radiographer @SCoRMembers cannulation course delegates”
  • “I will be bringing this up with the ward sister in the morning!”
  • “EBP must inform Trust policy – so time for a review of it, conversations start tomorrow!”

These last two came from nursing student Darren and from Craig, an Infection Prevention Nurse, and they were as good as their word. Darren was told by the ward sister that “she likes them out after three days” and when Darren told her about the evidence she said replacing after 72 hours is Trust policy. Other nurses there said this policy had been implemented as a knee-jerk reaction to an incident, instead of improving checking of PVCs. Darren is now going to contact infection control about this. Great news Darren and do go clutching epic3! Craig tweeted an update too: “we are on it and will be making change soon based on the latest evidence: tweetchat to action.” Fantastic!

Do share what you’re doing

It would be wonderful to hear what other people have done since reading and discussing the evidence. Have you shared it with colleagues or done something towards changing practice where it doesn’t follow this evidence? Do tell us about it here in the comments section. You can also join in the conversation on Twitter with me @SarahChapman30 and @ukcochranecentr, and of course @WeNurses. If you can, use our series hashtag #EENursing as well as #WeNurses.

Another tweetchat?

Thank you everyone for what was an incredibly interesting tweetchat. At the end, Nick Chinn @NRCUK, who had been lurking from #WeNurses HQ, asked “how often is policy driven by best quality care? Are other factors important to them?” while Teresa @AgencyNurse wanted to know “how empowered/supported do clinicians feel to be able to challenge policy?” Interesting questions for another tweetchat surely, and perhaps we can also come back in six months to find out if there have been changes in PVC replacement policy.

...........................................................................................................

Above extracted from http://www.evidentlycochrane.net by @@SarahChapman30





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 #WeNurses transcript

 
@WeNurses
17 November 2015 20:00
Hello,how are u on this blustery night? Please say hi if u are joining #WeNurses ...& update us on local wind speed https://t.co/MfdzemulDX
@loveebhc
17 November 2015 20:00
Hello ?? #WeNurses
@SarahChapman30
17 November 2015 20:00
I'm here, blown home from Oxford! #wenurses
@_Michael_Palmer
17 November 2015 20:00
In God we trust, everyone else bring data W Edwards Deming #wenurses @WeNurses @UKCochraneCentr
@SarahChapman30
17 November 2015 20:00
@loveebhc Hi Healther! #wenurses
@AgencyNurse
17 November 2015 20:00
Hello Teresa here - Bristol, very windy indeed ¡ #WeNurses
@CochraneVasc
17 November 2015 20:00
Hello #WeNurses, this is @CochraneVasc, look forward to hearing your thoughts on blog and Cochrane review on peripheral venous catheters
@SarahChapman30
17 November 2015 20:01
@loveebhc Or Heather even - made you super-healthy there! #wenurses
@TeamClaytonULHT
17 November 2015 20:01
@WeNurses Hi Averil here tweeting for Clayton Ward at ULHT #wenurses
@SarahChapman30
17 November 2015 20:01
@CochraneVasc Great to have you with us to discuss your review! #wenurses
@CochraneUK
17 November 2015 20:01
Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@kaye_rolls
17 November 2015 20:01
Joining from downunder #PIVC #ebp #WeNurses
@SarahChapman30
17 November 2015 20:01
RT @CochraneVasc: Hello #WeNurses, this is @CochraneVasc, look forward to hearing your thoughts on blog and Cochrane review on peripheral v…
@CraigBradleyF1
17 November 2015 20:01
Very windy in Birmingham, I'm not sure the roof will hold to the end of the chat! #WeNurses
@WeNurses
17 November 2015 20:01
Tonight we are joined by the awesome @SarahChapman30 from @UKCochraneCentr and we are looking at peripheral venous catheters #WeNurses
@SarahChapman30
17 November 2015 20:01
RT @UKCochraneCentr: Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@AgencyNurse
17 November 2015 20:02
RT @UKCochraneCentr: Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@WeNurses
17 November 2015 20:02
RT @UKCochraneCentr: Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@WeNurses
17 November 2015 20:02
@CraigBradleyF1 gosh, hold on tight :) #wenurses
@SarahChapman30
17 November 2015 20:02
@WeNurses @SarahChapman30 @UKCochraneCentr Hi all! Really looking forward to hearing your thoughts on evidence and practice #wenurses
@loveebhc
17 November 2015 20:02
RT @SarahChapman30: @loveebhc Or Heather even - made you super-healthy there! #wenurses
@Claire_AVATAR
17 November 2015 20:02
Hi @SarahChapman30 ready for @CochraneWounds chat with #wenurses
@TeamClaytonULHT
17 November 2015 20:02
RT @UKCochraneCentr: Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@WeNurses
17 November 2015 20:03
Is everyone happy to use PVC for Peripheral Venous Catheters tonight ? #WeNurses
@WeNurses
17 November 2015 20:03
thanks @kaye_rolls great to have a global view this evening/morning :) #wenurses
@SarahChapman30
17 November 2015 20:03
@Claire_AVATAR @SarahChapman30 @CochraneWounds Brilliant! Give Claire a wave - she's an author on this review! #wenurses
@SarahChapman30
17 November 2015 20:03
RT @Claire_AVATAR: Hi @SarahChapman30 ready for @CochraneWounds chat with #wenurses
@SarahChapman30
17 November 2015 20:03
RT @WeNurses: Is everyone happy to use PVC for Peripheral Venous Catheters tonight ? #WeNurses
@vivatcarriole
17 November 2015 20:03
@loveebhc @WeNurses Unfortunately got to go out but will review the summary of the chat later Have a great discussion #wenurses
@WeNurses
17 November 2015 20:03
#WAVING #WeNurses https://t.co/WYK6Pm9W5n
@CraigBradleyF1
17 November 2015 20:03
@UKCochraneCentr Not always, we replace at 72hr, although encourage review to keep in, in practice that doesn't tend to happen #wenurses
@SarahChapman30
17 November 2015 20:03
@WeNurses PVC for peripheral venous catheter will help our tweety fingers! #wenurses
@SENSARorg
17 November 2015 20:03
RT @UKCochraneCentr: Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@jstjohnmatthews
17 November 2015 20:03
Lurking tonight for #wenurses. Waves from blustery Newport. not sure if any other cannulating @SCoRMembers are also lurking???
