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Cindy Harrison
Hours per day PICC team available for placement

We have a physician upset that our PICC team only operates Monday through Friday  8am-4:30pm. We only have Radiology back up until 4:00 pm at our facility. We are curious to know the hours of operation at other facilities please. 

 

fizerjk
7a-7p seven days a week.
7a-7p seven days a week.

Jeffery Fizer RN, BSN

Anita La Roche
 Routine or non-urgent

 Routine or non-urgent PICCs placed m-f  10a - 3pm last case.  Radiology support until 5pm by 1 PICC nurse. No IR PICC services by radiologists are available.  Urgent/ICU patients 24 /7 PICC services. using  RN overtime or premium pay contracted agency after hours and weekends.  AVG 3-400 PICC's per month.

 

Anita La Roche, R.N.

Anita La Roche
 Please note 

 Please note  typo-correction.  we place approximately 90 to100 PICCs per month

Anita La Roche, R.N.

Anita La Roche, R.N.

Gina Ward
Gina Ward R.N., C.P.A.N We

Gina Ward R.N., C.P.A.N

We have this come up regularly at our small (110 bed hospital). 

 Basically, I have told the staff PICC lines are not lifesaving/emergent procedures.  If you have no access andmust get access how did you do it before I started doing picc lines?  You had a Dr put in a central line.  There has been a rare ocassion where even a Dr couldnt put in a central line and I have come back in to do a PICC. 

 The staff however, is aware of our hours M-F 7;30-4:00 pm and knows to plan accordingly.  Most of these last minute, must do piccs have been patients for days and they are just now reacting to the access issue.  Quite a few times these last minute piccs are ones where I can put in a peripheral and the patient goes home in the next day or two.   

I am a one man picc team and am very flexible with my hours.  It does seem if I try to come in and get started at 7 am I still cant get out of here on time.  So, I will come in later so the afternoon volume will be covered better and end of staying till 8 pm.  It just seems like if you are here, they see you and will always find work for you.  Some days I am here 8 hours , many days 10 hours.  I do all picc insertions, dressing changes, cap changes, and trouble shooting ports and difficult peripherals, in my "spare time". I do about 50 picc lines a month.

Regarding radiology;  in the past we had the same issue and then the ER docs had to look at my films wich they hated, and I had to wait alot.  Now we have a service we can fax stat films for tube placement and line confirmations and they fax results within in minutes .  It is great. 

I know I didnt solve your problems , but confirmed that it is an issue across the board.  I think if we looked at numbers and volume we would find the main volume is in our regular working hours and that rare case where they wanted us here  isnt enough reason to require someone on call when there are other options available. 

Gina Ward R.N., CPAN

Gina Ward R.N., VA-BC

lynncrni
I can understand your

I can understand your situation of being one person in a small hospital, but I would have a very strong caution about letting other alternatives fill your void. This is just a basic business principle - the person that is most available to provide the service is the one who gets the work. If you only look at this situation from your personal perspective, then you can easily come up with your conclusions. But I would also urge you to step back and take a look at this from a patient's perspective and also a financial perspective of your organization. The patient is not being adequately cared for when those last minute situations arise. That means you are currently missing business opportunities while patient needs are going unmet. This means that additional dollars are being lost by your organization because it is costing a lot more to do those repeated peripheral sticks. I know that it is hard to remember that your job was to drain the swamp when you are up to your a----- in alligators.  But allowing alternative methods to replace your services is not a wise business move. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

Gina Ward
Lynn,  You bring up very

Lynn, 

You bring up very good points  "Thank You".  My number one concern is for the patient and the appropriate treatment for them.  ( however, upon examination my decision making regarding picc alternatives might not reflect it too well hu??)Maybe that is why I stay late so many times.  I definitely see what you are saying about availability and the patient suffering the consequences of not being available.

Strictly on a business aspect; I do not mean this to be argumentative in anway and maybe you can clarify something for me.  But, my understanding is that this PICC service I provide basically costs the hospital more that it makes in regards to inpatients.  They were even considering not allowing me to offer this service because of this.  Most of our population here in Okeechobee Florida is Medicare /Medicaid  or no insurance so this service is either not being paid for or included in the DRG.  When and if I came back on call back they are paying me overtime and administration is watching my hours closely and not happy about my late days much less coming in on overtime.  They even gave me a hard time about coming in on weekends to do the 24 hour dressing changes on my Friday picc insertions.    I do realize, a lack of access can cost delays in treatment and extended stays because of this.  I also realize that you can add cost of nursing staff attemting multiple lines; supplies used, but they are already on the clock and not getting overtime.  Like I said , I certainly am not making this argument, this is what I hear from administration.   Many times also, when I come back to work on Monday and have several weekend consults in my box I find the patient has been discharged, expired or doesnt need a picc anymore.  This is where I say they sometimes just  call for a picc line a little to quick.  I certainly do a pre assessment of all patients and see if the PICC line is the access that is appropriate  for them.

Considering the times that this has occured ;  the need for after hours or weekend picc lines,  ( or maybe I just dont hear about it much, an ocassional comment from my pulmonologists) I guess our facility isn't at that point yet.  I am sure we will and then I will hear alot more discussion of the subject.

Once again thank you for your input.  I always look forward to your expert advice  and respect it .

Sincerely, Gina Ward R.N, CPAN 

   

Gina Ward R.N., VA-BC

lynncrni
I just ran some numbers for

I just ran some numbers for a presentation at the Nursing Symposium in May. A DRG of a respiratory infection is currently around $4200 and the average LOS is around 5 days. Published reports indicate that 2.18 attempts are needed to start a PIV in adults, 2.35 in peds. Using the average of $40 operational cost for PIV X 2.18 = $87 to obtain 1 PIV. If your patient has to be restarted daily over 5 days, that would equal about 10% of the DRG. A midline and PICC cost would consume a much lower amount of the DRG. So don't let anyone convince you that your service is costing money to the hospital - far to the contrary. By using a PICC appropriately early in the course of therapy, you are containing cost by using far less of the DRG. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

Sharon Davis
Sharon Davis Smith,  Rn

Sharon Davis Smith,  Rn CRNI     BarnesJewish Hospital

Since the inception of our team we had been 24h/7 days a week, including w/e and holidays. About  18 months ago, due to budget cuts, our night shift was deleted. During that time we still worked 24/7, but 7am-9pm. Now they are trying to get our night shift back together.  Well the staff who previously worked that shift do not want to go back (can't say I blame them). 

Sharon Davis Smith,

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