I have an MD who continually ordres a D/L PICC for an outpatient population requiring antibitocs when a D/L PICC is not necessary. We have had numerous conversations with this physician that the fewer the lumens the better and that treatment can be completed w/ a single lumen PICC. This MD is just not listening and continues to order D/L devices.
My question is this: As the inserter is there any legality to follow the order to place X amount of lumens or can I disregard the request for numerous lumens and place a single lumen if a single lumen will do the job?
As an RN, you have the right and responsibility to NOT follow any order that you know will increase risk of complications for your patients. But before you take this step, you should try other avenues. Gather the evidence showing more lumens equal an increased risk for BSI. Work with your infection prevention staff and risk management. Get them involved in this issue. Do not try to do this alone. You will need evidence and support from others to change this risky practice. Learn what your current CLABSI rates are. How much money is the hospital loosing due to this rate? Work the clinical side and the financial side of this issue. Medical QA/QI will be involved. This should be addressed in your policies and procedures to use the most appropriate number of lumens for the prescribed therapy. Physician colleagues should put pressure on this MD to change his ways. If that does not happen, you have hospital policy to back you up and physician orders do NOT change policy.
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
We have found that the majority of doctors ordering lines don't really have an understanding of the mechanics or differences in PICCs/midlines/multiple lumens vs. single lumens. Not that they necessarily need to. We are the experts, one of our roles is to educate. So a few years ago we decided to have a meeting with out Medical Executive Committee to discuss our role as the Vascular Access Team. The president of the Committe was one of our Infectious Disease docs who we have worked very closely with and actually educated her a few years prior on the use of single vs double lumen piccs for home antibiotics. She really took an interest when she started noticing her patients were developing a higher incidence of picc related thrombus when they had a double lumen picc in . She sort of spearheaded our nurse driven policy that allows the Vascular Access Team decide what catheter is best for the patient. We have it written in our policy " Selection of Vascular Access Devices" that the 'least invasive catheter for the therapy prescribed will be placed.' Once we met with the med exec committee a couple times as well as nursing council and we were able to present them answers to their questions using research studies (primarily we presented the MAGIC study) and our own results as proof, they approved the policy. There was some initial pushback in the beginning, really related to education. We had to track some of these docs down and have personal conversations with them explaining why a central device wasn't needed for 1 week of home Rocephin. Now docs just pretty much consult us and we decide what is the best device for the patient based on a thorough assessment of the medical record, the patient and a conversation if we need it. It wasn't very difficult, kind of liberating actually, to be valued as an expert based on our experience and education, but it was a change in how things were done, so there was an adjustment.
Wonderful! It takes this collaborative and educational approach! Great job. Lynn
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