Incorporating Peripherally InsertedCentral Catheters (PICC) into hospitalclinical practiceAn example of evidence based pro...
BackgroundINCORPORATING TECHNOLOGY INTO HOSPITAL  CLINICAL PRACTICE                              REQUEST TO               ...
Background • Incorporating technology into hospital clinical practice                                     FEARS   ECONOMIC...
BackgroundPICC : Peripherally Inserted Central Catheter     Long-term: Third generation polyurethane or silicone     Ins...
Background   LIFE CYCLE OFHEALTH TECHNOLOGY    EMERGING  TECHNOLOGIES
Background“Technologies have occasionally had rapid development and   dissemination in the health care system (…) influenc...
Objective• To describe the evidence-based incorporation of  PICC for cancer patients in the Araba University  Hospital.
Methods1) Bibliographic review: January 2010-June 20102) Nurses education/ training3) Protocol desining: prior, insertion,...
PATIENTS INTERVENTIONS COMPARISONS        OUTCOME Cancer           PICC         CVC         DURATION Patient       PLACEME...
Methods                 Depth: 0.5-1 cm                  Depth: 0.5-1 cm                                          Diameter...
PREINSERTION  INSERTIONPOST INSERTION MAINTENANCE                        PATIENT                       EDUCATION    Eviden...
Methods  ObservationalProspective Study
Methods   Request to thePurchasing Committee
10                              15                                   20                                        25         ...
Results 100   100        100        100                                 100        100    100      100                    ...
Results       WithdrawedN                      90       CathetersMean                147.6Median               99.5Stand. ...
Results                                    TOTAL: 24,031 Catheter Days                                    Nº of Adverse Ef...
IMPLANTED PORT                           PICC                          Results 247 €                              95€ Oper...
Discussion• PICC are an example of how technology can be incorporated  into hospital practice based on evidence criteria.•...
Implications for Practice• PICC is now an available, safe, and cost-effective central  venous device in our hospital, pref...
Thank you      Eskerrik Asko                  Gracias                             Lucia Garate Echenique                  ...
Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice
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Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice

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Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice

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  • As Osteba implicitly acknowledges, incorporation of technology into clinical practice is not always based in scientific evidence criteria. In our hospital the incorporation of new technology is usually as follows: Clinicians hear about new technologies in congresses or meetings. Comercial agent offers the product to clinicians or material resources responsible. Clinicians test the product, in best of cases, read about the product. If they like it, they request it to the purchasing commitee, providing bibliographic references, use description… Purchasing commettee makes the decision. The purchasing commitee is integrated by: Director Económico-Financiero        HUA Director Médico                              HUA………..Delega en Subdirector Médico          HUA Directora Enfermería                       HUA………..Delega en Responsable de RR.MM   HUA Subdirectora Económica Compras   HUA Responsable Gestión Económica    HUA Responsable Compras Txagorritxu  And asks for the following information in the application form: +Justify the need of the product or device +Expected benefits/ Beneficios esperados con la adquisición del nuevo producto/técnica referidos a: +Safety and technical quality +Work organization changes +Improvement in diagnosis or therapeutic techniques +Economical impact +Use of technology in other hospitals +Bibliography supporting the benefits of the new product/ device or technique. Calidad técnica y seguridad Modificaciones en la metodología de trabajo Beneficios referidos al paciente Mejoría de las técnicas diagnosticas/terapéuticas empleadas Impacto económico Referencia de su uso en otros hospitales Soporte bibliográfico: existencia de evidencia científica de los beneficios de la utilización del nuevo producto ó técnica.
  • As Osteba implicitly acknowledges, incorporation of technology into clinical practice is not always based in scientific evidence criteria. In our hospital the incorporation of new technology is usually as follows: Comercial agent offers the product to clinicians or material resources responsible. Clinicians test the product, in best of cases, read about the product. If they like it, they request it to the purchasing commitee, providing bibliographic references, use description… Purchasing commettee makes the decision. The purchasing commitee is integrated by: Director Económico-Financiero        HUA Director Médico                              HUA………..Delega en Subdirector Médico          HUA Directora Enfermería                       HUA………..Delega en Responsable de RR.MM   HUA Subdirectora Económica Compras   HUA Responsable Gestión Económica    HUA Responsable Compras Txagorritxu  And asks for the following information in the application sheet: Justificación de la necesidad ó conveniencia de su incorporación Beneficios esperados con la adquisición del nuevo producto/técnica referidos a: Calidad técnica y seguridad Modificaciones en la metodología de trabajo Beneficios referidos al paciente Mejoría de las técnicas diagnosticas/terapéuticas empleadas Impacto económico Referencia de su uso en otros hospitales Soporte bibliográfico: existencia de evidencia científica de los beneficios de la utilización del nuevo producto ó técnica.
