the impact of focused nursing education on picc occlusion rates dayna holt, rn, crni rady...

The Impact of Focused Nursing Education on PICC

Occlusion Rates

Dayna Holt, RN, CRNIRady Children’s Hospital, San Diego

BACKGROUND

• Peripherally inserted central catheters (PICC) have become an essential tool in pediatric care.

• At Rady Children’s Hospital 550 to 600 pediatric PICCs are placed annually.

• The small lumen and length of pediatric PICCs requires specialized skill and knowledge in proper care and maintenance.

THE PROBLEM

• Occluded catheters compromise patient care and increase costs.

• Necessary medications and fluids are delayed and can affect patient outcomes or delay discharge.

• Considerable nursing time is required to restore the patency of occluded catheters.

• Occluded PICCs can result in patient dissatisfaction, anxiety, discomfort and stress.

PICO QUESITON

• Population~ Patients with 3F Groshong PICCs.• Intervention~ Focused nursing education

specifically designed to prevent and reduce catheter occlusions.

• Comparison~ Basic nursing orientation and the availability of policy and/or mentors for reference.

• Outcome~ Occlusion rates of 3F Groshong PICCs.

PICO QUESTION

In patients with 3f Groshong PICCs, does implementing a focused nursing education as compared to basic orientation and the availability of policy and procedures decrease catheter occlusion rates?

SYNOPSIS OF EVIDENCE

• Recognizing the causes of PICC occlusion assists the nurse in preventing occlusion occurrences.

• Proper flushing, catheter care and lab sampling technique reduces the occurrence of PICC occlusions.

SYNOPSIS OF EVIDENCE

• Nursing knowledge in the care and flushing of PICCs reduces total catheter occlusions.

• Recognizing and treating partial catheter occlusions prevents the occurrence of total catheter occlusions.

• 3F Groshong PICCs can be utilized effectively for lab sampling with out significant increases in catheter occlusion rates.

METHODS

• A Pre-Test/Post-Test project was designed.

• Convenience sample of all core staff nurses working in Med/Surg at RCHSD

May 2007 to August 2007.

• All data was aggregated and anonymous.

METHODS

• Objective written Test of nursing knowledge.

• Direct observations of nurse’s PICC flushing technique.

• Retrospective chart review to determine catheter occlusion rates.

DATA COLLECTION

• Retrospective chart review December 1, 2006 through February 28, 2007

(N=97)• Direct nursing observations April 16,

2007 through May 9, 2007 days and nights (N=37)

• Written Pre-test followed by educational intervention at Med/Surg mandatory annual education May 2007 (N=101)

DATA COLLECTION

• Written post-test June, 2007 (N=53)4 tests returned in August 2007

• Direct nursing observations August 2007 days and nights (N=39)

• Retrospective Chart Review June 1, 2007 through August 24, 2007 (N=92)

RESULTS

• Nursing knowledge increased – Pre-test mean written test score 0.78– Post-test mean written test score 0.93

(p=<0.0001 equal variances t-test 1 tailed)• Nursing flushing technique improved

– Pre-test mean observation score 0.88– Post-test mean observation score 0.95

(p=0.0045 unequal variances t-test 1 tailed)SSPS statistical software version 14.0

NURSING KNOWLEDGE and PERFORMANCE

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Written Test Observations

Mea

n A

gg

reg

ate

Sco

re Pre

Post

RESULTS

• Pre-test occlusion rates:– M/S 21.11/1000 catheter days (N=55)– Non M/S 18.92/1000 catheter days (N=42)

• Post-test occlusion rates:– M/S 15.49/1000 catheter days (N=50)– Non M/S 24.24/1000 catheter days (N=42)

(Med/Surg p=0.0515 unequal variances t-test 1 tailed)

(Non Med/Surg p=0.45 equal variances t-test 1 tailed)SSPS statistical software version 14.0

3F Groshong PICC Occlusion Rates

0.002.004.006.008.00

10.0012.0014.0016.0018.0020.0022.0024.00

MEDSURG NON MED SURG ALL UNITS

Rat

e pe

r 100

0 ca

thet

er d

ays

PRE

POST

LIMITATIONS

• 50% written post-test return.

• Post-test observations completed over 2 months after focused education.

• Post-test observations completed by simulation rather than actual patient observations.

LIMITATIONS

• Nursing attrition during the study period.

• No provision post intervention for 3F Groshong PICC care only by nurses who participated in the focused education.

CONCLUSIONS

• Focused Nursing Education improved nursing knowledge and flushing technique.

• Focused Nursing Education significantly reduced 3F Groshong PICC occlusions and the associated costs due to PICC occlusions.

RECOMMENDATIONS

• Consider other evidenced-based projects to determine if product selection or cap design has an impact on the rates of catheter occlusion.

• Annually provide PICC specific focused education to all RNs responsible for the care of PICCs.