V. Intervention Decision
Discussion of implications for practice that can be drawn from results of EBP inquiry
Specific Evidence Based Practice Intervention
Evidence Based Model to be applied
Influence of patients, administration and team members on implementation
Ability to implement based on resources and clinical setting
V1.Implementation Plan
The intervention decision pertaining to this project relates to the PICOT question, ‘in the hospital
setting how does the use of central venous catheters (CVC) compare to the use of peripherally inserted central catheters (PICC) influence the risk of infection rate? After completing a comprehensive literature search and review this researcher is committed to making an intervention decision to inform future evidence based practice in the science.
Nursing: Evidence-Based Practice Project Guidelines and Grading Criteria
V. Intervention Decision
A comparative analysis of studies used to answer the PICOT question under review revealed that PICC insertions were less likely to cause infections than CVC. All five researchers in their concluding remarks displayed statistical data retrieved from each study in support of this piece of evidence. Consequently, the intervention decision would focus on limiting the use of central venous catheters in hospital settings for both long term and short term periods.
Discussion of implications for practice that can be drawn from results of EBP inquiry
The implications for practice emerging from this EBP inquiry are closely related to adopting preventative measures that will reduce the prevalence/ incidence of catheter insertion infections occurring in a hospital setting. These include reducing the severe influence created by central venous catheter insertions on blood borne infections (Raiy, Fakih, Bryan, 2010). There has been enough supporting evidence advanced by studies cited in this PICOT presentation for the implementation process to proceed.
Further, admitting that the need for frequent changing of sites to control infection creates damage to major entry points and large blood vessels in critically ill patients must be addressed (Griffins & Philpot, 2002);recognizing that incidences of deep vein thrombosis being a consequence of catheter insertions when peripheral central access is used in burns patients ought to be a focus of intervention (Fearounce et. al, 2010); acknowledging that there are less infections with peripheral insertions than ones done through the central venous route in neurocritical care cases is an advantage (DeLemos et.al, 2011) and realizing that the exposure to increased bloodstream infections when a significant portion of CVCs were left unattended must be corrected (Tejedor, 2011).
Specific Evidence Based Practice Intervention
The specific evidence based practice intervention is aimed at reducing the incidence of catheter insertion infections by limiting the use of CVC; in critically ill patients avoid frequent changing of sites by adopting a safer techniques; careful monitoring of patients when peripheral central access is used in burns patients; adopting peripheral insertions in neurocritical care rather than CVC and removing the idle catheter.
Evidence Based Model to be applied
The specific evidence based model to be applied in this intervention decision process consists of four stages. First, assessment of data retrieved from research; dissemination of findings through education; application of findings to clinical practice and evaluation of application regarding the effectiveness in improving nursing outcomes.
Influence of patients, administration and team members on implementation
Once the cooperation of administration is gained then, team members even though may be resistant, initially, would eventually adapt to revolution towards improving patient care and outcome regarding catheter insertion in a hospital setting among critically ill burns and neurocritical patients.
Ability to implement based on resources and clinical setting
The ability to implement this evidence based practice regarding reducing the incidence of catheter influenced infections in a hospital setting, largely depends on whether administration acknowledges that there is a problem and recognizes the urgency to correct this irregularity. Precisely, any significant increase in hospital based infections denotes initially, poor aseptic techniques during nursing management as well as the need for urgent intervention.
Evidently, the resources necessary to implement this intervention are available. They include retraining of hospital staff regarding adherence to efficient aseptic techniques measures in their interaction with each other and patients. Doctors and nurses directly related to the catheterization procedure and care ought to be informed and educated pertaining to the discovery and encouraged to cooperate with improvement changes.
V1.Implementation Plan
1. Assessment of Data Retrieved ( Please see Appendix A)
2. Dissemination of findings through Education
Design
Setting and sample
Description of intervention
Description of outcome measurement
Procedure/ protocol
Data Analysis
Time Frame
Remarks
Workshop
Hospital staff
Dissemination of findings from research through discussion forum
Completion of survey by participants regarding evidence presented
Prior permission is
obtained from
Utilize percentages to analyze responses obtained from survey
2 days
Gather feedback from participants
Follow up workshop
Hospital staff
Education and discussion on strategies which could be adopted to reduce the incidences of catherization infections.
Same as above
Same as above
Same as above
Same as above
Same as above
3. Application / Intervention and evaluation
Design
Setting and sample
Description of intervention
Description of outcome measurement
Procedure/ protocol
Data Analysis
Timeframe
A pilot project on the medical surgical critical care unit.
24 patients, 4 doctors, 6 critical care trained nurses.
Patients are monitored during and after catheter insertion and vitals recorded hourly.
Catheters are removed when not in use; PICC is used instead of CVC whenever catheters are indicated and replace frequency of site changes with safer insertion devices
Patients’ blood, pressure, temperature and respiration are recorded on an hourly basis. Any irregularities in vitals are reported to team leaders. Catheter insertion sites are assessed twice daily for damage
White blood cell count is also measured for impending infection.
Written consent of participants is obtained prior to commencement of project and administrative permission obtained.
Mean and median scores will be measured regarding incidences of infection when PICC is used; cathers are not left unattended and frequency in changing catheterization sites are reduced
Six months
Extending project to more units in the hospital setting such as burns and neurocritical department making adjustments to intervention from data gained in pilot project.
Patients, doctor, nurses in the critical, burns and neurocritical care units of the hospital setting.
Same as above
Same as above
Same as above
Same as above
Evaluation of Interventions after one year at half yearly intervals
Same as above
Retrieving results from computer database that was recorded and saved during the project intervention phase.
Display results on a spread sheet to facilitate reading and interpretation.
Utilize tables and graphs to display results achieved during the intervention.
Same as above
Same as above.
Also, take
note of and report any significant changes in the
Management of catheter influenced infections occurring in critical care, burns and neurocritical units in the hospital setting.
Six monthly intervals.
DeLemos, C. Abi-Nader, J., & Atkins, P. (2011) Use of Peripherally inserted central
venous catheters, CareNurse, 31(2), 70-84.
Fearounce, G. (2010).Peripherally inserted central venous catheters and central venous
and central venous catheters in burns patients. Journal of Burns Care and Research, 31(1),
24-34
Griffins, V., & Philpot, P. (2002).Peripherally inserted central catheters: Do they play a role in
the care of the critically ill patient. Intensive and critical care nursing. Elsevier.
Raiy Al B., et.al (2010).Peripherally inserted central venous catheters .in acute care setting:
A safe alternative to high risk short term central venous. Association for Professionals in
infection control and epidemiology. Elsevier.
Tejedor, S .et.al (2012).Temporary central venous catheter utilization patterns in a large
tertiary care center. Tracking the ‘idle venous catheter,’ Infection control and hospital
epidemiology, 33(1), 52-60.
APPENDIX A. - Assessment of Data Retrieved
Author of study
Summary
DeLemos Christie, Abi-Nader Judy &Atkins Paul
The aim of this study was to evaluate the infection occurrence from central venous catherization
Versus peripheral among patients in the neurocritical unit of hospitals because of their lengthy
Hospitalization process; ultimately to use it as an alternative to central venous catherization
Data was retrieved from 35 patients of a neurological unit and matched with data from neurological registry
Neurocritical patients and registry with relevant information
35 patients from neurological unit were investigated. They had PICC insertions rather than CVC
PICC use in Neurological units greatly reduced procedural infection
Fearounce
This is a comparative analysis relating PICC and CVC effects on Burns Patients’ Researchers conducted a comparative analysis showing the consequences of PICC insertions and CVC in burns patients.
Minimal risk study involving the institutional review board at the University Health sciences department. Hospital billing records were squired as part of the investigation
Burns Patients
Records of Burns Patients from health care hospitals
PICC were inadequate for fluid replacement in burns patients
Griffins Vivien &Philpot
The purpose of this study was to determine whether there was a significant difference between PICC and CVC insertion as it relates to infection incidence and prevalence.
Cross-sectional 8 month study
Patients with PICC and CVC
177 patients
There were no significant difference in the PICC and CVC rates of infection influence
Tejedor Sheri .et.al
The aim of this study was to identify an aspect of PICC and CVC management that could influence infection’
In patients with PICC or CVC
Retrospective observational study
Patients with PICC and CVC
89 patients and a 579 academic tertiary care facility
Reducing blood stream risk can be achieved if CVCs are removed or PICC are used instead
Raiy Al Basel et.al
The aim of this study was to determine whether there are significant differences in PICC and CVC influence on bloodstream infections.
A prospective study was conducted whereby patients were followed over time from ICU as well as on the open wards to determine whether it PICC and CVC were relevant to care and their influence related to infection.
Retrospective observational study
Patients in hospital with PICC and CVC.
608 tertiary bed critical
care facility.
When the time range for infection to develop between the two interventions PICC was recommended above CVC.
