Loading…

A Quality Improvement Project to Reduce Unnecessary Use of Multilumen PICCs

Background: Peripherally inserted central catheters (PICCs) are an increasingly common vascular access device. At our institution, >4,000 devices are placed per year by a trained team of vascular access nurses. Although PICCs are generally safe and effective, they do carry the risk of infection a...

Full description

Saved in:
Bibliographic Details
Published in:Infection control and hospital epidemiology 2020-10, Vol.41 (S1), p.s101-s102
Main Authors: Kleinman-Sween, Jennifer, Lowrie, Angela, Kirmse, Jane, Sampathkumar, Priya
Format: Article
Language:English
Subjects:
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites
container_end_page s102
container_issue S1
container_start_page s101
container_title Infection control and hospital epidemiology
container_volume 41
creator Kleinman-Sween, Jennifer
Lowrie, Angela
Kirmse, Jane
Sampathkumar, Priya
description Background: Peripherally inserted central catheters (PICCs) are an increasingly common vascular access device. At our institution, >4,000 devices are placed per year by a trained team of vascular access nurses. Although PICCs are generally safe and effective, they do carry the risk of infection and thrombosis, and this risk increases exponentially with increasing number of lumens. As part of a multidisciplinary quality improvement effort to address rising CLABSI rates, we designed interventions to improve PICC utilization. Methods: The project team used 6-σ methodology, specifically following the DMAIC (define, measure, analyze, implement, control) framework to guide analysis and interventions. Process mapping, semistructured interviews with key stakeholders, electronic surveys, and audits were performed to identify gaps and inform interventions. The interventions consisted of 3 components: changes to the electronic ordering system, education (presentations to ordering providers and an online toolkit), and clinical decision support in the form of a team of vascular-access subject-matter experts who provided guidance on line selection. Results: In total, 4,655 PICCs and 434 midlines were inserted in the 12 months before the intervention, and 7,457 PICCs and 929 midlines were placed in the 24 months after the intervention. Following the implementation of the intervention, proportions of triple-lumen catheter utilization decreased from 31.9% to 22.3% ( P < .0001). Concurrently, the proportion of single-lumen catheters has increased from 28.5% to 41.9% ( P < .0001). Overall PICC utilization decreased in the postintervention period from an average of 387.9 PICCs placed per month to 310.7. The proportion of midline catheters increased from 8.5% of total lines inserted to 11.4% in the postintervention period ( P < .001). Conclusions: Our intervention reduced overall PICC use and triple-lumen PICC use and increased relative utilization of single-lumen PICCs and midline catheters. Optimization of electronic orders, in conjunction with targeted education and decision support, can have a sustained impact on provider ordering behaviors and can shift the culture of utilization, even in a large academic medical center with frequent turnover of trainees. Funding: None Disclosures: Consulting fee- Merck (Priya Sampathkumar)
doi_str_mv 10.1017/ice.2020.603
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2898343871</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2898343871</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1033-977647247256a1ccf9fea1f1af9bfcfb3e5bf41ae165fbd271f4f1c313d1a3963</originalsourceid><addsrcrecordid>eNotkE9Lw0AQxRdRsFZvfoAFr6buZJNs9liCf4oVq1jwtmy2M5CSJnU3Efrt3VJh4F3ezLz3Y-wWxAwEqIfG4SwVqZgVQp6xCeS5TopSZudsIkqtkzKV35fsKoStEEJpDRP2Oucfo22b4cAXu73vf3GH3cBXvt-iG_jQ80_cjA75uuvQYQjWH_g6IO-Jv43t0LRjXOCrRVWFa3ZBtg14869Ttn56_KpekuX786KaLxMHQspEK1VkKo2TFxacI01ogcCSrslRLTGvKQOLUORUb1IFlBE4CXIDVupCTtnd6W7M-zNiGMy2H30XX5q01LGvLBVE1_3J5Xwfgkcye9_sYnwDwhxxmYjLHHGZiEv-AQM8XTM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2898343871</pqid></control><display><type>article</type><title>A Quality Improvement Project to Reduce Unnecessary Use of Multilumen PICCs</title><source>Cambridge Journals Online</source><creator>Kleinman-Sween, Jennifer ; Lowrie, Angela ; Kirmse, Jane ; Sampathkumar, Priya</creator><creatorcontrib>Kleinman-Sween, Jennifer ; Lowrie, Angela ; Kirmse, Jane ; Sampathkumar, Priya</creatorcontrib><description>Background: Peripherally inserted central catheters (PICCs) are an increasingly common vascular access device. At our institution, &gt;4,000 devices are placed per year by a trained team of vascular access nurses. Although PICCs are generally safe and effective, they do carry the risk of infection and thrombosis, and this risk increases exponentially with increasing number of lumens. As part of a multidisciplinary quality improvement effort to address rising CLABSI rates, we designed interventions to improve PICC utilization. Methods: The project team used 6-σ methodology, specifically following the DMAIC (define, measure, analyze, implement, control) framework to guide analysis and interventions. Process mapping, semistructured interviews with key stakeholders, electronic surveys, and audits were performed to identify gaps and inform interventions. The interventions consisted of 3 components: changes to the electronic ordering