@kaye_rolls
17 November 2015 20:04
In NSW we still replace @72hrs because of #BSI & that #PIVC will be replaced when clinically indicated concerns #WeNurses
@WeNurses
17 November 2015 20:04
thanks for saying hi @vivatcarriole @loveebhc hope you have a fun evening :) #wenurses
@SarahChapman30
17 November 2015 20:04
@CraigBradleyF1 @UKCochraneCentr Is this policy in your workplace? #wenurses
@nursingSUni
17 November 2015 20:04
@WeNurses @SarahChapman30 @UKCochraneCentr Hello @wlasinclair on behalf of Salford, multitasking so mainly lurking! :-) #wenurses
@SarahChapman30
17 November 2015 20:04
I should just say I tweet for @ukcochranecentr but tweeting as myself mostly tonight #wenurses
@cmrwdk
17 November 2015 20:04
RT @UKCochraneCentr: Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@WeNurses
17 November 2015 20:05
RT @jstjohnmatthews: Lurking tonight for #wenurses. Waves from blustery Newport. not sure if any other cannulating @SCoRMembers are also lu…
@SarahChapman30
17 November 2015 20:05
@nursingSUni @WeNurses @SarahChapman30 @UKCochraneCentr @wlasinclair happy to have you! #wenurses
@SarahChapman30
17 November 2015 20:05
RT @jstjohnmatthews: Lurking tonight for #wenurses. Waves from blustery Newport. not sure if any other cannulating @SCoRMembers are also lu…
@SarahChapman30
17 November 2015 20:05
RT @kaye_rolls: In NSW we still replace @72hrs because of #BSI & that #PIVC will be replaced when clinically indicated concerns #WeNurses
@WeNurses
17 November 2015 20:05
1st QUESTION Do you change PVCs routinely or only when there are clinical signs that this is necessary? #WeNurses https://t.co/sQ3RQrk8rN
@WeNurses
17 November 2015 20:05
RT @SarahChapman30: I should just say I tweet for @ukcochranecentr but tweeting as myself mostly tonight #wenurses
@AgencyNurse
17 November 2015 20:06
RT @WeNurses: 1st QUESTION Do you change PVCs routinely or only when there are clinical signs that this is necessary? #WeNurses https://t…
@lllbdlll2
17 November 2015 20:06
RT @UKCochraneCentr: Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@CraigBradleyF1
17 November 2015 20:06
@SarahChapman30 @UKCochraneCentr Yes policy is for 72hr with the caveat 'but review & document if keeping in' #wenurses
@TeamClaytonULHT
17 November 2015 20:06
@WeNurses We are instructed to change after 72 hours unless access v difficult #wenurses
@WeNurses
17 November 2015 20:06
RT @kaye_rolls: In NSW we still replace @72hrs because of #BSI & that #PIVC will be replaced when clinically indicated concerns #WeNurses
@TeamClaytonULHT
17 November 2015 20:06
RT @WeNurses: 1st QUESTION Do you change PVCs routinely or only when there are clinical signs that this is necessary? #WeNurses https://t…
@loveebhc
17 November 2015 20:06
#EBP #PVC routine replacement at 72 hours causes unnecessary pain for patients #WeNurses
@WeNurses
17 November 2015 20:06
@vipvctraining hi :) #wenurses
@AgencyNurse
17 November 2015 20:06
RT @SarahChapman30: @WeNurses PVC for peripheral venous catheter will help our tweety fingers! #wenurses
@SarahChapman30
17 November 2015 20:06
@kaye_rolls @72hrs Interesting. @Claire_AVATAR found moderate quality evidence that it made no difference to #BSI #wenurses
@SarahChapman30
17 November 2015 20:06
RT @loveebhc: #EBP #PVC routine replacement at 72 hours causes unnecessary pain for patients #WeNurses
@_Michael_Palmer
17 November 2015 20:06
In the community a pragmatic approach is often adopted using VIP scale #WeNurses @SarahChapman30 @CraigBradleyF1 @UKCochraneCentr
@WeNurses
17 November 2015 20:06
RT @TeamClaytonULHT: @WeNurses We are instructed to change after 72 hours unless access v difficult #wenurses
@AgencyNurse
17 November 2015 20:06
RT @CraigBradleyF1: @SarahChapman30 @UKCochraneCentr Yes policy is for 72hr with the caveat 'but review & document if keeping in' #wenurses
@WeNurses
17 November 2015 20:06
RT @CraigBradleyF1: @SarahChapman30 @UKCochraneCentr Yes policy is for 72hr with the caveat 'but review & document if keeping in' #wenurses
@DarrenStokes35
17 November 2015 20:06
#WeNurses my placement area tend to change them after 4 days, regardless of need
@SarahChapman30
17 November 2015 20:07
@loveebhc Yes - routine replacement = routine pain! #wenurses
@ClareNash20
17 November 2015 20:07
@WeNurses local wind speed fast = bins taking off! Lights flickering #torchhandy #wenurses
@WeNurses
17 November 2015 20:07
RT @loveebhc: #EBP #PVC routine replacement at 72 hours causes unnecessary pain for patients #WeNurses
@anna_eol_doula
17 November 2015 20:07
RT @ndccharity: Talk on 'Death & the Maiden' on Thursday @deadmaidens https://t.co/Tm1RDPb6zZ at @florencemuseum #wenurses #WeEOLC with @…
@WeNurses
17 November 2015 20:07
RT @_Michael_Palmer: In the community a pragmatic approach is often adopted using VIP scale #WeNurses @SarahChapman30 @CraigBradleyF1 @UKCo…
@SarahChapman30
17 November 2015 20:07
@DarrenStokes35 is this a triumph of tradition/culture/habit over evidence? #wenurses
@vipvctraining
17 November 2015 20:07
@WeNurses #wenurses the Trust I used to work at still has 72-96 hour in their policy
@WeNurses
17 November 2015 20:08
Thanks Darren #WeNurses https://t.co/vspkm9uXN7
@SarahChapman30
17 November 2015 20:08
RT @vipvctraining: @WeNurses #wenurses the Trust I used to work at still has 72-96 hour in their policy
@jstjohnmatthews
17 November 2015 20:08
As a #radiographer I change if I am not happy with a PVC irrespective of time in situ. We use high flow rates in some CT exams #Wenurses.
@TeamClaytonULHT
17 November 2015 20:08
Can be confusing as saving lives guidance dictates 72-96 hours....#wenurses
@SarahChapman30
17 November 2015 20:08
@vipvctraining @WeNurses Yet that's not what the guidelines say as I understand it! #wenurses
@loveebhc
17 November 2015 20:08
The key to #BSI prevention & #PVC duration is regular monitoring #WeNurses
@WeNurses
17 November 2015 20:08
Interesting yes this is a consideration - what are others thoughts here ? #WeNurses https://t.co/NW75mJRJqG
@TeamClaytonULHT
17 November 2015 20:08
RT @loveebhc: #EBP #PVC routine replacement at 72 hours causes unnecessary pain for patients #WeNurses
@gallagher_rose
17 November 2015 20:08
RT @UKCochraneCentr: Please tell us: Do you replace peripheral venous catheters only when clinically indicated? #WeNurses
@CraigBradleyF1
17 November 2015 20:08
@loveebhc @SarahChapman30 Really important evidence base for #PVC care - we would like to see review for PICC by 72hr #wenurses
@leemiller77
17 November 2015 20:08
Within my placements it has been 72 hrs unless difficult access then monitor and record #WeNurses @wenurses
@WeNurses
17 November 2015 20:09
#eek !!! #WeNurses https://t.co/zmXDhEJ39z
@SarahChapman30
17 November 2015 20:09
@TeamClaytonULHT does it say you SHOULD do this or unclear? Not good when guidelines open to interpretation #wenurses
@ClaireMMcGinley
17 November 2015 20:09
RT @mattbirchdesign: @qubnursing @mattbirchdesign: @qubnursing #WorldPrematurityDay #prematurebirth #preemie #Wenurses #nurse #tinylife #mi…
@jstjohnmatthews
17 November 2015 20:09
Just to add #wenurses is that we have to be mindful of IV contrast extravasation over in imaging....
@kaye_rolls
17 November 2015 20:09
I understand & agree. their argument is that translation into practice is difficult & are gun shy #wenurses @SarahChapman30 @Claire_AVATAR
@WeNurses
17 November 2015 20:09
#WeNurses - important point - what do we mean by "clinically indicated" here ? https://t.co/shL39lKoYA
@AgencyNurse
17 November 2015 20:09
RT @SarahChapman30: @DarrenStokes35 is this a triumph of tradition/culture/habit over evidence? #wenurses
@SarahChapman30
17 November 2015 20:09
RT @CraigBradleyF1: @SarahChapman30 @UKCochraneCentr Yes policy is for 72hr with the caveat 'but review & document if keeping in' #wenurses
@CraigBradleyF1
17 November 2015 20:10
@SarahChapman30 @loveebhc I'm using that quote tomorrow Sarah!! #wenurses
@HW_Surrey
17 November 2015 20:10
Hi #wenurses tonight we're talking about #menshealth in #Surrey. What advice would you give men who are worried about seeing their GP?
@kaye_rolls
17 November 2015 20:10
RT @SarahChapman30: @loveebhc Yes - routine replacement = routine pain! #wenurses
@TeamClaytonULHT
17 November 2015 20:10
@SarahChapman30 hmm, unsure tbh, trust policy states 72 I believe, saving lives national guidance... #wenurses #confused
@WeNurses
17 November 2015 20:10
RT @vipvctraining: @WeNurses #wenurses the Trust I used to work at still has 72-96 hour in their policy
@vipvctraining
17 November 2015 20:10
@SarahChapman30 @WeNurses #wenurses I know I think hospitals may be nervous re what they see as a big training issue maybe?
@Claire_AVATAR
17 November 2015 20:10
@SarahChapman30 @TeamClaytonULHT epic3 are very clear that clinically indicated is the way to go! #wenurses
@WeNurses
17 November 2015 20:10
Great to have another perspective here #WeNurses https://t.co/hEynfCxhkx
@SarahChapman30
17 November 2015 20:10
RT @Claire_AVATAR: @SarahChapman30 @TeamClaytonULHT epic3 are very clear that clinically indicated is the way to go! #wenurses
@WeNurses
17 November 2015 20:10
RT @TeamClaytonULHT: Can be confusing as saving lives guidance dictates 72-96 hours....#wenurses
@SarahChapman30
17 November 2015 20:10
@Claire_AVATAR @SarahChapman30 @TeamClaytonULHT yes that was my impression - good! #wenurses
@TeamClaytonULHT
17 November 2015 20:11
@WeNurses @MikeRNCoach @UKCochraneCentr VIP score greater/equal to 1 = damage already done? #wenurses
@kaye_rolls
17 November 2015 20:11
But it always has won?! #wenurses #PIVC @SarahChapman30 @DarrenStokes35
@AgencyNurse
17 November 2015 20:11
RT @loveebhc: The key to #BSI prevention & #PVC duration is regular monitoring #WeNurses
@SarahChapman30
17 November 2015 20:11
RT @WeNurses: Great to have another perspective here #WeNurses https://t.co/hEynfCxhkx
@CraigBradleyF1
17 November 2015 20:11
@WeNurses although rare now we still see 'just in case' PVCs - is that clinically indicated? #wenurses
@TeamClaytonULHT
17 November 2015 20:11
RT @WeNurses: Interesting yes this is a consideration - what are others thoughts here ? #WeNurses https://t.co/NW75mJRJqG
@TeamClaytonULHT
17 November 2015 20:11
RT @SarahChapman30: @DarrenStokes35 is this a triumph of tradition/culture/habit over evidence? #wenurses
@SarahChapman30
17 November 2015 20:11
@WeNurses yes & we had a comment on this by a vet last week too! Great cross-discipline discussions! #wenurses
@WeNurses
17 November 2015 20:11
RT @jstjohnmatthews: Just to add #wenurses is that we have to be mindful of IV contrast extravasation over in imaging....
