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1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship

BACKGROUND: Nearly 40% of all peripherally inserted central catheter (PICC) placements may be inappropriate. Validated appropriateness criteria (Michigan Appropriateness Guide for Intravenous Catheters or MAGIC) were developed to improve patient safety and decrease adverse events from PICC line use....

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Autores principales: Linsenmeyer, Katherine, Gupta, Kalpana, Mosesso, Suzanne, House, Christine, Strymish, Judith
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808710/
http://dx.doi.org/10.1093/ofid/ofz360.1036
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author Linsenmeyer, Katherine
Gupta, Kalpana
Mosesso, Suzanne
House, Christine
Strymish, Judith
author_facet Linsenmeyer, Katherine
Gupta, Kalpana
Mosesso, Suzanne
House, Christine
Strymish, Judith
author_sort Linsenmeyer, Katherine
collection PubMed
description BACKGROUND: Nearly 40% of all peripherally inserted central catheter (PICC) placements may be inappropriate. Validated appropriateness criteria (Michigan Appropriateness Guide for Intravenous Catheters or MAGIC) were developed to improve patient safety and decrease adverse events from PICC line use. Recent studies have demonstrated the impact of MAGIC implementation with success but involve multimodal interventions that may not be sustainable. We evaluated the effect of a nursing-driven MAGIC-derived triage tool online utilization. METHODS: We conducted a quasi-experimental before and after study evaluating the effect of a MAGIC-derived triage tool including all patients for whom a PICC consult was ordered. The triage tool was implemented January 1, 2018 as part of the consult order and required providers to identify an indication for placement. All consults were reviewed by the IV Team Nurses who collaborated with ID providers when warranted. Providers were contacted if MAGIC criteria suggested alternate access was more appropriate and encouraged to either place a mid or peripheral line or to consider an oral medication. Rates of line utilization and line infections pre-intervention and post-intervention were compared. RESULTS: Overall, 242 consults for PICC lines were placed during the one year intervention period January 1, 2018 to December 31, 2018. Indications included: antibiotics (54%), TPN/chemo (21%) difficult access (17%), no response (8%). Thirty-five PICCs were averted directly related to the intervention. Appropriate indication of PICC placement with the tool was 88%. During this same time period, the line utilization ratio (lines/1,000 patient-days of care) decreased from a mean of 3.8 (range 3.3 to 4.2 for years 2015–2017) to 2.6, a 32% reduction (IIR 0.72; P < 0.05). Central line bloodstream infection rates (infections/1,000 line days of care) also decreased from a mean of 0.81 (range 0.56 to 1.18 for years 2015–2017) to 0.37, a 54% reduction (IIR 0.4; P = 0.10). CONCLUSION: Even in a setting of low line infection and line utilization rates, further reductions in potential device harm can be achieved using point of care feedback tools. This intervention empowers nursing involvement in device stewardship, thus expanding the range of their involvement in stewardship activities. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68087102019-10-28 1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship Linsenmeyer, Katherine Gupta, Kalpana Mosesso, Suzanne House, Christine Strymish, Judith Open Forum Infect Dis Abstracts BACKGROUND: Nearly 40% of all peripherally inserted central catheter (PICC) placements may be inappropriate. Validated appropriateness criteria (Michigan Appropriateness Guide for Intravenous Catheters or MAGIC) were developed to improve patient safety and decrease adverse events from PICC line use. Recent studies have demonstrated the impact of MAGIC implementation with success but involve multimodal interventions that may not be sustainable. We evaluated the effect of a nursing-driven MAGIC-derived triage tool online utilization. METHODS: We conducted a quasi-experimental before and after study evaluating the effect of a MAGIC-derived triage tool including all patients for whom a PICC consult was ordered. The triage tool was implemented January 1, 2018 as part of the consult order and required providers to identify an indication for placement. All consults were reviewed by the IV Team Nurses who collaborated with ID providers when warranted. Providers were contacted if MAGIC criteria suggested alternate access was more appropriate and encouraged to either place a mid or peripheral line or to consider an oral medication. Rates of line utilization and line infections pre-intervention and post-intervention were compared. RESULTS: Overall, 242 consults for PICC lines were placed during the one year intervention period January 1, 2018 to December 31, 2018. Indications included: antibiotics (54%), TPN/chemo (21%) difficult access (17%), no response (8%). Thirty-five PICCs were averted directly related to the intervention. Appropriate indication of PICC placement with the tool was 88%. During this same time period, the line utilization ratio (lines/1,000 patient-days of care) decreased from a mean of 3.8 (range 3.3 to 4.2 for years 2015–2017) to 2.6, a 32% reduction (IIR 0.72; P < 0.05). Central line bloodstream infection rates (infections/1,000 line days of care) also decreased from a mean of 0.81 (range 0.56 to 1.18 for years 2015–2017) to 0.37, a 54% reduction (IIR 0.4; P = 0.10). CONCLUSION: Even in a setting of low line infection and line utilization rates, further reductions in potential device harm can be achieved using point of care feedback tools. This intervention empowers nursing involvement in device stewardship, thus expanding the range of their involvement in stewardship activities. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6808710/ http://dx.doi.org/10.1093/ofid/ofz360.1036 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Linsenmeyer, Katherine
Gupta, Kalpana
Mosesso, Suzanne
House, Christine
Strymish, Judith
1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship
title 1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship
title_full 1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship
title_fullStr 1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship
title_full_unstemmed 1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship
title_short 1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship
title_sort 1173. expanding the magic: engagement of frontline nursing staff in device stewardship
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808710/
http://dx.doi.org/10.1093/ofid/ofz360.1036
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