Molly Harrod1, Ana Montoya2,3, Lona Mody2,3, Helen McGuirk4, Suzanne Winter4, Vineet Chopra5,6. 1. Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan. 2. Geriatric Research, Education and Clinical Center, University of Michigan, Ann Arbor, Michigan. 3. Division of Geriatric and Palliative Care Medicine, University of Michigan, Ann Arbor, Michigan. 4. Patient Safety Enhancement Program, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan. 5. Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan. vineetc@umich.edu. 6. Patient Safety Enhancement Program, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan. vineetc@umich.edu.
Abstract
OBJECTIVES: To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs. DESIGN: Exploratory, qualitative pilot study. SETTING: Two community based SNFs. PARTICIPANTS: Residents with PICCs, frontline nurses (RNs, LPNs), unit nurse managers, and SNF administrators. METHODS: Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. RESULTS: Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety. CONCLUSION: Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety.
OBJECTIVES: To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs. DESIGN: Exploratory, qualitative pilot study. SETTING: Two community based SNFs. PARTICIPANTS: Residents with PICCs, frontline nurses (RNs, LPNs), unit nurse managers, and SNF administrators. METHODS: Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. RESULTS: Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety. CONCLUSION: Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety.
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