@JoanXwebster
17 November 2015 20:11
#wenurses Our policy is routine replacement but of courses that doesn't happen!!
@loveebhc
17 November 2015 20:12
Interesting, #EBP needs translation to system, but the evidence is clear. System change is the key #WeNurses https://t.co/DRLtgJUDrY
@kaye_rolls
17 November 2015 20:12
Absolutely, as it is in all things! #wenurses @loveebhc @AgencyNurse
@WeNurses
17 November 2015 20:12
thanks to you all for joining and sharing views and expertise, please try to add #wenurses so we can all see you :) https://t.co/VQFpS8l16N
@SarahChapman30
17 November 2015 20:12
@JoanXwebster Hi Joan - everyone, Joan is also an author on this review! #wenurses
@DarrenStokes35
17 November 2015 20:12
RT @SarahChapman30: @loveebhc Yes - routine replacement = routine pain! #wenurses
@CraigBradleyF1
17 November 2015 20:12
RT @Claire_AVATAR: @SarahChapman30 @TeamClaytonULHT epic3 are very clear that clinically indicated is the way to go! #wenurses
@loveebhc
17 November 2015 20:12
RT @Claire_AVATAR: @SarahChapman30 @TeamClaytonULHT epic3 are very clear that clinically indicated is the way to go! #wenurses
@WeNurses
17 November 2015 20:12
RT @SarahChapman30: @JoanXwebster Hi Joan - everyone, Joan is also an author on this review! #wenurses
@Claire_AVATAR
17 November 2015 20:12
Many international guidelines have not been updated since new #evidence came out. How long do we have to wait? #wenurses
@SarahChapman30
17 November 2015 20:13
Big thanks to @JoanXWebster & @Claire_AVATAR for joining us so early in the morning in Australia to discuss their review! #wenurses
@jstjohnmatthews
17 November 2015 20:13
@WeNurses where possible I flush with saline after the exam and check with the ward if I can leave the cannula in #wenurses.
@HallamCarole
17 November 2015 20:13
RT @Claire_AVATAR: @SarahChapman30 @TeamClaytonULHT epic3 are very clear that clinically indicated is the way to go! #wenurses
@vipvctraining
17 November 2015 20:13
@WeNurses @jstjohnmatthews #wenurses sounds good do you use the BD Nexiva Diffusic cannula
@leemiller77
17 November 2015 20:13
RT @SarahChapman30: @DarrenStokes35 is this a triumph of tradition/culture/habit over evidence? #wenurses
@WeNurses
17 November 2015 20:14
What are your thoughts on the evidence presented in the Cochrane Review? #WeNurses https://t.co/gXj3XceA4E
@Claire_AVATAR
17 November 2015 20:14
I've been told we have to keep the routine policy 'so junior doctors can get enough practice' #selfish #patientsnotguineapigs #wenurses
@TeamClaytonULHT
17 November 2015 20:14
Ditto! #wenurses https://t.co/svgPOi63Zx
@kaye_rolls
17 November 2015 20:14
Exactly @JoanXwebster #wenurses suboptimal care is suboptimal care #PIVC
@AgencyNurse
17 November 2015 20:14
Really interesting question ? #WeNurses https://t.co/dLBXl25d7X
@Claire_AVATAR
17 November 2015 20:14
RT @SarahChapman30: @JoanXwebster Hi Joan - everyone, Joan is also an author on this review! #wenurses
@AnnMarieRiley10
17 November 2015 20:14
@WeNurses @UKCochraneCentr @SarahChapman30 am lurking #wenurses ??
@loveebhc
17 November 2015 20:14
Just checking No additional evidence since epic3 #EBP #WeNurses https://t.co/XsKJpVpues
@WeNurses
17 November 2015 20:15
RT @Claire_AVATAR: Many international guidelines have not been updated since new #evidence came out. How long do we have to wait? #wenurses
@SarahChapman30
17 November 2015 20:15
RT @Claire_AVATAR: Many international guidelines have not been updated since new #evidence came out. How long do we have to wait? #wenurses
@JoanXwebster
17 November 2015 20:15
@SarahChapman30 #wenurses Tweeting, a totally new experience for me!!
@TeamClaytonULHT
17 November 2015 20:15
@WeNurses high quality evidence that needs discussion & well thought out dissemination #wenurses
@Claire_AVATAR
17 November 2015 20:15
RT @WeNurses: What are your thoughts on the evidence presented in the Cochrane Review? #WeNurses https://t.co/gXj3XceA4E
@WeNurses
17 November 2015 20:15
Great to have you guys here #WeNurses https://t.co/HcqyHT8RoK
@vipvctraining
17 November 2015 20:15
@SarahChapman30 @Claire_AVATAR @TeamClaytonULHT I totally agree with clinical guidelines & teach this on my courses #wenurses
@SarahChapman30
17 November 2015 20:15
@JoanXwebster @SarahChapman30 In at the deep end Joan! #wenurses
@AgencyNurse
17 November 2015 20:15
RT @WeNurses: What are your thoughts on the evidence presented in the Cochrane Review? #WeNurses https://t.co/gXj3XceA4E
@kaye_rolls
17 November 2015 20:16
the weight of tradition & experience of #BSI outweighs the evidence for clinical replacement @loveebhc #wenurses
@RDNS_Education
17 November 2015 20:16
Join the #catheter conversation using #wenurses in your comments. https://t.co/Vez8uMwW9X
@AgencyNurse
17 November 2015 20:16
errrmmmm not sure thats a valid reason !!!! #WeNurses https://t.co/x2z6E0fgow
@kirstyadams7
17 November 2015 20:16
I also think its important not to site or re-site unless clinical need.....and removing them as soon as no longer required!#wenurses
@TeamClaytonULHT
17 November 2015 20:16
@AgencyNurse @CraigBradleyF1 @WeNurses must admit we tend to keep them in with patients with #epistaxis #wenurses
@SarahChapman30
17 November 2015 20:16
@Claire_AVATAR Noooooooooo! That is so bad....! #wenurses
@AnnMarieRiley10
17 November 2015 20:16
RT @SarahChapman30: @DarrenStokes35 is this a triumph of tradition/culture/habit over evidence? #wenurses
@loveebhc
17 November 2015 20:16
Has anyone heard of simulation! #EBP #WeNurses https://t.co/xi7yoEq32J
@HealthUKTD
17 November 2015 20:16
RT @CraigBradleyF1: @SarahChapman30 @UKCochraneCentr Yes policy is for 72hr with the caveat 'but review & document if keeping in' #wenurses
@AgencyNurse
17 November 2015 20:16
@AnnMarieRiley10 @WeNurses @UKCochraneCentr @SarahChapman30 lurkers always welcome #WeNurses
@CraigBradleyF1
17 November 2015 20:16
@WeNurses Makes complete sense, I worry about quality of VIP scores used in studies, not all recorded accurately in my experience #wenurses
@AgencyNurse
17 November 2015 20:17
RT @TeamClaytonULHT: @WeNurses high quality evidence that needs discussion & well thought out dissemination #wenurses
@WeNurses
17 November 2015 20:17
RT @TeamClaytonULHT: @WeNurses high quality evidence that needs discussion & well thought out dissemination #wenurses
@AgencyNurse
17 November 2015 20:17
@TeamClaytonULHT @WeNurses agree high quality evidence and needs to be shared - huge implications to pt care here #wenurses
@Claire_AVATAR
17 November 2015 20:17
@WeNurses it's not that early 7am and the sun is shining, birds are singing and we are at a grant writing retreat at the beach #wenurses
@sydeveau
17 November 2015 20:17
Surely we should all change PVCs when not happy with it…because of VIP score, placement or PVC falling out #WeNurses https://t.co/Vra1llrLX2
@WeNurses
17 November 2015 20:17
RT @kaye_rolls: the weight of tradition & experience of #BSI outweighs the evidence for clinical replacement @loveebhc #wenurses
@AgencyNurse
17 November 2015 20:17
RT @kaye_rolls: the weight of tradition & experience of #BSI outweighs the evidence for clinical replacement @loveebhc #wenurses
