Convene a Vascular Access Committee to review PICC use and outcomes on a monthly to quarterly basis

Action Items: 

• Numerous studies suggest audit and feedback of data related to utilization and outcomes of central lines (including PICCs) to frontline clinicians improves outcomes
• A multi-disciplinary team consisting of key stakeholders that includes (but is not limited to), organizational leadership (e.g., CMO, CQO, CNO), vascular access team members, interventional radiology, critical care physicians, hematology/oncology physicians, emergency room physicians and hospitalists is suggested for maximal impact
• The multidisciplinary team should meet quarterly, identify opportunities for improvement (e.g., PICC use <5 days) by reviewing HMS data and outline strategies, resource requirements and next steps for implementing change. 
• The team should follow the impact of their interventions using both local and HMS data to fully understand barriers, facilitators and outcomes affected as a result of the changes made or workflow improvements performed.
• Designate an internal facilitator for all PICC-related QI efforts. The internal facilitator may be a member of the Vascular Access Committee but focuses their work on implementing changes recommended from the committee. The internal facilitator will work with the coordinating center to identify barriers and facilitators in implementing PICC QI efforts
• Designate a physician champion to assist with PICC initiatives. The physician champion should work closely with the vascular access team and HMS PICC abstractor to facilitate changes and support initiatives throughout the project.

Resources & Tools: 

• HMS site reports (hard copy distributed at collaborative wide meetings and live reports available daily via the HMS data entry system) ​

References: 

• Pronovost PJ, et al. An Intervention to Reduce CLABSI in the ICU. New England Journal of Medicine 2006
  • Participation in a statewide initiative- MHA Keystone- resulted in a large and sustained reduction (up to 66%) in rates of catheter-related bloodstream infection.
• Bosk C, et al. The art of medicine: Reality Check for Checklists. Lancet 2009
  • To achieve results in wider contexts: recruit advocates within the organization, keep the team focused on goals, create an alliance with central administration to secure resources, shift power relations, create social and reputational incentives for cooperating, open channels of communications with units that face the same challenges, and use audit and feedback.
• Holden RJ, et al. SEIPS 2.0:  A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 2014
  • This model uses a systems engineering model to identify the types of factors, barriers and facilitators to consider when implementing a change or improvement process. The model identifies technologies, tools, environment, people and the work environment as key components for a Vascular Access Committee to consider. 
• Infusion Therapy Standards of Practice 2016 – Overview Presentation
• Infusion Therapy Standards of Practice – Purchase Site
• Kirchner JE, et al. Outcomes of Partnered Facilitation Strategy to Implement Primary Care- Mental Health. Journal of General Internal Medicine 2014
  • The addition of a highly Partnered Implementation Facilitation strategy to national level support resulted in greater Reach and Adoption of the mandated PC-MHI initiative, thereby increasing patient access to VA mental health care.

Proceed to Step 2