Its been a little over a year since we published MAGIC in Annals of Internal Medicine. Today, at the Annual Association for Vascular Access Annual Scientific Meeting, I shared just why and exactly how we developed this tool. I also provided some early insights into how it has started to influence practice. The journey, thus far has been amazing. Here are but a few highlights:
1. Many recommendations from MAGIC were widely incorporated in the latest Infusion Nursing Standards of Practice 2016;
2. MAGIC recommendations are being actively implemented in an ongoing project aimed at preventing CLABSI in over 500 US Hospitals;
3. Working with the AVATAR Group, discussion on creating MAGIC-Australia have begun. In this project, MAGIC recommendations will be adapted to the Australian context with respect to devices, operators, and practice standards;
4. In partnership with the Michigan Hospital Medicine Safety Consortium, we have started to move towards interventions that use MAGIC to improve PICC use and outcomes across 51 Michigan hospitals.
5. A recent market report from iData finds that use of midlines has increased in recent years - and credits MAGIC and the new INS Standards as being key forces in this change within the device market.
From a professional perspective, I cannot be happier. A tool is only as good as its user and I am delighted that MAGIC met with a warm reception today at AVA. I hope my talk today has inspired more people to take a closer look at MAGIC as a way to measure, evaluate and improve their performance. It has been heartwarming to see smaller hospitals with scarce resources turn to MAGIC to tackle CLABSI and VTE. I visited just one such hospital in Michigan that is making fantastic strides in midline and US peripheral IV catheter use in using MAGIC. It's inspiring to see the hard work of vascular access professionals in this way. I said it today and I will say it again: You are the secret....
This being said, I am wary of the future. Why? Because much more work needs to be done. Many changes need to be made. And these changes will not be easy.
If there is one thing that MAGIC makes perfectly clear, it's that choosing a vascular access device is not and should not be a reflexive process. We shouldn't knee-jerk to a PICC from a peripheral IV when faced with a patient with difficult IV access. Similarly, we shouldn't stick people two or three times blindly before we pull out the ultrasound machine to have a look. And yet, I know full well that this type of practice continues today...
There is a science to choosing devices that is based not just on indication on use and nature of infusion, but also on patient-, provider- and device-characteristics. Throughout our research - we have shown that these factors have to be carefully considered when selecting a vascular access device as they are most often associated with complications. And yet, I remain surprised at the overall lack of awareness of these issues - especially among my medical colleagues who order these devices. In fact, many aren't just blissfully unaware of catheters, they are also unaware of the risk of complications associated with these devices as we've shown here, here and here...
Why might this be the case? There are myriad reasons: lack of knowledge, awareness, ownership. But I want to discuss one more subtle one from our lexicon: use of the term "PICC nurse."
Think about it: what goes through your head when you hear PICC nurse? Do you think of a person empowered to help you make the right choice for what vascular device is best for a patient? Or do you think of someone who can place one device, and one device only? In fact, is it a verb or a noun?
In his best-selling book Blink, Malcolm Gladwell talks about how impressions and decisions about people and objects are made within milliseconds in our brains. He calls this the "unconscious adaptive," and the process - thin slicing. In my work and conversations with hundreds of providers to date, I am convinced that thin-slicing is a fundamental, dark part of the problem when it comes to vascular access. We are anchored to old ways of thinking about vascular teams and their roles.
We must move away from this euphemistic and naive approach and emphasize three linked components:
1. Vascular access professionals are consultants, not a procedure delivery service;
2. To attain #1, respect for the art and science of vascular access (and those that practice it) must rise;
3. In order to attain #2, vascular access specialists must work to define their value and role within the healthcare enterprise.
I heard someone at AVA say that, "we as a specialty should not be defined by the devices we place." And yet, vascular access specialists remain trapped in exactly this silo.
It is time for us to be the change we want to see.
No longer should the term PICC nurse or PICC team be used to characterize those involved in the placement of IV devices. Rather, vascular access consultant should be the new norm. Each of us in partnership with leading organizations such as AVA must take this charge so as to legitimize the specialty that we all know and love. MAGIC is one way to bring forward this legitimization -- a tool that harnesses evidence-based recommendations to inform and change practice. A tool that can measure, evaluate and benchmark your performance in ways that none other can.
So what's in a name? A lot. And I hope it changes with MAGIC.
If you were at the presentation and have thoughts about MAGIC, I would love to hear from you. Leave a comment below!