  • This is what we have try to do with PICC. Purchasing Commitee doors seem to be closed at that time. How did we opened them? This is an example of evidence criteria process.
  • The results of the bibliographical search and some clinical practice guidelines supported the PICC use for cancer patients going into quimotherapy. So we decided start using it, monitooring closelly all the results achived. With this aim a database was designed. In this database the nursign supervisor and main lider of this project of incorporating PICC to the hospital practice, recorded every PICC placement and every incidence ocurred with them. Data were recorded from the very begining, June 2010, and are at the moment still being recorded.
  • Una diapositiva con el aprendizaje de las enfermeras: investigacion (busqueda y lectura critica), profundización en conocimientos de terapia intravenosa, y por ultima técnica de inserción de PICC (Pata de pavo y ecógrafo). Fruto de esto fueron las mismas enfermeras de la planta las que diseñaron los protocolos de insercion, mantenimiento y adiestramiento a pacientes. Nurses Education and Trainning Programme: Research methodology, IV therapy, simulated practice and real practice.
  • Including learining period
  • Actualizar datos
  • Others like catheter migration, catheter damage, inflammation at the insertion point
  • From Jan 2012 to Jun 2012 were consumed 12. Cancer of colon screening started 2011. Direct cost Indirect staff/facilities costs
  • I wonder if in
  • Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice

    1. 1. Incorporating Peripherally InsertedCentral Catheters (PICC) into hospitalclinical practiceAn example of evidence based process Lucia Garate Echenique Nursing Research Supervisor lucia.garateechenique@osakidetza.net
    2. 2. BackgroundINCORPORATING TECHNOLOGY INTO HOSPITAL CLINICAL PRACTICE REQUEST TO PURCHASING COMMITTEE ACCEPTANCE REJECTION
    3. 3. Background • Incorporating technology into hospital clinical practice FEARS ECONOMICAL ACHIEVEMENT OF MANAGEMENT OBJETIVES RESURCES PREVIOUS CONCESSIONS PROFESSIONAL ATTITUD PURCHASING PATIENT COMMITTEE PREFERENCESIMPRESSIONS OF PREVIOUSCLINICAL BENEFIT PURCHASES/ INVESTMENTS
    4. 4. BackgroundPICC : Peripherally Inserted Central Catheter  Long-term: Third generation polyurethane or silicone  Inserted in upper arms: Peripherally inserted  End of catheter in superior cava vein  Can be inserted at bed-side by trained nurses
    5. 5. Background LIFE CYCLE OFHEALTH TECHNOLOGY EMERGING TECHNOLOGIES
    6. 6. Background“Technologies have occasionally had rapid development and dissemination in the health care system (…) influenced by factors such as social pressure, commercial pressure, the enthusiasm of health professionals, lack of barriers to their implementation or the existence of technical difficulties for evaluation. This fact has led sometimes to further demonstrate its ineffectiveness and even harm.”The EARLY ASSESSMENT OF EMERGING TECHNOLOGIES aims: 1. To identify characteristics in terms of improvement in clinical practice, adverse effects, ethical and economic aspects. 2. To Help in the decision-making 3. To Prevent the undesirable consequences of the introduction of new health technologies.
    7. 7. Objective• To describe the evidence-based incorporation of PICC for cancer patients in the Araba University Hospital.
