We are in a healthcare system - my hospital is the major one with three critical access hospitals that we are affiliated with. Two of the three regional critical access hospitals do not place their own PICCs due to low volume. If a patient needs a PICC they are transported to my hospital and it is placed by Interventional Radiology (they do all outpatients). Then the patient is immediately returned to the regional hospital.
Question: if one of these PICCs gets infected/has positive blood cultures from it, is this my hospital's line since it was placed here or is it the critical access hospital's line since they have been caring for it? Should I be counting the catheter days for these lines or should that be done at the regional site?
Wow, great question and one I have not heard before. I am assuming this is motivated by the value based purchasing from CMS and the lack of payment for hospital-acquired conditions. While I do not know the concrete answer to this, my first thought would be your hospital system would own the problem and it would be a hospital-acquired condition for which your hospital system would not be paid. This is based on the CMS information about these VAD infections occuring after admission. If I understand you correctly, the patient is an in-patient at one of the critical access hospitals that is part of your hospital system. The PICC is inserted at the larger hospital within that system then moved back to the critical access hospital. All of this is being done within the same hospital system as an inpatient. So I would think that this would qualify as a hospital-acquired condition and there would be no payment. I guess it would all depend on whether CMS treats these hospital systems as one entity or as separate hospitals. I hope someone knows the answer to this and will post it soon. 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
Thanks, Lynn - you have the correct scenario. As we discussed more, we don't see that this is any different than the other outpatients that have their line placed in IR and then go home or back to a nursing home, for example. We do track those lines and if they become infected, we would count it as a CLABSI for our hospital. So I would agree that we do need to count it here.
Anyone else have any further insight on this?
Wendy Erickson RN
Eau Claire WI
So if the patient is fine for 3-4 weeks then develops an infection you consider that your infection and not the facility caring for it daily?
I would say that a CLABSI more than one week after placement would be related to poor hub disinfection prior to manipulation and or poor central line dressing change technique and would not be related to insertion technique.
Valorie Dunn,BSN, RN, CRNI, PLNC
I think, for surveilance purposes, you can only count patients with lines who are actually in your facility. If a patient comes to you with a line, that line is yours until the patient leaves, regardless of where it was originally placed. If a patient comes to you with a port and it is never accessed during their stay, it is not counted in your line days. If it is accessed, it counts regardless of who placed or last accessed it. You cannot count patients who are not in your facility, because you have no control over that outcome.,
It is very valuable to know the overall outcomes of your patients with lines in order to target education and process improvement. If you lump together all of the line days from 3 different facilities, it would be virtually impossible to identify specific areas where your processes are breaking down and areas where standards are being met. The reason to collect data on line days is to use your surveilance to identify problems and address them with a targeted plan.
Daniel Juckette RN, CCRN, VA-BC
I think this discussion has identified 2 issues. One would be the correct method for doing surveillance for infection control and prevention. The other is adequate documentation for purposes of correct reimbursement based on value based purchasing processes. Maybe Wendy can give us additional information about which is her priority. 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
I just attended a local APIC meeting, NHSN guidelines were that if a patient is discharge with a line and then returns within 48 hours with temp, or suspected infection. Then the hopital gets to take the credit for it, other wise the place caring for does. I agree with the others if its weeks later then its not yours!