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Baker
Pros / Cons of Bedside Placement vs. dedicated area to bring patients to

Please give your input on the benefits and hassles of a dedicated area to place PICC lines for inpatients. We have run into trouble trying to comply with IHI CLB @ the bedside r/t family / visitors coming into the room, bumping into sterile field etc., actually had housekeeping pick up the trash behind me & the sterile field, I heard her lift up the bag & shake the contents..Had to break down the entire sterile field & start over. We have a sign we place on the outside of the door that says "Please do not enter, Sterile procedure in process., it doesn't seem to help much., this is particularly bad when there are 2 patients in the same room.Appreciate input from successful programs both @ Bedside and other., What works , what doesn't! TY

lynncrni
Bedside is best in my

Bedside is best in my opinion because there will always be patients that can not be transferred to another location - those in critical care, on a vent, with traction, etc. My question is why is the sterile field left without someone in the patient's room actually doing the procedure? I can not think of any situation where I have had this problem.

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Baker
Stephanie Baker Hi Lynn, I

Stephanie Baker

Hi Lynn,

I was right there... just about to start, left sided approach  with the sterile field, patients arm in front of me.   I didn't even hear the housecleaner approach me until she grabbed the waste basket bag which was behind me  off to the right.

I've always thought bedside was best before as well., & certaiinly expect that there would still be that cadre of immobile patients  done at bedside for very good reasons. It just seems lately that we don't have the control over the room , sterile area that we should have especiallly when we'r e filling out the IHI CLB checklist which states "Everyone in room with caps and mask"

We are aware more lately it seems that we are wasting so much time getting patients back into bed, consents signed etc that we contemplated if it might be more effiecient to have it done in a designated area. Just kicking the idea around at this point.

Stephanie Baker

lynncrni
Let us know what you decide.

Let us know what you decide. Thanks, Lynn 

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

mary ann ferrannini
   Take care of any urgent

   Take care of any urgent patient needs prior to the procedure...we often find out patient is in pain and we request that they be medicated before..we also take a quick look at the pt in the other bed and make sure they do not need anything right away. We b use the door sign and place it at eye level between the frame and the door.I was going to look into the rope across the door as well as a friend of mine told me they do it this way where she works. We also give the Job to the assistant to monitor the area and IF the a nurse does have to enter for the other pt..we have a BIG sign that says "MASKS" so they know to grab one and use it. You have to be fast though b/c someone can slip in in a heartbeat. We also have trained many a nurse...RTs ..lab etc that they need to stay out until the sign is removed

Glenda Dennis
We also have several units
We also have several units with 2 bed rooms and very tight space.  Performing a sterile procedure is sometimes very difficult due to traffic and visitors.  I do bedside insertions for patients in ICU and CCU where the space is larger, no other patients in the room, and the environment is more controlable.  If the patient is very difficult to move, I stay at the bedside.  For all others, I use a room in Diagnostic Imaging.  It is big space, the capability of chest x-ray is there, if I need fluro (which is uncommon) it too, is readily available.  I love placing PICCs in DI.  I have a CD player with an assortment of different kinds of music to suit the patient in there as well.  DI is learning to use music with several of their procedures as a result.
tamster
Stephanie, I have had the

Stephanie,

I have had the same issues- I even had a nurse in the SICU come into the room to get a blood glucose from the patient, it was right after I had accessed the vein and she started reaching over from the other side of the bed with the glucometer and was going to get a drop of blood from my cannula. Can you believe that?????  I almost killed her! 

I have put in a request for a space where pts. can be brought to me if possible, but space is very tight around here. Good luck with getting your space!

pjean
We place PICCs at bedside in

We place PICCs at bedside in ICU patients and occasionally patients on our telemetry units that are private rooms.  It is not feasible to maintain any kind of sterile field in semi-private rooms here at our hospital......rooms just too small.  You get 2 beds, 2 bedside tables, 2 over the bed tables, a couple of chairs/loungers for visitors and 1 or 2 bedside commodes in there and you might as well hang it up! 

Like Glenda, we bring our patients to a dedicated room in Radiology.  We have cardiac monitor, pulse ox, music to play for the patients, we do not have the constant "tap-tap-tap" at the door with the never ending coming and going.  After insertion, we are right there in Radiology which makes our x-ray times go way down.  Our Medical Director which is our Interventional Radiologist is also close at hand and we have had to move patients there to get their assistance with fluro for proper placement on rare occasions.  The draw back to this is that the patients have to be brought to the department.  We sometimes have transport that helps us with that, but at other times we are the transporters and that does take up time. (although, less time than waiting on Radiology to come to us for x-ray).

Baker
Stephanie Baker Can you tell

Stephanie Baker

Can you tell me if / how your fee structure had to change if you 're doing them in a  dedicated area vs. at the bedside.

I'm afraid space is tight here as well.

