Improving Patient Safety By Decreasing Peripherally Inserted Central Catheter Occlusion Rates Through Education

Purpose:
An innovative process was used to educate nurses on a surgical unit with high occlusion rates about peripherally inserted central catheter(PICC) maintenance. The goal was to empower nurses with knowledge to reduce occlusion rates and improve patient safety, an essential component of quality care.

Significance:
The occlusion rate on the surgical unit increased from 18% to 27% within a year. A clear vision of patient safety related to PICC occlusion was needed to create a culture of excellence where concern for the patient is paramount. Avoidance of risks associated with care is a patient's right.

Strategy and Implementation:
Multiple calls were being received by the Vascular Access Specialty Team (VAST) about occluded PICC lines on the surgical unit. Nurses were unable to flush or withdraw blood which signals withdrawal occlusion, the step before a complete occlusion. VAST activity data base showed increase in occlusion rates and use of declotting medication. The workload was not conducive to spot education moments so permission for inservices was obtained from the nurse manager. A pre-test/post-test design using a convenience sample of the core staff nurses working on the surgical unit at Durham Regional Hospital was utilized. Objective measures included written assessment of nurse's knowledge and direct observation of nurse's flushing techniques during inservices held. An educational packet was created and an arm with PICC inserted was constructed for hands on use. Educational sessions were provided at skills day and on all shifts. Proper management of lines was taught to prevent future occlusions.

Evaluation:
Mean written test scores improved from 0.88 to 0.99. Mean observation rate improved from 0.74 to 0.99. Pre education occlusion rate was 30%. Post results were 22%. The nurses rated the project "excellent" and felt able to serve as competent PICC line managers. Learned behaviors were then modeled.

Implications for Practice:
Focused education improved patient outcomes by reducing PICC occlusions and delay in care caused by use of declotting medication. Key was empowering nurses with the right technique to use every time. A culture of mutual accountability was created and nurses disseminated the information to others.