School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia.
Herston Infectious Diseases Institute, The University of Queensland, Herston, Queensland, Australia.
PLoS One. 2022 Nov 4;17(11):e0277302. doi: 10.1371/journal.pone.0277302. eCollection 2022.
Peripherally inserted central catheters (PICCs) are prevalent devices for medium-to-long-term intravenous therapy but are often associated with morbid and potentially lethal complications. This multi-center study sought to identify barriers and facilitators of implementing evidence-based appropriateness criteria to improve PICC safety and patient outcomes in a pay-for-performance model. Participating hospitals received an online toolkit with five recommendations: establishing a vascular access committee; implementing a clinical decision tool for PICC appropriateness; avoiding short-term PICC use (≤5 days); increasing use of single-lumen PICCs; and avoiding PICC placement in patients with chronic kidney disease. Longitudinal online surveys conducted biannually October 2014-November 2018 tracked implementation efforts. A total of 306 unique surveys from 34 hospitals were completed. The proportion of hospitals with a dedicated committee overseeing PICC appropriateness increased from 53% to 97%. Overall, 94% of hospitals implemented an initiative to reduce short-term and multi-lumen PICC use, and 91% integrated kidney function into PICC placement decisions. Barriers to implementation included: achieving agreement from diverse disciplines, competing hospital priorities, and delays in modifying electronic systems to enable appropriate PICC ordering. Provision of quarterly benchmarking reports, a decision algorithm, access to an online toolkit, and presence of local champion support were cited as crucial in improving practice. Structured quality improvement efforts including a multidisciplinary vascular access committee, clear targets, local champions, and support from an online education toolkit have led to sustained PICC appropriateness and improved patient safety.
经外周静脉穿刺中心静脉置管（PICC）是一种常用于中、长期静脉治疗的装置，但常与严重且可能致命的并发症相关。这项多中心研究旨在确定在按效付费模式下实施基于证据的适宜性标准以提高 PICC 安全性和患者结局的障碍和促进因素。参与医院收到了一个带有五个建议的在线工具包：建立血管通路委员会；实施 PICC 适宜性的临床决策工具；避免短期 PICC 使用（≤5 天）；增加单腔 PICC 的使用；避免在慢性肾脏病患者中放置 PICC。2014 年 10 月至 2018 年 11 月期间每两年进行一次纵向在线调查，以跟踪实施情况。来自 34 家医院的 306 份独特调查完成。专门监督 PICC 适宜性的委员会的医院比例从 53%增加到 97%。总体而言，94%的医院采取了减少短期和多腔 PICC 使用的举措，91%的医院将肾功能纳入 PICC 放置决策。实施的障碍包括：达成来自不同学科的共识、医院优先事项的竞争以及修改电子系统以支持适当的 PICC 订购的延迟。提供季度基准报告、决策算法、在线工具包的访问权限以及当地冠军的支持被认为是改善实践的关键。包括多学科血管通路委员会、明确的目标、当地冠军和在线教育工具包支持在内的结构化质量改进措施，已导致 PICC 适宜性的持续提高和患者安全性的改善。