@TeamClaytonULHT
17 November 2015 20:17
RT @AgencyNurse: @TeamClaytonULHT @WeNurses agree high quality evidence and needs to be shared - huge implications to pt care here #wenurses
@SarahChapman30
17 November 2015 20:17
@kaye_rolls @loveebhc What do @Claire_AVATAR & @JoanXWebster think? This was the weaker evidence in the review I think #wenurses
@Claire_AVATAR
17 November 2015 20:18
@CraigBradleyF1 @WeNurses and if people don't act on them, what's the point? #wenurses
@kaye_rolls
17 November 2015 20:18
that's fatuous & other less polite terms #wenurses #PIVC replacement https://t.co/D2FKp8UuUD
@CraigBradleyF1
17 November 2015 20:18
RT @AgencyNurse: @TeamClaytonULHT @WeNurses agree high quality evidence and needs to be shared - huge implications to pt care here #wenurses
@AgencyNurse
17 November 2015 20:18
I agree - this is really important .. need to think of our patients #Wenurses https://t.co/h8e0ZMgXyV
@SarahChapman30
17 November 2015 20:18
@Claire_AVATAR @WeNurses Wow! That sounds ok! Different from dark and very windy Britain! #wenurses
@TeamClaytonULHT
17 November 2015 20:18
@AgencyNurse @WeNurses not to mention financial implications....?????? #wenurses
@Leannejane1975
17 November 2015 20:18
RT @WeNurses: What are your thoughts on the evidence presented in the Cochrane Review? #WeNurses https://t.co/gXj3XceA4E
@Claire_AVATAR
17 November 2015 20:18
@loveebhc poroblem with simulation is they usually simulate 'good veins' #whohasgoodveinsanymore #wenurses
@SarahChapman30
17 November 2015 20:19
@AgencyNurse yes good point. #wenurses
@SarahChapman30
17 November 2015 20:19
RT @Claire_AVATAR: @loveebhc poroblem with simulation is they usually simulate 'good veins' #whohasgoodveinsanymore #wenurses
@PDN_Kat
17 November 2015 20:19
We use posiflush for PVC for nurses who aren't yet IV competent as they are licensed as a medical device #WeNurses
@SarahChapman30
17 November 2015 20:19
RT @WeNurses: What are your thoughts on the evidence presented in the Cochrane Review? #WeNurses https://t.co/gXj3XceA4E
@CraigBradleyF1
17 November 2015 20:19
@AgencyNurse @TeamClaytonULHT @WeNurses Implications can't be understated here #wenurses
@AgencyNurse
17 November 2015 20:19
absolutely - i wonder what @nhsFFF would think of this evidence ? #WeNurses @SamSherrington https://t.co/ndqNUc45Sw
@LynneOmar
17 November 2015 20:19
RT @HW_Surrey: Hi #wenurses tonight we're talking about #menshealth in #Surrey. What advice would you give men who are worried about seeing…
@AnnMarieRiley10
17 November 2015 20:20
#wenurses https://t.co/sqh9093jku
@CraigBradleyF1
17 November 2015 20:20
RT @Claire_AVATAR: @CraigBradleyF1 @WeNurses and if people don't act on them, what's the point? #wenurses
@CochraneUK
17 November 2015 20:20
RT @RDNS_Education: Join the #catheter conversation using #wenurses in your comments. https://t.co/Vez8uMwW9X
@TeamClaytonULHT
17 November 2015 20:20
Could this risk leading to complacency & PVC left insitu > 7 days #wenurses (what is the maximum length of time to leave insitu?)
@CochraneUK
17 November 2015 20:20
RT @TeamClaytonULHT: @WeNurses high quality evidence that needs discussion & well thought out dissemination #wenurses
@jstjohnmatthews
17 November 2015 20:20
@sydeveau agreed #wenurses. Sometimes the PVC size is too small for the CT exam even though it is fine otherwise i.e. green for CT PA
@AgencyNurse
17 November 2015 20:20
@CraigBradleyF1 @TeamClaytonULHT @WeNurses even on fundemental level - its really quite painful for our pts to have these put in #WeNurses
@jstjohnmatthews
17 November 2015 20:20
RT @AgencyNurse: absolutely - i wonder what @nhsFFF would think of this evidence ? #WeNurses @SamSherrington https://t.co/ndqNUc45Sw
@loveebhc
17 November 2015 20:20
Clinical indications needed for insertion as well as resiting @CraigBradleyF1 "just in case" puts patients at risk #WeNurses
@SarahChapman30
17 November 2015 20:21
RT @loveebhc: Clinical indications needed for insertion as well as resiting @CraigBradleyF1 "just in case" puts patients at risk #WeNurses
@AgencyNurse
17 November 2015 20:21
#WeNurses https://t.co/9ooyx7Ty0o
@WeNurses
17 November 2015 20:21
@CJohnston1903 not forgetting #wenurses are we Charlotte??? Out of practice maybe :)
@SarahChapman30
17 November 2015 20:21
RT @TeamClaytonULHT: Could this risk leading to complacency & PVC left insitu > 7 days #wenurses (what is the maximum length of time to lea…
@jstjohnmatthews
17 November 2015 20:21
RT @loveebhc: Has anyone heard of simulation! #EBP #WeNurses https://t.co/xi7yoEq32J
@AgencyNurse
17 November 2015 20:21
#WeNurses - good point Charlotte but we do need to challenge policy when we know evidence strong https://t.co/7GzAJ15sGy
@AnnMarieRiley10
17 November 2015 20:21
@AgencyNurse @Claire_AVATAR @AgencyNurse @Claire_AVATAR surely that can't be right! #ethics #wenurses
@vipvctraining
17 November 2015 20:22
@loveebhc @SarahChapman30 @CraigBradleyF1 #wenurses absolutely we need to get everyone practicing this
@SarahChapman30
17 November 2015 20:22
#WeNurses https://t.co/k2yqroCjTr
@CraigBradleyF1
17 November 2015 20:22
@TeamClaytonULHT It could but balanced against the current risks I'm sure it would be outweighed. Need to mitigate with training #wenurses
@JoanXwebster
17 November 2015 20:22
@AnnMarieRiley10 #wenurses True but when will a trial so large ever be funded?
@Claire_AVATAR
17 November 2015 20:22
@TeamClaytonULHT #PVCs licensed by regulatory authorities for 30 days use #WhoKnew #wenurses I've used for 20+days
@DarrenStokes35
17 November 2015 20:23
RT @loveebhc: Clinical indications needed for insertion as well as resiting @CraigBradleyF1 "just in case" puts patients at risk #WeNurses
@PDN_Kat
17 November 2015 20:23
@WeNurses our policy was as per #Epic3, necessity/VIP=0, changing soon due to audit findings/poor monitoring /documentation #wenurses
@TeamClaytonULHT
17 November 2015 20:23
RT @Claire_AVATAR: @TeamClaytonULHT #PVCs licensed by regulatory authorities for 30 days use #WhoKnew #wenurses I've used for 20+days
@KarenJulieCros1
17 November 2015 20:23
RT @keeling_michael: Great article on mandatory training by @SarahhillsPDN @WeNurses @WeMidwives @WeDocs #WeNurses #whywedoresearch https:/…
@AgencyNurse
17 November 2015 20:23
#wenurses https://t.co/DuGBL9UUOu
@CraigBradleyF1
17 November 2015 20:23
@AgencyNurse @TeamClaytonULHT @WeNurses Yes they are extremely painful! Even anaesthetic creams don't do a great deal #wenurses
@SarahChapman30
17 November 2015 20:23
RT @Claire_AVATAR: @TeamClaytonULHT #PVCs licensed by regulatory authorities for 30 days use #WhoKnew #wenurses I've used for 20+days
@dwinter14
17 November 2015 20:23
@CraigBradleyF1 @WeNurses I worry about who puts it in also! Still not good enough! #WeNurses
@TeamClaytonULHT
17 November 2015 20:23
@Claire_AVATAR fascinating, thanks Claire, a real eye-opener! #wenurses
@SarahChapman30
17 November 2015 20:23
@Claire_AVATAR @TeamClaytonULHT I didn't know that! Wow! #wenurses
@AnnMarieRiley10
17 November 2015 20:23
RT @JoanXwebster: @AnnMarieRiley10 #wenurses True but when will a trial so large ever be funded?
