I was wondering if any one has any suggestions on how the nurse can obtain information on admissions to long term care with PICCs. The nurse never knows when the catheter was placed, CXR confirmation, length of catheter etc.. the organization is in the process of revising the admission orders and I would like to have some of this information added. Any ideas?
Also, our contracted IV team is now plaicng PICCs at the bedside in the facilities and I want to do monitoring on these sites. I wonder if any one could share some ideas on how to do audit these PICCs.
Ann Zonderman, BSN, JD, CRNI, LHRM
Your discharge planner/ admission coordinator should be getting the PICC insertion information for you. If you know the patient is to be admitted with continuing IV medications / fluids, the next question to ask is - what type of venous access does the patient have. If therapy will continue for more than a few days, a PICC may be indicated if not already in place. Each hospital record should have the report of the x-ray verification for placement in the lower SVC. Try to find the insertion notes, with measurements and brand of the catheter, number of lumens.
Once you have the patient in your facility- you MUST monitor and care for the PICC. You must have qualified staff to do so and policies and procedures. IF you receive your drugs and supplies from an IV pharmacy, ask if the provide policies / procedures and training.
Documentation on your MAR, ( after the admission assessment has noted the location of the PICC, the Brand, The lumes and external measurements ) Flushing according to your policy; dressing changes, site monitoring each shift, all should be documented..... you can audit the MAR and inspect the patient site for appearance to determine what your staff is doing in regard to the PICC.
Be sure to comply with your nurse practice act in what care each level of nursing staff may do for the PICC.
Ann = Infusion Nurse Specialist, Kindred Pharmacy Services/PharMerica ( my disclosure)
Ann Zonderman, BSN, JD, CRNI
Ann is right. The hospital that placed the line has all the information about it, but they are not asked for it! The Admissions planner at the facility has to be educated (as they are often not nurses) as to what requirements are needed for the chart, otherwise, they just accept what the hospital sends. If most referrals are from the same hospital, meet with their d/c planners and let them know you need that information. They also have to be educated, they do not know that the LTC needs this information.
As far as monitoring what your agency places, they should have a nurses note/documentation form that they place in the chart with the details of the placement, ask to have this faxed into the pharmacy to your attention when the line is placed.
As far as ongoing monitoring, you could create a form for the LTC staff to complete to collect data on what type of access, or what ever information you need for each patient, and then do chart reviews and patient monitoring occasionally.
You may find, however, that the DONs of these facilities will have little interest in outcomes, or education for their staff. Their focus is getting the patient out as quickly as possible, and they often do not like to have inservices because that means less nurses on the unit for patient care. Be persistant and do not take it personally! Good luck.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC