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Accuracy and Timeliness of RN vs. MD Radiological Interpretation of PICC Tips

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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.

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   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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