    8. 8. Methods1) Bibliographic review: January 2010-June 20102) Nurses education/ training3) Protocol desining: prior, insertion, postinsertion, education for patients.4) Database monitoring: success in placement, incidences, duration, reasons for withdrawal, complications. June 2011.5) Request to the Purchasing Commitee. Acceptance: PICC (October 2010) & Ultrasound (Febreary 2011).6) Observational prospective study
    9. 9. PATIENTS INTERVENTIONS COMPARISONS OUTCOME Cancer PICC CVC DURATION Patient PLACEMENT Implantable COMPLICATION Ports SATISFACTION Peripheral Cathethers UptoDATE Tripdatabase MEDLINE DARE MESH/ EMBASE Cochrane EMTREE CINAHL EMB Reviews 130 documents retrieved
    10. 10. Methods Depth: 0.5-1 cm Depth: 0.5-1 cm Diameter: 0,4 - -11 Diameter: 0,4 cm. cm.Microseldinger Technique Ultrasound
    11. 11. PREINSERTION INSERTIONPOST INSERTION MAINTENANCE PATIENT EDUCATION Evidence BasedPROTOCOL DEVELOPMENT
    12. 12. Methods ObservationalProspective Study
    13. 13. Methods Request to thePurchasing Committee
    14. 14. 10 15 20 25 0 5 jun -1 0 ju l-1Au 0 g- 1se 0 p- 10 oc t-1 0 no v- 1D 0 ec -1Ja 0 n- 11 95,8% to Cancer Patients fe b- 1m 1 ar -1Ap 1 r-1m 1 ay -1 1 ju n- 11 ju N=218 Inserted in Araba University Hospital l-1au 1 g- 1se 1 p- 11 oc t-1 no 1 v- 1de 1 c- 11 ja n- 11 Results
    15. 15. Results 100 100 100 100 100 100 100 100 95 94 90 91 90 92 84 80 80 75 70 66 60 56 54% 50 50 50 40 30 20 INSERTION SUCCESS RATE 96.3% (CI 95%: 92.9 – 98.1) 10 0 10 11 10 1 11 Au 0 1 0 11 10 11 1 1 11 11 1 10 0 11 11 l-1 l-1 -1 -1 t- 1 t-1 -1 r-1 v- v- n- n- n- g- n- g- p- b- p- c- ar ay ju ju ec oc oc Ap no no ju ju ja Ja au de fe se se m m D
    16. 16. Results WithdrawedN 90 CathetersMean 147.6Median 99.5Stand. Dev. 122,.2Mín. 9,0Max. 533.0 25 50,0Percentiles 50 99.5 75 235.5
    17. 17. Results TOTAL: 24,031 Catheter Days Nº of Adverse Effects: 49 Adverse Effect TOTAL CATHETER DAYS = 24.031 95% CI: 1.5-2.7 /1,000 Catheter-Days 1 0,9Complication/1,000 0,8 0,40 Catheter-Days 0,7 0,66 0,6 0,5 0,24 0,4 0,29 0,16 0,3 0,08 0,08 0,20 0,2 0,2 0,1 0,04 0 ) ) ) ) 6 =7 5) =5 =1 n =1 (n n= (n ( n l( n ( n tio si s ia va tio em o ec bo ru c er em .Inf om st ct .R r b id u sp Th O Ba c
    18. 18. IMPLANTED PORT PICC Results 247 € 95€ Operating Theatre Hospitalisation Room 90 min 60 min CENTRAL VENOUS 1 Surgeon 1 Nurse DEVICES CONSUMPTION 1 Nurse 1 Auxiliary Nursign Care (2008-2012)400 0,40350 336300 308 0,24 280250 Implanted Port200 214 0,16 Drum 0,08 0,08150 CVC 112 PICC100 2950 0 0 18 08 09 10 11 12 20 20 20 20 20
    19. 19. Discussion• PICC are an example of how technology can be incorporated into hospital practice based on evidence criteria.• However, the vast amount of technology hospitals manage and the effort needed to search, read, and create evidence constitute important difficulties to be faced in the technology incorporation processes.• In hospital routine this proccess may be insufficiently protected. The creation of hospital based technology evaluation committes could support the proccess of incorporation technology following evidence-based criteria.
    20. 20. Implications for Practice• PICC is now an available, safe, and cost-effective central venous device in our hospital, preferable to other devices for cancer patients.• When the process of adquiring technology in hospitals involves practicioners, researchers, material resources responsibles, and managers it is easier to incorporate technology which is relevant and appropriate, in both scientific and economical terms, to clinical practice.
    21. 21. Thank you Eskerrik Asko Gracias Lucia Garate Echenique Nursing Research Supervisor lucia.garateechenique@osakidetza.net

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