The PICC and Midline Virtual Ward: Building a vascular access catheter preservation programme
Dr Mary O’Regan – Consultant in anaesthesia and critical care medicine
Hywel Dda University Health Board
Many hospital and community-based patients receive intravenous medication via a PICC (peripherally inserted central catheter) or Midline (long peripheral cannula). These devices can be indwelling for many months facilitating the community-based care of patients who formerly endured long in-patient stays. They offer clear benefits but are associated with significant complications E.g. Thrombosis and catheter-related blood-stream infection.
Many healthcare staff are not confident managing PICC and Midlines. Substandard catheter care may be linked to adverse catheter events, morbidity, mortality, increased health-care costs and poor patient experience. Harm from PICC and Midline complications does not seem to be on the national radar and data is not subject to local or national surveillance.
Employing targeted staff education, patient engagement and regular real and virtual ward-rounds we wanted oversee the management of PICC and Midlines in our hospitals and communities. We aspired to unlock the potential of our staff and build a competent multidisciplinary network of staff and patient-partners that:
- Is invested in promoting and providing a formal vascular catheter preservation programme
- Has the capacity and capability to continuously enhance the health outcomes and experience of patients with PICC and Midlines in primary and secondary care
- Uses high quality data and incident analysis to fine tune performance and produce incremental quality improvements
- Produces a catheter preservation package that could be adopted and adapted by other organisations thus contributing toward prudent PICC and Midline care nationally.
- An ‘organically evolved’ PICC and Midline service with resource loaded heavily towards device insertion rather than catheter care.
- Organisational learning hindered by lack of data and data-analysis. The baselines we established during the highly unusual arrangements of a pandemic would be unlikely to represent the typical situation.
- Difficulty ring-fencing time in busy clinical schedules to deliver and participate in the virtual ward rounds, education, and programme promotion.
- Managing the increased demand for clinical trouble-shooting that arose as motivated and educated staff recognised adverse events and requested help more frequently.
- 120 patients admitted to the virtual ward
- Delivery of 34 ward rounds over a period of 40 weeks with an average of 20 patients per ward round
- A Monday-Friday 9-5 troubleshooting & advice service established
- A successful and highly interactive on-line showcase event catalysed the development of our network of ward and community team PICC and Midline champions
- An education programme that has already delivered more than 20 training sessions reaching more than 70 primary and secondary care staff members with direct responsibility for PICC and Midline care. Post-training evaluation of their confidence providing 11 basic PICC and Midline care interventions showed an average improvement from 42% to 88%.
- A database developed to record all substandard care and adverse catheter events
- Many clinical practice developments e.g. Clearer catheter labelling, use of skin glue reducing early dressing changes and hospital attendance for oncology patients, reduction in catheter redundancy as staff are confident removing devices, reduction in the use of double-lumen lines when incident analysis suggested an association with catheter-related blood stream infection.
- Many more catheter preservation interventions and much earlier recognition and management of complications
- Our goal is to provide more frequent ward rounds and a 24-7 troubleshooting service.
- We will engage with patients to empower them as champions of their own catheter care.
- We will promote our catheter preservation programme through showcase events, social media and an intranet website
- We will analyse our dataset to quantify substandard care and adverse events and reveal opportunities for clinical practice improvement.
- We will package the effective elements of our project as a formal catheter preservation programme that could be adopted nationally by a network of teams committed to improving the patient experience, sharing data and setting standards.
Bevan Exemplar Experience
Being a Bevan Exemplar gave me the tools I needed to transform a personal aspiration into a multidisciplinary project with momentum.