@AgencyNurse
17 November 2015 20:23
RT @SarahChapman30: #WeNurses https://t.co/k2yqroCjTr
@kaye_rolls
17 November 2015 20:24
No I disagree the weight of evidence does not change that often. System is not agile enough #wenurses https://t.co/A5lLwix8M9
@SarahChapman30
17 November 2015 20:24
@CraigBradleyF1 @AgencyNurse @TeamClaytonULHT @WeNurses & probably adults aren't offered them? #wenurses
@Claire_AVATAR
17 November 2015 20:24
@AnnMarieRiley10 there were half the #BSIs in clinically ind #PVCs, do we know making holes in skin 72hrly doesn't cause #BSI #wenurses
@CJohnston1903
17 November 2015 20:24
@WeNurses I am, sorry! But I had a point to make and it took too many tweets!! #naughtycorner #wenurses
@CJohnston1903
17 November 2015 20:24
RT @WeNurses: @CJohnston1903 not forgetting #wenurses are we Charlotte??? Out of practice maybe :)
@SarahChapman30
17 November 2015 20:25
@CJohnston1903 @WeNurses we can handle multiple tweets! Good to hear views #wenurses
@WeNurses
17 November 2015 20:25
Do you feel you should stop routine changing of PVCs? #WeNurses https://t.co/OnmoGgco18
@SafeCareSam
17 November 2015 20:25
@dermotor Looks like the review is prompting the same questions everywhere. #wenurses https://t.co/XrFsi7UXhm
@AgencyNurse
17 November 2015 20:25
@CJohnston1903 @TeamClaytonULHT @WeNurses hehehe sorry !! #WeNurses
@AgencyNurse
17 November 2015 20:25
#WeNurses https://t.co/ES6zpngFxu
@PDN_Kat
17 November 2015 20:25
Cannula packs useful but expensive, all needed equipment including documentation/VIP chart - no excuses not to be completed! #WeNurses
@SarahChapman30
17 November 2015 20:25
RT @AgencyNurse: @TeamClaytonULHT @WeNurses agree high quality evidence and needs to be shared - huge implications to pt care here #wenurses
@loveebhc
17 November 2015 20:26
So #EBP needs to be translated. Poor monitoring the problem not the recommendation? #WeNurses @Claire_Avatar https://t.co/tmpVyZnKxd
@TeamClaytonULHT
17 November 2015 20:26
@WeNurses yes, but I feel it would take a brave Trust to change their policy... #wenurses
@CJohnston1903
17 November 2015 20:26
Joined the #wenurses chat discussing peripheral venous lines for 2mins -in the naughty corner already (some things never change ??) #wenurses
@AgencyNurse
17 November 2015 20:26
#WeNurses @UKCochraneCentr > https://t.co/DMdgkM16En
@CochraneUK
17 November 2015 20:26
RT @AgencyNurse: #WeNurses @UKCochraneCentr > https://t.co/DMdgkM16En
@Claire_AVATAR
17 November 2015 20:26
#wenurses we never did routine #PVC change in children - why is that seen as safe but not in adults #kidsarecuter ?
@JoanXwebster
17 November 2015 20:27
#wenurses We need to focus more on insertion and maintenance practiced ... the clinically indicated argument should be over
@Claire_AVATAR
17 November 2015 20:27
@loveebhc poor ACTION is the problem, monitoring without action, complacency, big problem #wenurses
@AgencyNurse
17 November 2015 20:27
even in the light of high quality evidence, and huge cost implications? #wenurses https://t.co/4FxDHHLXDY
@WeNurses
17 November 2015 20:27
#wenurses https://t.co/1liV8muio3
@WeNurses
17 November 2015 20:28
RT @loveebhc: So #EBP needs to be translated. Poor monitoring the problem not the recommendation? #WeNurses @Claire_Avatar https://t.co/tmp…
@CochraneUK
17 November 2015 20:28
Million $ question! Too much for rapid tweets! @Claire_AVATAR RT @AgencyNurse: #WeNurses @UKCochraneCentr > https://t.co/FxEUW1Ogvd
@vipvctraining
17 November 2015 20:28
@WeNurses #wenurses yes better for patients nurses important staff have sound knowledge
@CJohnston1903
17 November 2015 20:28
@WeNurses yes, it's now evidence based&good evidence at that.... so why do something unnecessary? Wouldn't that be poor practice? #WeNurses
@AnnMarieRiley10
17 November 2015 20:28
@SarahChapman30 @CraigBradleyF1 @AgencyNurse @TeamClaytonULHT @WeNurses usually aren't as routine #wenurses
@TeamClaytonULHT
17 November 2015 20:28
@AgencyNurse @WeNurses Fear of bacteraemias/phlebitis etc accusations of neglect maybe? #wenurses
@SarahChapman30
17 November 2015 20:28
@AgencyNurse yes why not? We ought to ask what Trust would NOT change under these circumstances! #wenurses
@dwinter14
17 November 2015 20:28
@WeNurses not till everyone declared competent insertion and maintenance, roadside emergency cannula should not be in for days. #WeNurses
@WeNurses
17 November 2015 20:29
sensible question- anyone want to respond ? #WeNurses https://t.co/1liV8muio3
@Claire_AVATAR
17 November 2015 20:29
@TeamClaytonULHT @WeNurses once we get on the front page of papers for all the pain we cause, it'll be the brave ones that don't #wenurses
@kaye_rolls
17 November 2015 20:29
Indeed this is the big question & not the only practice where paeds does better than adults @Claire_AVATAR #wenurses #PVC
@AgencyNurse
17 November 2015 20:29
RT @SarahChapman30: @AgencyNurse yes why not? We ought to ask what Trust would NOT change under these circumstances! #wenurses
@WeNurses
17 November 2015 20:29
RT @SarahChapman30: @AgencyNurse yes why not? We ought to ask what Trust would NOT change under these circumstances! #wenurses
@AgencyNurse
17 November 2015 20:29
ooh i like this tweet :D #Wenurses https://t.co/J9mtyaatSl
@CraigBradleyF1
17 November 2015 20:29
@WeNurses We need the 3Rs - review rather than replace #wenurses
@SarahChapman30
17 November 2015 20:29
RT @WeNurses: sensible question- anyone want to respond ? #WeNurses https://t.co/1liV8muio3
@JoanXwebster
17 November 2015 20:29
@UKCochraneCentr @Claire_AVATAR @AgencyNurse #wenurses What evidence would you suggest then Dave?
@SarahChapman30
17 November 2015 20:29
RT @CraigBradleyF1: @WeNurses We need the 3Rs - review rather than replace #wenurses
@WeNurses
17 November 2015 20:29
like that :) #wenurses https://t.co/aTuXnE3q7r
@SarahChapman30
17 November 2015 20:30
RT @AgencyNurse: ooh i like this tweet :D #Wenurses https://t.co/J9mtyaatSl
@CJohnston1903
17 November 2015 20:30
RT @SarahChapman30: @AgencyNurse yes why not? We ought to ask what Trust would NOT change under these circumstances! #wenurses
@Claire_AVATAR
17 November 2015 20:30
@kaye_rolls parents protecting patients!! #wenurses
@CJohnston1903
17 November 2015 20:30
@SarahChapman30 @AgencyNurse fully agree ?? #wenurses
@AnnMarieRiley10
17 November 2015 20:30
RT @WeNurses: like that :) #wenurses https://t.co/aTuXnE3q7r
@AgencyNurse
17 November 2015 20:30
Doesnt the evidence address this though ?https://t.co/wAJI3Prhp9 #WeNurses https://t.co/5mzW994Z9t
@trentyarwood
17 November 2015 20:30
.@Claire_AVATAR @AnnMarieRiley10 #wenurses it probably does, but I don't think your data proves that clin ind doesn't cause #BSIs, either
@SarahChapman30
17 November 2015 20:30
RT @vipvctraining: @loveebhc @SarahChapman30 @CraigBradleyF1 #wenurses absolutely we need to get everyone practicing this
@loveebhc
17 November 2015 20:30
Work on "best available evidence" where RCT not available or feasible. #EBP #WeNurses https://t.co/KDLvsPNN2R
@WeNurses
17 November 2015 20:31
#wenurses https://t.co/FYXggfiUs3
@leemiller77
17 November 2015 20:31
RT @CraigBradleyF1: @WeNurses We need the 3Rs - review rather than replace #wenurses
@Intl_Nurses
17 November 2015 20:31
RT @WeNurses: #wenurses https://t.co/1liV8muio3
@iahcp
17 November 2015 20:31
RT @WeNurses: #wenurses https://t.co/1liV8muio3
@silv24
17 November 2015 20:31
@WeNurses yes yes yes yes yes #wenurses
@loveebhc
17 November 2015 20:31
RT @CraigBradleyF1: @WeNurses We need the 3Rs - review rather than replace #wenurses
@AgencyNurse
17 November 2015 20:31
@TeamClaytonULHT @WeNurses and (being devils advocate here) what about our poor patients in this ? #WeNurses potential unecessary procedure?
@CJohnston1903
17 November 2015 20:32
RT @silv24: @WeNurses yes yes yes yes yes #wenurses
@WeNurses
17 November 2015 20:32
could you be a little clearer in your tweets please @silv24 :) thanks for joining #wenurses
@trentyarwood
17 November 2015 20:32
.@Claire_AVATAR @AnnMarieRiley10 #wenurses less phlebitis is great, sure,but 1 SABSI >15% mortality, $20k costs to health system is big deal
@CochraneUK
17 November 2015 20:32
@JoanXwebster @Claire_AVATAR @AgencyNurse @davecfcgate12 RCT seems very appropriate here surely #WeNurses
@loveebhc
17 November 2015 20:32
Could be applied to all invasive devices! #WeNurses https://t.co/3OK4CjXgNV
@TeamClaytonULHT
17 November 2015 20:32
@AgencyNurse some patients/relatives may perceive lack of replacement/extended time insitu neglectful, vital to communicate well #wenurses
@AgencyNurse
17 November 2015 20:32
This sounds sensible to me #WeNurses https://t.co/ZkygP1ctkx
@katieboooo4
17 November 2015 20:32
#WeNurses in paediatrics we don't routinely change. Use vip score and assess regularly - why replace if not needed, unnecessary procedures?
