Page 9 - IQ February 2018

VAsculAr Access gets A A A A A fAcelift
A faceli is the most comprehensive approach to trea ng ng ng facial wrinkles and sagging caused by aging The vascular access sec on in in in in the the LDA desperately needed a a a a a a a a a faceli and the the results are fantas c c c c c c These comprehensive changes took e e e e e e e e e e e e e ect in in September at Saint Luke’s Hospital which has nurses rounding on on the units to assist with any ques ons Here is a a a quick overview of the presenta on: LDA Op miza on • FYI “Vascular Access Flag” created to alert sta about vascular access concerns • Admission Navigator has two screening ques ons related to to vascular access • “PIV Inser Inser on on A A empt” changed to “Unsuccessful IV IV Inser Inser on on on on A A A empt empt ” ” Addi onally the number of inser on on on on a a a a a empts changed from from three to two Consult Vascular Access or or or reach out for assistance from from a a a a a a a a a a a a a more advanced PIV clinician a a a a a a a a a a a a a er er two a a a a a a a a a a empts per facility availability • “Not present on on on admission” added as a a a a a a removal op on on on on when the pa ent’s LDA was not removed from a a a a previous admission • “Ultrasound Guided PIV” created as as a a a a a a a part of the LDA to improve documenta on and iden fy pa pa ents who have obtained an an ultrasound-guided PIV in in the past • Quality measures surrounding “Line Necessity” for all central lines went from a a a a a a “yes” or or “no” to to a a a a a a a a a a a mul -select op on The goal is to to to evaluate central lines daily and and encourage dialogue between clinician and and provider to to determine if access is s s s s ll needed • Sample picture with instruc ons on on how to measure external catheter length One main component of troubleshoo ng ng a a a a a a a a non- func onal line is to to compare the the external catheter catheter length length at at at placement to to current external catheter catheter length length • New row added to all central central lines lines tled “Lumen Patency ” central central lines lines are checked for patency every shi by con rming brisk blood return and line ushes without resistance to all lumens • PICCs do not have a a a a a a a a distal medial or proximal lumen lumen lumen because all lumens end at at the the the p p of the the the catheter The PICC lumen lumen lumen lumen names have changed to lumen lumen No No No 1 No No No 2 and No No No 3 (as applicable) • A color should be assigned to the lumen from a a a dropdown menu upon inser on on or during the the rst assessment (if the the admi ed ed pa ent ent has a a a a a a a PICC) The color assigned to the lumen should not change during that admission • The nurse will link an an infusion or IV push medica on on to lumen No No No 1 No No No 2 and No No No 3 (as applicable) by no ng the the color of each lumen in the owsheets • Policy links side row informa on on and step- by-step instruc ons added to to to Epic to to to assist the bedside nurse with how to to to troubleshoot central lines 8 | | FeBruary 2018 | 9