Tx for all your input

Stephanie Baker

Sheila
Sheila's picture
Sheila Fiscus, RN, CRNI,

Sheila Fiscus, RN, CRNI, Seton Family of Hospitals, Austin, TX 

We tried just the sign and had to add a yellow rope.  We attach the sign to the rope and have clips with magnets on them at either end of the rope.  The magnets can be used on the floors as the doors are metal but in ICU we use the clip part to clip to the top of the doors as those are aluminum.  We have not had anyone but MD's walk UNDER our sign and come in the room.  The housekeepers know what it means and we have it in English and Spanish. We cannot have a room to take patients to because we are a Network of hospitals-we would have to have a place at each facility that we travel to and it works great at bedside.

Sheila Hale, BSN, RN, CRNI, VA-BC, Austin, TX

windstrings
At one facilty I worked as

At one facilty I worked as an IV therapist and did all the inpatients in their rooms, but had to use a special procedures room for our "out patients"

I would like to share some of the problems and frustrations we encountered and I will use that experience to suggest some problems with non-outpatient patients as well.


Special procedures are usually done with a large team of sorts and they have people come get the patient and bring them to them so they are set up and ready when they get there... we had non of that.

First the "Out patient" problems.
1. Patients would be late and they would have no one to link up with to wait till you got there.
2. Or you would get there and couldn't find them as they got confused and went to the wrong place or was told wrong by registration or they misunderstood their instructions.... 3. They hadn't registered properly and didn't have appropriate paperwork.. orders etc and we would have to call to get verbal orders.
4. If the patient was not ambulating well, it was a danger to the patient as well as yourself to get them from their wheelchair to the bed and back... as well as having to babysit them all the way to and from x-ray.
5. When it was time for the patient to leave.. if they had no ride right there available, we would have to wait as we couldn't just leave them alone with no one.
6. If the patient needed to use a bedpan etc, it was totally not cool as you were equipped only to handle the procedure of placing a picc without any assistance or other staff members!

Now for inpatient problems:
1. extra time taken to take their bed, remove objects and find help to navigate the halls... many times the beds won't steer right anyway and there will be no one to help you.
2. The patients nurse would not have time to go with you and wait the whole procedure as they have other patients to attend to.
3. If and "when" the patient gets nauseated, you will  have to deal with that as well as bedpans if the patient really has to go.
4. You will not have the patients medicines available to you for PRN situations.
5. If the patient was to become unstable, you would have no help nor drugs to help and would be forced to call a code just to get some help.
6. You are the patients only help.... you cannot leave them to attend to x-rays or paperwork or any other matter as they have no one that will answer or respond to a "call light" that they dont' have..... we would be liable if they became unstable and were not right there to help immediately.
7. We had to schedule and make arrangements in advance to make sure no one else would be using the special procedures room.

 

technically, yes you are an RN and should be able to handle any of those situations, but reality is.... you usually service a whole hospital or facility that has high demands for your attention and specialty and you will not have the resources to handle "all things within the scope of RN practice" alone in a special procedures room. 

 Funny.... when  Dr. does something.. they have 3 assistants and the room is cleared and all attention if given to his procedure.....

But when the RN does it, they are now being asked to transport to and fro and take total holistic care of the patient alone in a procedures room and still do thier procedure efficiently?

Who should demand more pay and what is wrong with this expectation? 

-------------------------------

Always remember that you're unique. Just like everyone else.

The second mouse gets the cheese!

achoosa1
I'm glad to know other side

I'm glad to know other side of the story of a dedicated PICC room. I just placed a PICC in a semi private room and the other patient kept calling out to get attention. Consequently, there were people coming in and out of the room including a bunch of nursing students. I had the sign posted on the door too to avoid coming in the room while procedure was in progress. I was very frustrated!

VAT RN
I prefer bedside because of

I prefer bedside because of all the issues already mentioned...and MY BACK! Our facility does have transportations services from 830-6 but they are not reliable for schedule and we work 7am-11pm. We also have 7 bulidings. Some patients are literally 1/2 mile away! No way am I pushing all those beds/carts. In addition, my procedure room would have to be cleaned after each patient. More wasted time.Outpatients are done in our procedure room or we have an "Infusion Center" if they are going to recieve meds post placement.

 Here's what I do. Put on your bossy britches and use the MOM voice. I usually holler "Sterile Procedure in Progress" if I hear or see someone trespassing. Even if they don't understand the words, they do understand the voice. I also lay masks/hats outside the room for anyone that has to come & go.....especially in ICU. Anyone who stays has to mask/hat, Doctors included. I have actually just gone up and put it on them. I am the one who has to chart it and the one who is ultimately responsible. I let family stay if they want to but I ask if they are ok with hat/mask and then ask if they are ok seeing blood. You would be amazed how honest people are. Some hear the word blood and run! I always insist they sit in a chair in the corner.

That said, there will always be times where some goof will violate your field......surgeons included! Do the best you can but know that if the field is toast....its toast. Open a new pack.

HTH. That's what works for us.

Martha

Rhonda Wojtas
We had an area to do PICC's

We had an area to do PICC's when we first started. However patient transportation added an hour to the procedure. In the begining we had the same problems as mentioned, but now the nurses are more aware and refrain from coming in the room.

Rhonda Wojtas, RN VA-BC

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