@loveebhc
17 November 2015 20:33
RT @AgencyNurse: @TeamClaytonULHT @WeNurses and (being devils advocate here) what about our poor patients in this ? #WeNurses potential une…
@WeNurses
17 November 2015 20:33
RT @katieboooo4: #WeNurses in paediatrics we don't routinely change. Use vip score and assess regularly - why replace if not needed, unnece…
@TeamClaytonULHT
17 November 2015 20:33
RT @AgencyNurse: This sounds sensible to me #WeNurses https://t.co/ZkygP1ctkx
@SarahChapman30
17 November 2015 20:33
@TeamClaytonULHT @AgencyNurse as ever - clear communication is definitely vital #wenurses
@AgencyNurse
17 November 2015 20:33
@TeamClaytonULHT yes indeed - so maybe we need to highlight and document review process ? #Wenurses robust review ?
@AgencyNurse
17 November 2015 20:33
RT @SarahChapman30: @TeamClaytonULHT @AgencyNurse as ever - clear communication is definitely vital #wenurses
@WeNurses
17 November 2015 20:33
RT @SarahChapman30: @TeamClaytonULHT @AgencyNurse as ever - clear communication is definitely vital #wenurses
@sircwn
17 November 2015 20:33
RT @katieboooo4: #WeNurses in paediatrics we don't routinely change. Use vip score and assess regularly - why replace if not needed, unnece…
@WeCYPnurses
17 November 2015 20:33
RT @kaye_rolls: Indeed this is the big question & not the only practice where paeds does better than adults @Claire_AVATAR #wenurses #PVC
@SarahChapman30
17 November 2015 20:33
@CraigBradleyF1 @WeNurses 4 Rs - RCT then review rather than replace!!! #wenurses
@WeNurses
17 November 2015 20:33
#WeNurses > https://t.co/FYXggfiUs3
@kaye_rolls
17 November 2015 20:34
applies to everything we do to patients regardless of route #wenurses @WeNurses
@SarahChapman30
17 November 2015 20:34
RT @katieboooo4: #WeNurses in paediatrics we don't routinely change. Use vip score and assess regularly - why replace if not needed, unnece…
@loveebhc
17 November 2015 20:34
Unnecessary insertion poses a new risk of BSI You wouldn't change a CVC routinely? #WeNurses https://t.co/R6ozkNTkM2
@silv24
17 November 2015 20:34
@WeNurses only cannulate when a patient needs one, remove as soon as not needed & monitor it but no routine change if working #wenurses
@WeNurses
17 November 2015 20:34
#wenurses we aim to please @doeeyedlettuce :) https://t.co/jkSsPC1XJm
@WeCYPnurses
17 November 2015 20:34
Loving this tweet! #Wenurses https://t.co/nazdokRqvc
@Claire_AVATAR
17 November 2015 20:35
Know WHY we started routinely changing #PVCs ? #wenurses
@kaye_rolls
17 November 2015 20:35
Great chat but alas my station is next. Keep up the good work & see you sometime soon #WeNurses
@SarahChapman30
17 November 2015 20:35
RT @kaye_rolls: Indeed this is the big question & not the only practice where paeds does better than adults @Claire_AVATAR #wenurses #PVC
@SarahChapman30
17 November 2015 20:35
RT @Claire_AVATAR: #wenurses we never did routine #PVC change in children - why is that seen as safe but not in adults #kidsarecuter ?
@a_ullman
17 November 2015 20:35
@Claire_AVATAR - not on my veins thanks! #WeNurses
@tracyreek
17 November 2015 20:35
RT @Claire_AVATAR: #wenurses we never did routine #PVC change in children - why is that seen as safe but not in adults #kidsarecuter ?
@vipvctraining
17 November 2015 20:35
@puncloulou19 @WeNurses correct and the epic3 say so and research #wenurses good thinking common sense
@tracyreek
17 November 2015 20:35
RT @kaye_rolls: Indeed this is the big question & not the only practice where paeds does better than adults @Claire_AVATAR #wenurses #PVC
@SarahChapman30
17 November 2015 20:35
@Claire_AVATAR Why did we start changing them routinely? #wenurses
@PDN_Kat
17 November 2015 20:36
As a part of ward rounds we (nurses, Dr's) should be checking PVC, antibiotic necessity #patientsafety #WeNurses
@silv24
17 November 2015 20:36
@WeNurses having a cannula is painful and unpleasant, the evidence supports close monitoring rather than an arbitrary time limit #WeNurses
@WeNurses
17 November 2015 20:36
thanks for joining for NSW @kaye_rolls loved your input, have a great day! #wenurses
@angelawindle
17 November 2015 20:36
#WeNurses policies are not easy to change, cannulas are painful + expensive, if it's patient experience and lean working you want @LTHTrust
@WeCYPnurses
17 November 2015 20:36
RT @katieboooo4: #WeNurses in paediatrics we don't routinely change. Use vip score and assess regularly - why replace if not needed, unnece…
@WeNurses
17 November 2015 20:36
#WeNurses https://t.co/EMM0RdvDJp
@TeamClaytonULHT
17 November 2015 20:36
#wenurses exciting data! https://t.co/F20BA58Vun
@WeNurses
17 November 2015 20:36
#wenurses https://t.co/xekZ1d0Bc8
@jstjohnmatthews
17 November 2015 20:42
@PDN_Kat yes we do #wenurses. As a cannulating #radiographer it is a priority that I work with my Nursing colleagues to ensure best practice
@AgencyNurse
17 November 2015 20:44
RT @JoanXwebster: #wenurses Repeat patients in our hospital, who have been in our trials, now refuse to have their catheter changed routine…
@WeNurses
17 November 2015 20:44
RT @JoanXwebster: #wenurses Repeat patients in our hospital, who have been in our trials, now refuse to have their catheter changed routine…
@TeamClaytonULHT
17 November 2015 20:44
RT @AnnMarieRiley10: @AgencyNurse @TeamClaytonULHT staff should raise evidence with their infection control team #wenurses
@AnnMarieRiley10
17 November 2015 20:44
RT @JoanXwebster: #wenurses Repeat patients in our hospital, who have been in our trials, now refuse to have their catheter changed routine…
@EyesNurse
17 November 2015 20:44
@WeNurses #WeNurses is there any difference in ported and non-ported PVC? Often port cap comes open and collects "stuff" - ?increases VIP.
