Published online March 30, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. 1155-1161 (doi:10.1542/peds.2007-3670)

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ARTICLE

Governing Peripherally Inserted Central Venous Catheters by Combining Continuous Performance Improvement and Computerized Physician Order Entry

Darren S. Migita, MD^a,b, Liz Postetter, RN, BSN^a, Susan Heath, RN, MN, NEA-BC^a, Patrick Hagan, MHSA^a, Mark Del Beccaro, MD^a,b

^a Seattle Children's, Seattle, Washington
^b Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington

OBJECTIVE. Seattle Children's in Seattle, Washington sought to establish governance over peripherally inserted central catheters. Preventing overuse and creating an efficient placement process were of paramount importance.

METHODOLOGY. We describe a process by which the marriage of continuous performance-improvement projects and computerized physician order entry has led to a reproducible reduction in peripherally inserted central catheter volumes and an increase in overall provider satisfaction with the ordering process. This was accomplished by increasing daily awareness of central venous catheters, establishing peripherally inserted central catheter-specific insertion criteria, establishing a governing vascular-access service, and creation of a peripherally inserted central catheter-specific computerized order set.

RESULTS. After implementation of these measures, peripherally inserted central catheter insertion volumes decreased by 33.4%; these results have been sustained over a period of 19 months. From August 2006 to October 2006, 48% of peripherally inserted central catheters were placed on the same calendar day of order entry, 37% within 24 hours of order entry, and 15% within 48 to 72 hours. Overall, provider satisfaction with the ordering process improved according to a Likert scale. Scores increased from 2.68 of 5 to 3.55 of 5 over a 9-month period. This result was statistically significant at the 95th percentile level according to the t-test method.

CONCLUSIONS. We conclude that properly constructed computerized order sets can be effective in altering physician ordering practices through standardization.

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Key Words: peripherally inserted central venous catheter • computerized physician order entry • continuous performance improvement • rapid process-improvement workshop

Abbreviations: PICC—peripherally inserted central catheter • CVC—central venous catheter • CABSI—catheter-associated bloodstream infection • BSI—bloodstream infection • PIV—peripheral intravenous line • CPI—continuous performance improvement • CPOE—computerized physician order entry • VAS—vascular-access service • SC—Seattle Children's • IR—interventional radiology • RN—registered nurse • RPIW—rapid process-improvement workshop • MD—doctor of medicine • TPN—total parenteral nutrition

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Accepted Aug 19, 2008.

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