I have been looking for years for "benchmarks" for outcome monitoring of PICC lines. I have put out requests and and have just done a search of this website only to find really; there is no benchmarks, or 0% is the goal say for infection, and I found a paper 8 years old from the Interventional Radiology group with some statistics.
The new Journal of Infusion Nursing Standards of Practice regarding quaility imiprovement Standar 7.1 A Says Quality improvement activities include evaluating patient or clinical outcomes; identifying clinical indicators, benchmarks, and areas for improvement;...........
Where do I find these benchmarks to grade my results against, how do I know what is seen across the country with PICC lines. I know our goal is to have a PICC line in and out with no problems but; we all get an ocassional D.V.T., tip malpostitions, positive blood cultures, occlusions, etc.....and we evaluate and act according if any thing was not handled according to best practice. But, how are we to compare ourselves to anything else or any "benchmarks" if we cant find any data to compare ourselves to. Basically we are collecting data, acting on evidenced practice and keeping statistics, what are our goals, what are our thresholds????
Thanks, Gina Ward R.N, CPAN
PICC nurse at Raulerson Hospital
Okeechobee, Florida
How do you define "Benchmarks"? I think you are overthinking this. A benchmark does not mandate that you compare yourself to some highly sophisticated national number from a large database. Where does your outcomes fall in relationship to those studies you have found? Are your numbers on outcomes improving, getting worse or staying the same? That is what you should be looking at.
There are no national databases for outcomes of catheters for any complication except infection from the National Healthcare Safety Network from CDC. I think you have to be employed by an organization contributing to that database to access it, not quite sure though. Anyway outcomes from that database are published periodically.
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
Thank you so muc for your response. I was thinking exactly that; there was a data base to compare to. I see what you are saying; compare my own numbers, see where we are going and act accordingly. Thank you very much! Bonus is; I have been doing it this way but just thought I needed to plug in more information.
Any input from others out there?
What kind of indicators , or items are you keeping up with? What are your results?
I am keeping up with;
#1 Adherence and documentation of "insertion bundles"; this data is pulled from my documentation in our computer charting system.
I do the procedures by myself so I do not have anyone doing a "checklist". I do complete a checklist when done in the computer system.
#2 I initiate an outcome monitor on all piccs inserted and keep up with it until the line is removed;( if they are transferred to another facility I am unable keep up with from there) I document any unexpected event; such as occlusions needing cathflo, pain, swelling, pt pulling out etc..
Items that occur; pt pulling the picc line out, guidewire exchange needed to restore proper catheter position , excessive bleeding post insertion , dvt., or non desired tip location , any signs /symptoms of infections, positive blood cultures etc...
#3 success rate
#4 average picc dwell time
Our computer charting system; if we chart correctly can print out reports daily, weekly etc.. on documentation; so I look at is line necessity reviewed and documented, is proper line maintence documented.
Regarding line maintence bundles; data collection is done from our charting, I havent kept data from actual observation which I feel is key since sometimes people may answer "yes" and not always practice that. I just cant figure out how to do a monitor of the staffs actual practice with line maintence; I would just have to stay in a patients room that has a line and watch staff handle it, wouldnt know when to go and monitor since staff is in and out. Have any of you done that??
Thank you !! Gina Ward R.N., CPAN
Gina Ward R.N., VA-BC
Gina, I think you are doing a great deal of monitoring! Congratulations. Even if you could see actual practice of the staff nurses, your presence and their knowing you were there to monitor them would change their behavior. This is known as the Hawthorne effect. We are all on our best behavior when we know someone is watching us. This has been the big problem with monitoring hand hygiene compliance. Creative ways that people have used to monitor hand hygiene include monitoring the use of gel and soap used. I think compliance with cleaning needleless connectors would be the most important thing to monitor but no one has published anything but self-reported data, or the nurse reporting on what they do. This is never the best way to get to this information, but all we have at present. One other suggestion is with the new protective caps that go on top of the connecters. If your hospital uses those, you could make rounds to see which patients have them on and which do not to get some idea of compliance with that. 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
In keeping with this topic, I am in search of someone who is placing PICC lines primarily for out-patients within a hospital setting or primarily from an out-patient setting. I am researching for appropriate indicators used to collect data considering that follow-up and tracking is much different than when these lines are placed for in-house based patients. I realize one can make follow-up calls to these patients but am looking at what factors you are considering as part of the questionaire and also what time interval should these calls be made? If anyone would be so kind as to share an indicator that represents out-patients specifically and too I am looking for a discharge informational sheet that would be sent home with the patient as I am in the midst of putting one together I would really appreciate any help that I can receive! You can e-mail me directly at [email protected]
Thank You!!
Historically it seems we have experienced the rise and fall of DVTs r/t PICCs. Most recently though it seems that we have seen a large spike with no change in practice or practitioners. This has gained the attention to physicians and Quality Management.
We have never calculated a rate and quality would like to compare our rates against other facilities (like we do for central line bloodstream infections). In doing so they recommend using PICC line days as the denominator. Should we use this or just the number of insertions?
Should we not compare ourselves to others? I can understand always trying to improve and zero being the goal but I would like to know how bad/good things are. If someone else is better what are they doing that we are not. It's kind of like practicing in a vacuum if you cannot share with each other.