@SarahChapman30
17 November 2015 20:44
@Claire_AVATAR This works a treat for shared decisions about antibiotic use for acute respiratory infections! #wenurses
@AgencyNurse
17 November 2015 20:44
RT @susanerobertson: Need to be careful routine practice doesn't = ritualistic #WeNurses
@WeNurses
17 November 2015 20:44
RT @susanerobertson: Need to be careful routine practice doesn't = ritualistic #WeNurses
@TeamClaytonULHT
17 November 2015 20:44
RT @PDN_Kat: Do our allied health colleuges have a role/responsibility to play in PVC care/monitoring? #WeNurses
@a_ullman
17 November 2015 20:44
RT @JoanXwebster: #wenurses Repeat patients in our hospital, who have been in our trials, now refuse to have their catheter changed routine…
@CraigBradleyF1
17 November 2015 20:44
@WeNurses Don't we have to? Can't ignore #EBP Sure more research needed but what we see so far is enough for a call to action #wenurses
@SarahChapman30
17 November 2015 20:45
@susanerobertson Yes it's dangerous! #wenurses
@vipvctraining
17 November 2015 20:45
@WeNurses #wenurses I will keep on teaching this and encourage delegates to take back to practice or recheck their policy to check itsays to
@AnnMarieRiley10
17 November 2015 20:45
@vipvctraining @PDN_Kat @SarahChapman30 agree, all care workers should know signs that should be reported #wenurses
@jstjohnmatthews
17 November 2015 20:45
.@WeNurses for me it is about ensuring good communication with colleagues on the ward and only changing if absolutely necessary #WeNurses
@SarahChapman30
17 November 2015 20:45
@CraigBradleyF1 @WeNurses Most of the evidence in the review is high quality & more trials very unlikely to change it #wenurses
@WeNurses
17 November 2015 20:45
What are others peoples thoughts ? is there enough evidence here to change practice ? #WeNurses https://t.co/V1H9qzJ9vp
@Claire_AVATAR
17 November 2015 20:45
most #PVCs fail before 72 hours anyway, if they make it to 72 hours let's not ruin it!! #wenurses
@TeamClaytonULHT
17 November 2015 20:46
@EyesNurse @WeNurses I've often wondered about that too... #wenurses
@CraigBradleyF1
17 November 2015 20:46
@JoanXwebster @Claire_AVATAR Whoop! Patient power! No routine replacement thank you very much! #wenurses
@WeNurses
17 November 2015 20:46
RT @vipvctraining: @WeNurses #wenurses I will keep on teaching this and encourage delegates to take back to practice or recheck their polic…
@TeamClaytonULHT
17 November 2015 20:46
RT @Claire_AVATAR: most #PVCs fail before 72 hours anyway, if they make it to 72 hours let's not ruin it!! #wenurses
@AgencyNurse
17 November 2015 20:46
RT @WeNurses: Do you feel that this is something that you could bring to your practice area? If so how ? #WeNurses https://t.co/zoXIVgW…
@SarahChapman30
17 November 2015 20:46
RT @Claire_AVATAR: most #PVCs fail before 72 hours anyway, if they make it to 72 hours let's not ruin it!! #wenurses
@loveebhc
17 November 2015 20:46
Patients & caters are powerful advocates in achieving #EBP implementation. #WeNurses https://t.co/rPkXILmTMn
@Claire_AVATAR
17 November 2015 20:47
Do you know that 24 hourly resite was changed to 48 hour in the 80s based on expert opinion only #nodata #backintheday #wenurses
@AnnMarieRiley10
17 November 2015 20:47
@CraigBradleyF1 @WeNurses couldn't this be raised at regional IPC meetings for wider discussion? #wenurses
@WeNurses
17 November 2015 20:47
RT @cathywev: @WeNurses does anyone have phlebotomists that cannulate? #WeNurses
@AgencyNurse
17 November 2015 20:47
Don't we have a professional obligation to practice using best available evidence ? isnt this a prime example ? #nmccode #wenurses
@Claire_AVATAR
17 November 2015 20:47
RT @WeNurses: What are others peoples thoughts ? is there enough evidence here to change practice ? #WeNurses https://t.co/V1H9qzJ9vp
@WeNurses
17 November 2015 20:48
RT @loveebhc: Patients & caters are powerful advocates in achieving #EBP implementation. #WeNurses https://t.co/rPkXILmTMn
@SarahChapman30
17 November 2015 20:48
Doing unnecessary things to patients, that are unpleasant if not potentially harmful, isn't generally justifiable is it?! #wenurses
@AgencyNurse
17 November 2015 20:48
RT @WeNurses: What are others peoples thoughts ? is there enough evidence here to change practice ? #WeNurses https://t.co/V1H9qzJ9vp
@puncloulou19
17 November 2015 20:48
@silv24 @WeNurses totally agree, especially for children, close monitoring and checking is a much better way of dealing with them #wenurses
@vipvctraining
17 November 2015 20:48
@AgencyNurse #wenurses yes
@SarahChapman30
17 November 2015 20:49
#WeNurses - another view https://t.co/zMOwt5dwrw
@AgencyNurse
17 November 2015 20:49
RT @SarahChapman30: #WeNurses - another view https://t.co/zMOwt5dwrw
@WeNurses
17 November 2015 20:49
RT @SarahChapman30: #WeNurses - another view https://t.co/zMOwt5dwrw
@CraigBradleyF1
17 November 2015 20:49
@SarahChapman30 @AgencyNurse @WeNurses In that case leaves little room for argument, let's get on it! #wenurses
@SarahChapman30
17 November 2015 20:50
@AgencyNurse I would say yes! Best practice should be evidence-based and in this instance we have good evidence! #EBP #wenurses
@SarahChapman30
17 November 2015 20:50
RT @CraigBradleyF1: @SarahChapman30 @AgencyNurse @WeNurses In that case leaves little room for argument, let's get on it! #wenurses
@jstjohnmatthews
17 November 2015 20:50
.@sarahchapman30. TY for g8 chat. Will share the chat summary with future #radiographer @SCoRMembers cannulation course delegates #wenurses
@PUNC14EmilyM
17 November 2015 20:50
@PDN_Kat @SarahChapman30 Most certainly,I think all health professions have a duty and responsibility to raise concerns #wenurses
@WeNurses
17 November 2015 20:50
#wenurses https://t.co/nh8FuS9E7f
@susanerobertson
17 November 2015 20:50
And not challenging current practice and using critical decision making can let us down as a profession. #wenurses
@kirstyadams7
17 November 2015 20:50
@jstjohnmatthews @WeNurses clear communication and precise documentation is definatlely required #WeNurses
@WeNurses
17 November 2015 20:50
Will you personally change your practice in light of this evidence? #WeNurses
@leemiller77
17 November 2015 20:50
@AgencyNurse exactly! #EBP is drummed into us during training, surely it must be followed through with evidence present?? #WeNurses
@SarahChapman30
17 November 2015 20:51
RT @WeNurses: Will you personally change your practice in light of this evidence? #WeNurses
@jstjohnmatthews
17 November 2015 20:51
RT @kirstyadams7: @jstjohnmatthews @WeNurses clear communication and precise documentation is definatlely required #WeNurses
@WilliamNixonltd
17 November 2015 20:51
RT @cathywev: @WeNurses does anyone have phlebotomists that cannulate? #WeNurses
@WeNurses
17 November 2015 20:51
#WeNurses https://t.co/xxTfZBu2wT
@WeNurses
17 November 2015 20:51
Thats really good to hear - heres the link to the Cochrane blog > https://t.co/K3YUjN52WQ #WeNurses https://t.co/xxTfZBu2wT
@SarahChapman30
17 November 2015 20:51
Do you have scope to decide if you will change routinely or only when indicated or are you bound by Trust policy? #wenurses
@SarahChapman30
17 November 2015 20:52
RT @WeNurses: Thats really good to hear - heres the link to the Cochrane blog > https://t.co/K3YUjN52WQ #WeNurses https://t.co/xxTfZBu2wT
@AgencyNurse
17 November 2015 20:52
my thoughts too #wenurses https://t.co/ZcbLrO8XpC
@TeamClaytonULHT
17 November 2015 20:52
@WeNurses some of us may want to but are bound by policies/procedures & need to go through proper channels first #WeNurses
@WeNurses
17 November 2015 20:52
@DarrenStokes35 @AgencyNurse do us know the response Darren :) you can decide to share the source of your knowledge or not :) #wenurses
@Claire_AVATAR
17 November 2015 20:52
CDC changed recommendation from 48hr to 72-96hr in 90s based on cohort studies with 2500 people. Many more pts in RCTs of clin ind #wenurses
@PDN_Kat
17 November 2015 20:52
@betabetic @SarahChapman30 @JoanXwebster All the more reason it's important that nurses are able to cannulate! #WeNurses
@SarahChapman30
17 November 2015 20:52
More on vascular access coming next week on Evidently Cochrane - evidence on CVCs this time #EENursing #wenurses
@jstjohnmatthews
17 November 2015 20:52
.@kirstyadams7 @WeNurses I was only meant to be lurking tonight- will now need to do a CPD reflection on all this information ;-) #wenurses
@susanmcgavock
17 November 2015 20:52
#WeNurses evidence tends to show they don't last more than 72 hours but regular checks and protection can prevent unnecessary changes
@PUNC14EmilyM
17 November 2015 20:52
@jstjohnmatthews @PDN_Kat Questioning fellow health colleges of your concerns over a patient ensures best practise #wenurses
@AgencyNurse
17 November 2015 20:52
a really important point too #wenurses https://t.co/vlZUCvkO3Q
@AnnMarieRiley10
17 November 2015 20:53
@SarahChapman30 staff will be bound by trust policy -key is to challenge policy #wenurses
@WeNurses
17 November 2015 20:53
#wenurses https://t.co/21uhoattYj
@AgencyNurse
17 November 2015 20:53
RT @susanmcgavock: #WeNurses evidence tends to show they don't last more than 72 hours but regular checks and protection can prevent unnece…
@WeNurses
17 November 2015 20:53
RT @susanmcgavock: #WeNurses evidence tends to show they don't last more than 72 hours but regular checks and protection can prevent unnece…
@SarahChapman30
17 November 2015 20:53
RT @susanmcgavock: #WeNurses evidence tends to show they don't last more than 72 hours but regular checks and protection can prevent unnece…
@EyesNurse
17 November 2015 20:53
@cathywev @WeNurses #WeNurses we have clinical support workers. They take bloods and blood cultures as well as cannulate.
@CraigBradleyF1
17 November 2015 20:53
Key to #PVC insertion & care is training, education and good audit cycle. So #infectioncontrol and #IVTeams can play a part #WeNurses
@loveebhc
17 November 2015 20:53
Trust policy should be evidence-based where available Epic3 #WeNurses https://t.co/NPxXEeTRTV
@JoanXwebster
17 November 2015 20:53
#wenurses Pretty simple really, if the site is red, swollen etc, take the device out. This may be after 10 hours or ten days ...
