My hospital system has recently merged with several smaller hospitals in the area that do not currently have vascular access or PICC teams. We are looking to implement PICC training at these sites. We currently require 20 successful PICC placements for competency, but we are hearing numbers from other facilities as low as 3. Does anyone go by a set number of successful sticks? If not, what do you base your competency on?
There are no specific numbers of procedures that will ensure competency for any procedure. See definition of competency in INS STOP GLossary. Each person will be different. The process begins with obtaining knowledge through an educaton course, in a regualr classroom or online. The next step is delibrate practice in a simulation setting until the learner is confident in their knowledge of the steps. The final step is supervised insertion into real patients until the procedure has been completely mastered. You will need a tool to document competency such as a detailed checklist or a global rating scale. One person may accomplish this process with 10 or so procedures, while others may require supervision in 25 or more. The goal is not completion of a specific number of procedures. The goal is being able to successfully perform the procedure independently and documenting that will require a different number for each person.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I agree Lynn, PICC insertion is not a specific number per individual as every one is different and grasps certain ideas, instructions, skill, hand eye coordination, and technology application depending on the systems used. The vascular access portion of PICC insertions is pretty straight forward as well as the procedure. The sterile field, field prep, and overall process (patient and family education, time out, consent, follow up, discharge instructions) we have found to be more intensive than the procedure itself. The INS standards outline a good work flow followed by institutional policy/protocol. I have trained several RN in placing PICC lines and some have taken anywhere from 3 to 20. Practice on a model, practicing the sterile field, and outline workflows are essential. We also bring in out product reps after training to assist in identifying small things regarding the equipment and the products used. We have policies/procedures/protocols/competencies in placed highly referrencing INS standards.
Andrew Walker RN, BSN, VA-BC, CRNI
[email protected]
I am giving a presentaiton at AVA on this very topic of skill acquisition and the process for it. Hope you will be in Columbus in a few weeks.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861