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The standard of care when a PICC is placed is to wait for clearance for use from a radiologist. Because the radiologist at WVUH is responsible for films for the whole facility, (519 beds), the PICC team noticed a lag time between placement and clearance of the PICC. [...] this study has had a positive impact on the autonomous practice of the members of the PICC team and will serve as a catalyst for future evidence-based research studies to guide practice.
C ST IA M T ER E AT E R E S E A R C H L Accuracy and Timeliness of RN vs. MD Radiological Interpretation of PICC Tips Stacey Pocius, RN-BC, BSN,MBA, Kristine Miley, RN, BSN, Judy Rockwood, RN, BSN, NE-BC Abstract Traditionally, nurses placing peripherally inserted central catheters, (PICCs) must obtain radiological clearance be- fore utilizing the catheter. At West Virginia University Hospitals, this clearance is performed by a radiologist. The PICC team at WVUH felt strongly that this process could be expedited if they were able to interpret the PICC placements themselves. They took a proactive approach and attended specialized training in the radiological interpretation of PICC tips. They then utilized the West Virginia State Board of Examiners for Registered Nurses decision making algorithm to determine that this practice would be within their scope of practice. The team chose to conduct a retrospective study of cross-sectional data to determine if their radiological interpretations were as accurate as the radiologists. A two-tailed t-test was done to determine if they could clear the PICCs in a more timely fashion than awaiting clearance from the radiologists. The premise of reviewing this data was to ensure that their accuracy and timeliness would have a positive impact on patient care delivery. Background vidual PICC team members completed the PICC tip interpreta- Many healthcare facilities across the country rely heavily on tion classes in early 2008.Some of the team members also took PICC (peripherally inserted central catheters) placements to courses on statistics and writing for publication in preparation aid in their patientsʼ intravenous therapy. In most cases, PICC for conducting a study to address this issue. On April 23, 2009 placement is performed by a dedicated, specially trained group the authors received approval from the West Virginia Univer- of nurses. At West Virginia University Hospital, (WVUH), the sity IRB to proceed with the human subject research. The team PICC team consists of ﬁve nurses, with a total of 4.5 FTE. The chose to look retrospectively at a quarterʼs worth of data in the team places approximately 200 PICCs/month, and does so from time period in which all of the radiological training had been 7:00 am-7:00 pm Monday through Friday and 7:00 am-3:00 pm completed. The patients in this quarter had PICCs inserted from on Saturday and Sunday. The stafﬁng pattern is usually three April 10, 2008 through July 10, 2008. The patient data was nurses on Mondays and Fridays, two nurses Tuesday through compiled by a departmental staff assistant in a different ofﬁce Thursday, and one nurse on Saturday and Sunday. The standard from the PICC team. This staff assistant removed the name, of care when a PICC is placed is to wait for clearance for use medical record numbers, date-of-birth, insertion date, room from a radiologist. Because the radiologist at WVUH is re- number, physician and diagnosis from the data. The data that sponsible for ﬁlms for the whole facility, (519 beds), the PICC was being used to conduct the study was placed in a spread- team noticed a lag time between placement and clearance of the sheet format for review. The PICC team did not have access to PICC. This delay impacted a patientʼs ability to start treatment, the data that included patient identiﬁers, because it was housed and in some instances, delayed discharge if the PICC were to in a different department at the time the spreadsheet was being be placed for outpatient therapy. The PICC team at WVUH de- developed. The WV Board for Registered Nurses uses a deci- cided to take a proactive approach to this problem, and enrolled sion tree model, and interpretation of PICC tips on chest radio- in a PICC tip interpretation class. The plan was that once the graphs was a skill deemed within the scope of practice of the team received this education, a study would be conducted to team. If the PICC team was able to de
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