system, education (presentations to ordering providers and an online toolkit), and clinical decision support in the form of a team of vascular-access subject-matter experts who provided guidance on line selection. Results: In total, 4,655 PICCs and 434 midlines were inserted in the 12 months before the intervention, and 7,457 PICCs and 929 midlines were placed in the 24 months after the intervention. Following the implementation of the intervention, proportions of triple-lumen catheter utilization decreased from 31.9% to 22.3% ( P &lt; .0001). Concurrently, the proportion of single-lumen catheters has increased from 28.5% to 41.9% ( P &lt; .0001). Overall PICC utilization decreased in the postintervention period from an average of 387.9 PICCs placed per month to 310.7. The proportion of midline catheters increased from 8.5% of total lines inserted to 11.4% in the postintervention period ( P &lt; .001). Conclusions: Our intervention reduced overall PICC use and triple-lumen PICC use and increased relative utilization of single-lumen PICCs and midline catheters. Optimization of electronic orders, in conjunction with targeted education and decision support, can have a sustained impact on provider ordering behaviors and can shift the culture of utilization, even in a large academic medical center with frequent turnover of trainees. Funding: None Disclosures: Consulting fee- Merck (Priya Sampathkumar)</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2020.603</identifier><language>eng</language><publisher>Cambridge: Cambridge University Press</publisher><subject>Catheters ; Disease control ; Education ; Health risks ; Intervention ; Medical instruments ; Quality improvement ; Thromboembolism ; Venous access</subject><ispartof>Infection control and hospital epidemiology, 2020-10, Vol.41 (S1), p.s101-s102</ispartof><rights>2020 by The Society for Healthcare Epidemiology of America. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Kleinman-Sween, Jennifer</creatorcontrib><creatorcontrib>Lowrie, Angela</creatorcontrib><creatorcontrib>Kirmse, Jane</creatorcontrib><creatorcontrib>Sampathkumar, Priya</creatorcontrib><title>A Quality Improvement Project to Reduce Unnecessary Use of Multilumen PICCs</title><title>Infection control and hospital epidemiology</title><description>Background: Peripherally inserted central catheters (PICCs) are an increasingly common vascular access device. At our institution, &gt;4,000 devices are placed per year by a trained team of vascular access nurses. Although PICCs are generally safe and effective, they do carry the risk of infection and thrombosis, and this risk increases exponentially with increasing number of lumens. As part of a multidisciplinary quality improvement effort to address rising CLABSI rates, we designed interventions to improve PICC utilization. Methods: The project team used 6-σ methodology, specifically following the DMAIC (define, measure, analyze, implement, control) framework to guide analysis and interventions. Process mapping, semistructured interviews with key stakeholders, electronic surveys, and audits were performed to identify gaps and inform interventions. The interventions consisted of 3 components: changes to the electronic ordering system, education (presentations to ordering providers and an online toolkit), and clinical decision support in the form of a team of vascular-access subject-matter experts who provided guidance on line selection. Results: In total, 4,655 PICCs and 434 midlines were inserted in the 12 months before the intervention, and 7,457 PICCs and 929 midlines were placed in the 24 months after the intervention. Following the implementation of the intervention, proportions of triple-lumen catheter utilization decreased from 31.9% to 22.3% ( P &lt; .0001). Concurrently, the proportion of single-lumen catheters has increased from 28.5% to 41.9% ( P &lt; .0001). Overall PICC utilization decreased in the postintervention period from an average of 387.9 PICCs placed per month to 310.7. The proportion of midline catheters increased from 8.5% of total lines inserted to 11.4% in the postintervention period ( P &lt; .001). Conclusions: Our intervention reduced overall PICC use and triple-lumen PICC use and increased relative utilization of single-lumen PICCs and midline catheters. Optimization of electronic orders, in conjunction with targeted education and decision support, can have a sustained impact on provider ordering behaviors and can shift the culture of utilization, even in a large academic medical center with frequent turnover of trainees. Funding: None Disclosures: Consulting fee- Merck (Priya Sampathkumar)</description><subject>Catheters</subject><subject>Disease control</subject><subject>Education</subject><subject>Health risks</subject><subject>Intervention</subject><subject>Medical instruments</subject><subject>Quality improvement</subject><subject>Thromboembolism</subject><subject>Venous access</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNotkE9Lw0AQxRdRsFZvfoAFr6buZJNs9liCf4oVq1jwtmy2M5CSJnU3Efrt3VJh4F3ezLz3Y-wWxAwEqIfG4SwVqZgVQp6xCeS5TopSZudsIkqtkzKV35fsKoStEEJpDRP2Oucfo22b4cAXu73vf3GH3cBXvt-iG_jQ80_cjA75uuvQYQjWH_g6IO-Jv43t0LRjXOCrRVWFa3ZBtg14869Ttn56_KpekuX786KaLxMHQspEK1VkKo2TFxacI01ogcCSrslRLTGvKQOLUORUb1IFlBE4CXIDVupCTtnd6W7M-zNiGMy2H30XX5q01LGvLBVE1_3J5Xwfgkcye9_sYnwDwhxxmYjLHHGZiEv-AQM8XTM</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Kleinman-Sween, Jennifer</creator><creator>Lowrie, Angela</creator><creator>Kirmse, Jane</creator><creator>Sampathkumar, Priya</creator><general>Cambridge