Calculating your incidence rates by using line days is the recommeded method for other complications such as CLABSI. There is no recommeded method for calculating this or it would have been included in the 2011 Infusion Nursing Standards of Practice since we added a standard on Catheter Associated Venous Thrombosis. I would think you are already collecting the line days since you are probably doing that for your CLABSI rates. The number of insertions will not account for the length of dwell before the event was diagnosed. You could have a total of 100 PICCs with 30% having a vein thrombosis, but this looks very different if it is calculated for XX events per 1000 catheter days.
The only thing you can do is compare your rates to those published in other studies since there is no national database for this complication. 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
Alright, since I was the one who started this post and wanted to have info to compare I will tell youwhat I have been coming up with for 2010.
Now these are calculated per quarter and from the lines that have been discontinued or left the building.
PICC line insertion bundle; 100% all 4 quarters, now there have been breaches, say gloves touched, or item dropped but it was appropriatley corrected before the breach touches the patient.
No unplanned event; meaning picc line went smooth, and during entire course of therapy no event; our goal is 90% our numbers hae been for the 4 quarters; 87%, 94%, 79%, 91%
percentage of pts who pulled picc line outs; goal 0%; 5%, 3%, 3%, 1% (for each quarter)
guidewire exchange needed to replace or correct picc line; 4%, 3%, 5%, 0%
excessive bleed post insertion; 1%, 0%, 1%, 0%
dvt post insertion; goal is less than 6% ( got that threshold from a radiology journal on their line insertions) ours is 1%, 0%, 4%, 2%
success rates for insertions of picc line insertion; goal is 95%; ours is 98%, 98%, 95%, 96%
average line dwell time; threshold 16.1 days from benchmark listed in Bard teaching book; 8.7 days, 9days, 6 days, 8 days
positive blood cultures noted; now this is not our infection rate, this is just any pt with a picc line who has had a positive culuture, I forward these pts info and the I.F. nurse is aware of culture report and she screens it according to criteria to see if it meets criteria for a CL. BSI. anyway; i have had 0 for 1st and 2nd quarter and 3 patients during 3rd quarter and 1 during 4th quarter.
catheter occlusion requiring cath flo instillation; 19%, 16%, 20%, 10% this falls within the published literature rate of catheters that develop occlusions of up to 25%
I would love to see data anyone else would share.
thanks in advance, Gina Ward R.N.
Gina Ward R.N., VA-BC
Gina,
How do you calculate your DVT %?
Each quarter I take the outcome monitors; (tool I use to collect any data on each patients line) on any line that has been discontinued during that quarter and total up all data collected on those outcome monitors.
So, if I have 60 picc lines that I removed in the first quarter and I had 3 patients who had dvt I would find out what percent of those 60 patients that 3 is. so, 3 divided by 60 is 5%.
I may have a patient/patients who has still has a picc line for 3 months, and we have dealt with occusions, susp infection, or susp thrombus but...I do not add any of that into my quarterly reports until that line is discontinued. I first tried to include it ongoing, but it was a mess. It was very difficult to be sure you didnt count an issue many times if the line was still active, couldnt remember what you put down on last quarter stats or this one. So.. I wait till line is completed and all data is collected on that line and then it is totalled and added into the other data.
Thanks, Gina
Gina Ward R.N., VA-BC
I love this thread: I know that all PICC insertion clinicians are concerned with their outcomes and have great ideas on what to monitor and actually monitor a lot of things - maybe way too many things. I would love to see a break out group at AVA regarding this topic and have clinicians put into the hat what we think are the most important things to monitor so that everyone is looking at the same data so we really do have something to compare ourselves to. I think this would be a nice tool for all of us, of course within each facility, the clinicians would always be free to add to the monitoring tool items of importance to them, but it would be nice for all to have the same basic general monitoring. I think there are a lot of very talented and gifted people in the AVA organization and I think we could come up with a great tool. What do you think???
Hi Gina and everyone,
In your research and inquiry have you ran accross any national numbers on bedside placement PICC success rates and/or percentage of patients needing to go to interventional radiology for PICC placement?
Thanks!
It looks from this topic thread that many vascular access experts been looking for an easy way to collect data and to get more from your data? Did you realize that there is now a National PICC Database for vascular access? I have been using the first-ever, web-based picc registry for a few months now. It was officially launched at the AVA national meeting 2 weeks ago! This allows my team and me to utilize a very user-friendly, secure platform to enter all kinds of insertion, care and maintenance and infection data points. The reports generated are real time and each clinician only sees their own reports, while the team lead can view the overall team data. These quality reports are "First Attmept Success Rates," "Malpositon Rates," "Overall Success Rates," "Days from Admission to Referral" and many more! The national database can be used as an assessment tool as well. The line insertions for any new or previous patient will appear in one location for us to review and then this allows us to determine the right device for that patient. The great thing is that in the in the very near future I will be able to receive comparison data to other like hospitals from across the US. They are actually going to provide a national data comparison number to every particpating hospital. Vascular access clinicians are actually creating this non-biased, real-life data. If you are interested check out www.piccregistry.com.