A Nurse-Driven Strategy to Significantly Decrease PICC Insertion Delays Through the Design and Execution of a Pre-PICC Procedure Process

Purpose:
The mean time from room arrival to PICC procedure start was 15 minutes. By decreasing delays the PICC team encounterd for each patient, there was an opportunity to place more lines, decrease length of stay, increasethroughput, decrease ED boarding, and increase patient and nurse satisfaction.

Relevance/Significance:
The PICC team places approximately 200 PICC lines per month. This support for vascular access drives timely treatment delivery, patient comfort, and support for the plan of care. The P4 strategy was developed to improve workflow to allow the patient experience improved quality of care during a vulnerable time in their hospitalization. By addressing workflow issues and identifying strategies to improve PICC placement process, the team was able to exceed patient and organizational expectations.

Strategy and Implementation:
The team developed and implemented a Pre-PICC Procedure Process (P4) tool for the nursing staff. Four main components reminded them to assess for patient needs and prepare the patient and room adequately for the PICC team. The process included the PICC team calling ahead to the bedside nurse with an approximate time of arrival for the PICC line placement so prep and education could be initiated. A second call to the nurse was made by the PICC team about 20 minutes prior to arrival to the patient's room. The P4 was developed and implemented using a rapid cycle change methodology. Pre data was shared with nursing leadership and education was provided in a phased approached. Evaluation check points were developed and ongoing feedback toward goal achievement was provided at the unit level. An annual 'check in' process was develop in order to sustain the executed change and hold practitioners accountable to the P4 process.

Evaluation:
Total procedure delays decreased from 15 to nine minutes per case. Total PICC placement prep time delays decreased from 50 hours to 30 hours per month. Demonstrable patient outcomes include decreased LOS, increased patient throughput and decreased ED boarding. Further results were increased patient satisfaction, increased number of PICC lines placed and decreased delays in patient discharges.

Implications for Practice:
The P4 check list allows the nurse to adequately prepare the patient, family and room for the procedure. The P4 improved operational flow resulting in a positive ripple effect for the entire organization. The P4 strategy may be replicated in other organizations to yield similar positive outcomes.