@SarahChapman30
17 November 2015 20:53
RT @JoanXwebster: #wenurses Pretty simple really, if the site is red, swollen etc, take the device out. This may be after 10 hours or ten d…
@susanmcgavock
17 November 2015 20:54
@susanerobertson #WeNurses totally agree all checks better when brain is engaged
@CochraneUK
17 November 2015 20:54
RT @SarahChapman30: More on vascular access coming next week on Evidently Cochrane - evidence on CVCs this time #EENursing #wenurses
@vipvctraining
17 November 2015 20:54
@SarahChapman30 #wenurses I think if you can support removing when clinically indicated which you can withEBP this supports the Bolam test
@WeNurses
17 November 2015 20:54
Only 7 mins left - what are your final thoughts re routine replacement of PVCs ? #WeNurses https://t.co/IXKpSNZxBl
@WeNurses
17 November 2015 20:54
Trying out twitter's new poll tweets! Give it a go here #wenurses https://t.co/iZ82jUhhKK
@Claire_AVATAR
17 November 2015 20:54
RT @JoanXwebster: #wenurses Pretty simple really, if the site is red, swollen etc, take the device out. This may be after 10 hours or ten d…
@CraigBradleyF1
17 November 2015 20:55
@SarahChapman30 #EBP must inform Trust policy - so time for a review of it, conversations start tomorrow! #wenurses
@SarahChapman30
17 November 2015 20:55
RT @WeNurses: Trying out twitter's new poll tweets! Give it a go here #wenurses https://t.co/iZ82jUhhKK
@SarahChapman30
17 November 2015 20:55
RT @WeNurses: Only 7 mins left - what are your final thoughts re routine replacement of PVCs ? #WeNurses https://t.co/IXKpSNZxBl
@NattrassSusan
17 November 2015 20:55
#WeNurses how often is this policy revised and by whom?
@a_ullman
17 November 2015 20:55
RT @JoanXwebster: #wenurses Pretty simple really, if the site is red, swollen etc, take the device out. This may be after 10 hours or ten d…
@cathywev
17 November 2015 20:55
RT @EyesNurse: @cathywev @WeNurses #WeNurses we have clinical support workers. They take bloods and blood cultures as well as cannulate.
@Claire_AVATAR
17 November 2015 20:55
shouldn't trust policy be epic3 guidelines ? #wenurses https://t.co/OGOyxfcy6D
@SarahChapman30
17 November 2015 20:55
#WeNurses https://t.co/M8zzXBZQQG
@TeamClaytonULHT
17 November 2015 20:55
@WeNurses Evidence must be disseminated to IPC teams & policy revisited #wenurses
@susanerobertson
17 November 2015 20:55
@JoanXwebster This! Sad that trust policy/'this is what we do' etc takes away some health professionals own decision making #wenurses
@SarahChapman30
17 November 2015 20:56
RT @AnnMarieRiley10: @SarahChapman30 staff will be bound by trust policy -key is to challenge policy #wenurses
@AgencyNurse
17 November 2015 20:56
RT @WeNurses: Trying out twitter's new poll tweets! Give it a go here #wenurses https://t.co/iZ82jUhhKK
@WeNurses
17 November 2015 20:56
RT @SarahChapman30: #WeNurses https://t.co/M8zzXBZQQG
@SarahChapman30
17 November 2015 20:56
RT @PDN_Kat: @betabetic @SarahChapman30 @JoanXwebster All the more reason it's important that nurses are able to cannulate! #WeNurses
@josemaenfermero
17 November 2015 20:56
RT @UKCochraneCentr: MT @WeNurses: If you are sharing evidence during tonights #WeNurses dont forget to add #EBP to your tweets too https:/…
@AgencyNurse
17 November 2015 20:56
RT @TeamClaytonULHT: @WeNurses Evidence must be disseminated to IPC teams & policy revisited #wenurses
@WeNurses
17 November 2015 20:56
RT @TeamClaytonULHT: @WeNurses Evidence must be disseminated to IPC teams & policy revisited #wenurses
@vipvctraining
17 November 2015 20:56
@WeNurses #wenurses let's stop it now
@PUNC14EmilyM
17 November 2015 20:56
@JoanXwebster @SarahChapman30 To ensure an equal decision from health profession and patient,patient must be involve in their care #wenurses
@AgencyNurse
17 November 2015 20:56
RT @AnnMarieRiley10: @SarahChapman30 staff will be bound by trust policy -key is to challenge policy #wenurses
@WeNurses
17 November 2015 20:56
RT @AnnMarieRiley10: @SarahChapman30 staff will be bound by trust policy -key is to challenge policy #wenurses
@WeNurses
17 November 2015 20:56
RT @vipvctraining: @WeNurses #wenurses let's stop it now
@Claire_AVATAR
17 November 2015 20:56
print off epic3 guidelines and take into your trust to help argue case #wenurses
@WeNurses
17 November 2015 20:57
#wenurses > https://t.co/spslcM1bp3
@SarahChapman30
17 November 2015 20:57
RT @Claire_AVATAR: print off epic3 guidelines and take into your trust to help argue case #wenurses
@Ebevidencia
17 November 2015 20:57
RT @UKCochraneCentr: MT @WeNurses: If you are sharing evidence during tonights #WeNurses dont forget to add #EBP to your tweets too https:/…
@leemiller77
17 November 2015 20:57
@WeNurses evidence appears clear, but how long will it take for policy to follow? #EBP #WeNurses
@SantanaYeray
17 November 2015 20:57
RT @UKCochraneCentr: MT @WeNurses: If you are sharing evidence during tonights #WeNurses dont forget to add #EBP to your tweets too https:/…
@WeNurses
17 November 2015 20:57
RT @leemiller77: @WeNurses evidence appears clear, but how long will it take for policy to follow? #EBP #WeNurses
@Claire_AVATAR
17 November 2015 20:57
If you want to take something away, you have to give something in return. Implement a new #PVC removal daily checklist #wenurses
@susanmcgavock
17 November 2015 20:57
@NHSCampaigner1 @WeNurses #WeNurses practice varies but infection control is so important
@AgencyNurse
17 November 2015 20:57
Surely less time if clinicians challenge policy ? #wenurses https://t.co/67fIsZZ4qj
@WeNurses
17 November 2015 20:58
RT @AgencyNurse: Surely less time if clinicians challenge policy ? #wenurses https://t.co/67fIsZZ4qj
@JoanXwebster
17 November 2015 20:58
@NattrassSusan #WeNurses Interesting question. Policy developers in hospitals often don't understand the evidence. Check their references!!
@bjgw
17 November 2015 20:58
@WeNurses #WeNurses Barney is knocking very loudly at the windows and doors
@WeNurses
17 November 2015 20:58
RT @JoanXwebster: @NattrassSusan #WeNurses Interesting question. Policy developers in hospitals often don't understand the evidence. Check …
@SarahChapman30
17 November 2015 20:58
RT @JoanXwebster: @NattrassSusan #WeNurses Interesting question. Policy developers in hospitals often don't understand the evidence. Check …
@WeNurses
17 November 2015 20:58
RT @bjgw: @WeNurses #WeNurses Barney is knocking very loudly at the windows and doors
@JemmaOwen1
17 November 2015 20:58
RT @AgencyNurse: love this point - build on the evidence with patient feedback #WeNurses https://t.co/vjurkP2oA5
@kaye_rolls
17 November 2015 20:58
indeed 2 many layers of 'authority' @Claire_AVATAR this is the agility & professional social network problem #wenurses
@NattrassSusan
17 November 2015 20:59
RT @JoanXwebster: @NattrassSusan #WeNurses Interesting question. Policy developers in hospitals often don't understand the evidence. Check …
@susanerobertson
17 November 2015 20:59
If policy doesn't follow best evidence then identify gatekeepers to change if unsure. Be the patients advocate always #wenurses
@PUNC14EmilyM
17 November 2015 20:59
@susanmcgavock @WeNurses Thus reducing the risk of infection and further complications for the patient #wenurses
@Claire_AVATAR
17 November 2015 20:59
we see policy change blocked by infectious diseases dept. Make them personally do all the routine replacements?? #wenurses
@SarahChapman30
17 November 2015 20:59
Brilliant chat everyone. I will write a follow-up blog for Evidently Cochrane #EENursing #wenurses
@NRCUK
17 November 2015 20:59
how often is policy driven by best quality care? Are other factors important to them? #wenurses
@AgencyNurse
17 November 2015 20:59
Maybe a different discussion - but how empowered / supported do clinicians feel to be able to challenge policy ? #wenurses
@SarahChapman30
17 November 2015 20:59
RT @AgencyNurse: Maybe a different discussion - but how empowered / supported do clinicians feel to be able to challenge policy ? #wenurses




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