University Press</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope></search><sort><creationdate>202010</creationdate><title>A Quality Improvement Project to Reduce Unnecessary Use of Multilumen PICCs</title><author>Kleinman-Sween, Jennifer ; Lowrie, Angela ; Kirmse, Jane ; Sampathkumar, Priya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1033-977647247256a1ccf9fea1f1af9bfcfb3e5bf41ae165fbd271f4f1c313d1a3963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Catheters</topic><topic>Disease control</topic><topic>Education</topic><topic>Health risks</topic><topic>Intervention</topic><topic>Medical instruments</topic><topic>Quality improvement</topic><topic>Thromboembolism</topic><topic>Venous access</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kleinman-Sween, Jennifer</creatorcontrib><creatorcontrib>Lowrie, Angela</creatorcontrib><creatorcontrib>Kirmse, Jane</creatorcontrib><creatorcontrib>Sampathkumar, Priya</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SIRS Editorial</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kleinman-Sween, Jennifer</au><au>Lowrie, Angela</au><au>Kirmse, Jane</au><au>Sampathkumar, Priya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Quality Improvement Project to Reduce Unnecessary Use of Multilumen PICCs</atitle><jtitle>Infection control and hospital epidemiology</jtitle><date>2020-10</date><risdate>2020</risdate><volume>41</volume><issue>S1</issue><spage>s101</spage><epage>s102</epage><pages>s101-s102</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>Background: Peripherally inserted central catheters (PICCs) are an increasingly common vascular access device. At our institution, &gt;4,000 devices are placed per year by a trained team of vascular access nurses. Although PICCs are generally safe and effective, they do carry the risk of infection and thrombosis, and this risk increases exponentially with increasing number of lumens. As part of a multidisciplinary quality improvement effort to address rising CLABSI rates, we designed interventions to improve PICC utilization. Methods: The project team used 6-σ methodology, specifically following the DMAIC (define, measure, analyze, implement, control) framework to guide analysis and interventions. Process mapping, semistructured interviews with key stakeholders, electronic surveys, and audits were performed to identify gaps and inform interventions. The interventions consisted of 3 components: changes to the electronic ordering system, education (presentations to ordering providers and an online toolkit), and clinical decision support in the form of a team of vascular-access subject-matter experts who provided guidance on line selection. Results: In total, 4,655 PICCs and 434 midlines were inserted in the 12 months before the intervention, and 7,457 PICCs and 929 midlines were placed in the 24 months after the intervention. Following the implementation of the intervention, proportions of triple-lumen catheter utilization decreased from 31.9% to 22.3% ( P &lt; .0001). Concurrently, the proportion of single-lumen catheters has increased from 28.5% to 41.9% ( P &lt; .0001). Overall PICC utilization decreased in the postintervention period from an average of 387.9 PICCs placed per month to 310.7. The proportion of midline catheters increased from 8.5% of total lines inserted to 11.4% in the postintervention period ( P &lt; .001). Conclusions: Our intervention reduced overall PICC use and triple-lumen PICC use and increased relative utilization of single-lumen PICCs and midline catheters. Optimization of electronic orders, in conjunction with targeted education and decision support, can have a sustained impact on provider ordering behaviors and can shift the culture of utilization, even in a large academic medical center with frequent turnover of trainees. Funding: None Disclosures: Consulting fee- Merck (Priya Sampathkumar)</abstract><cop>Cambridge</cop><pub>Cambridge University Press</pub><doi>10.1017/ice.2020.603</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0899-823X
ispartof Infection control and hospital epidemiology, 2020-10, Vol.41 (S1), p.s101-s102
issn 0899-823X
1559-6834
language eng
recordid cdi_proquest_journals_2898343871
source Cambridge Journals Online
subjects Catheters
Disease control
Education
Health risks
Intervention
Medical instruments
Quality improvement
Thromboembolism
Venous access
title A Quality Improvement Project to Reduce Unnecessary Use of Multilumen PICCs
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T21%3A18%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20Quality%20Improvement%20Project%20to%20Reduce%20Unnecessary%20Use%20of%20Multilumen%20PICCs&rft.jtitle=Infection%20control%20and%20hospital%20epidemiology&rft.au=Kleinman-Sween,%20Jennifer&rft.date=2020-10&rft.volume=41&rft.issue=S1&rft.spage=s101&rft.epage=s102&rft.pages=s101-s102&rft.issn=0899-823X&rft.eissn=1559-6834&rft_id=info:doi/10.1017/ice.2020.603&rft_dat=%3Cproquest_cross%3E2898343871%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c1033-977647247256a1ccf9fea1f1af9bfcfb3e5bf41ae165fbd271f4f1c313d1a3963%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2898343871&rft_id=info:pmid/&rfr_iscdi=true