1. Use of a Standardized Process To Reduce Central Venous Catheter Utilization in a Community Hospital Vicki V. Sweeney, R.N.; 1 Ashley Perkins, R.N.; and Titus L. Daniels M.D., M.P.H. 2 1 Department of Patient Safety and Quality, Williamson Medical Center, Franklin, TN and 2 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN Abstract ISSUE: Evidence-based guidelines for Central Line-Associated Blood Stream Infection (CLABSI) prevention have been well publicized. A review of central line insertions in November 2009 revealed that 40/85 (47%) peripherally inserted central catheters (PICCs) met generally accepted criteria for use.To improve appropriateness of PICC and central venous catheter (CVC) use, a process improvement (PI) team was convened to develop a vascular access utilization process and education program. The team included representatives from nursing, infection prevention, pharmacy, administration, and the medical staff. PROJECT: The PI team reviewed data for PICC/CVC placement and appropriateness. To enhance knowledge of vascular access devices, the team developed new tools, guidelines, and educational materials to include: An algorithm providing guidance on appropriate venous access devices. A list of nurses with enhanced peripheral IV placement proficiency. Physician order sets and transfer orders that identify PICC/CVC indications. Discharge orders that identify patients discharged with PICC/CVC, the responsible provider, and the stop date for the PICC/CVC and medications. Patient education sheet for PICC/CVC. Situation, Background, Assessment, Recommendation (SBAR) handover tool The Associate Administrator for Nursing chaired the PI team, provided education to physician committees, and participated in unit-based education sessions with staff. RESULTS: In November 2010, 41 of 44 PICCs (93%) met criteria for appropriate placement. This represents a 51% reduction in PICC utilization (44 vs. 85) and a 50% improvement in appropriate placement from data collected in November 2009. (47% vs. 93%). LESSONS LEARNED: Nursing staff and physician involvement are critical to successfully create a culture change and gather support. Intensifying educational efforts through multiple formats is essential to improve central line utilization and appropriateness. Face-to-face unit presentations gathered the most support for the plan. Monthly data reports to each unit with on-site visits and acknowledgements from administration and directors provide staff with feedback and ownership of the process. Issue Williamson Medical Center is committed to “Zero” for Central Line-Associated Blood Stream Infections (CLABSI). In November 2009, eighty-five (85) peripherally inserted central catheters (PICC) were placed at Williamson Medical Center. Only forty-seven percent (47%) met criteria for central line placement. Results Project Process Improvement Included: Unit-based on-site education for staff and physicians Algorithm to provide guidance on venous access Physician order sets for PICC and Midline placement Daily assessment of need for PICC and Midline appropriateness Documentation of necessity every shift Patient education Lessons Learned Input from staff and physicians is necessary to create a culture change and gather support. Education must be presented in several formats to allow for input and support. Face-to-Face unit presentations gathered the most support for the plan. PICC appropriateness has increased from 47% to 93% in a 12-month study. There has been a 51% decrease in PICC utilization. WMC has not had a CLABSI for 12 months. Contact Information: Vicki Sweeney, R.N. Infection Preventionist Williamson Medical Center Franklin, TN 37067 vsweeney@wmed.org Ashley Perkins, R.N. Associate Administrator for Nursing Williamson Medical Center The number of PICCs per month decreased by more than 50% (85 to 40) Device utilization also decreased when calculating PICCs / 100 patient-days PICC appropriateness increased by 50%, to greater than 93% The decrease in PICC use was followed by a reduction in PICC infections The last recorded CLABSI was May 2010