Implementation plan for VAC in the acute care unit of Royal Hospital

This report proposes an implementation plan for vascular access device (VAD) practice or product in a clinical setting. The report provides an overview of the clinical setting and the effectiveness of new product or service. It focuses on developing a proper implementation plan for the PICC product mainly because of several arguments related to PICC associated complications. The report suggests several implementation strategies to successfully adapt PICCs in clinical setting.

Running head: IMPLEMENTATION PLAN
Implementation plan
Name of the student:
Name of the University:
Author’s note

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Title: Implementation plan for VAC in the acute care unit of Royal Hospital
Background:
Adapting suitable research evidence into practice is one of the tenets of evidence based
practice (EBP) and the interest in knowledge translation principles has increased because of
growing engagement in EBP. Knowledge translation is a concept that requires understanding of
influencing factors at the individual and contextual level and application of knowledge within a
complex system of interactions (Brownson, 2017). The main purpose of this briefing paper is to
capture the benefits of a product or service for a target health setting. This briefing report mainly
aims to use knowledge translation principles to propose an implementation plan for vascular
access device (VAD) practice or product in a clinical setting. The report provides an overview of
the clinical setting and the effectiveness of new product or service. This briefing report would
play a role in accelerating recruitment and addition of the product in the desired setting.
Clinical setting:
It is planned to implement the VAD product in the acute care unit of the Royal hospital
(hypothetical). The Royal hospital is a 200 bed hospital with several departments such as
emergency unit, acute care unit, surgical unit and intensive care unit. The acute care unit of the
hospital mainly handles patients with acute and long term health needs. Patients requiring blood
transfusion and other intravenous therapy regularly come to the unit for treatment and care.
There are many patients who require intravenous therapy for short period or prolonged period.
Although currently the hospital has been provided with other types of CADs like peripheral
catheter, however many quality issues has been reported because of the use of them. For

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examples, staffs have reported challenges in handling several types of infection associated with
the use of CADs.
The review of the incidences related to the cause behind catheter associated infections in
the hospital has revealed that improper insertion of VADs has been the major reason for negative
patient events. Nursing staffs using the device has been found to make errors during the time of
insertion (). Hence, catheter malposition or insertion of catheter to another venous location is one
significant issue in the unit. Currently, PICC has not been used for providing intravenous therapy
to patients. Another gap found in the unit is that no education or proper guidelines for VADs has
been given to staffs thus resulting in negative patient outcome. Hence, by introducting PICC at
the hospital, accessibility issues in relation to the use of VADs can be avoided. In addition, many
catheter related infection will be controlled as the implementation plan focus on addressing
patient, staff, environmental and resource factors that affects efficacy of a medical device in
clinical setting.
Product summary:
VADs are medical devices that has been widely used in the clinical setting to access the
venous system and other body systems such as epidural system, pleural system and others. Apart
from medicine administration, VADs are routinely used during blood transfusion and other
clinical activities. There are numerous types of VADs available to health care professionals
which aids them in increasing survival rate and quality of life of patients (). For this briefing
report, the target VAD product that has been planned to be implemented in the surgical ward of
Royal hospital includes the peripherally inserted central catheters. PICC is a type of long-term
VADs which are made up of biocompatible and silicone material. It is a device that is inserted

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percutaneously at a peripheral location, extends to the posterior vena cava and remains within the
veins for several days or weeks. The device was first used in 1960s as a replacement for central
venous catheters. Use of PICC is indicated for all types of intravenous therapies. PICC is most
commonly used for patients requiring long-term therapy such as antibiotic therapy and
chemotherapy (Cooper, Kelly & Brown, 2017).
PICC has been recommended to be implemented in the surgical ward because of several
advantage associated with the product compared to other VADS. Catheter handling is generally
regarded as a burden in hospital setting because of increase in risk of catheter related infection.
However, the main advantage of PICC is that it is easily inserted allowing both drug infusion and
blood sampling. In this way, it lessens the risk of central venous catheter infection (Park, Jun &
Oh, 2016). Because of high satisfaction with users, the use of PICC has increases significantly in
clinical setting. There are numerous evidences that reports association between the use of PICC
and patients and caregivers satisfaction with the product. For example, the study by Chopra et al.
(2015) investigated about the patterns of use and outcomes related to PICC use in a skilled
nursing facility. The study reported that PICC provides many advantage to hospitalized
individual particularly older adults. This is because it reduces length of hospital stay and costs
related to intravenous treatment. Rickard (2018) investigated about the efficacy of PICCs
compared to peripheral catheters by means of randomized controlled trial. By the use of
questionnaires, patient satisfaction with the product was evaluated and patient satisfaction level
was found to be higher for PICC group compared to the PC group. Hence, PICC was found as a
more efficient product compared to PC.
This briefing report is focussed on developing a proper implementation plan for the PICC
product mainly because of several arguments related to PICC associated complications. As

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evidence has given idea about major complications such as CLABSI (Catheter Line Associated
Bloodstream Infection) and VTE because of PICC use, efforts to improve the implementation of
the product may help prevent this limitation (Chopra et al., 2015). For example, the
implementation plan could focus on implementing best methods to secure and care for PICCs.
Implementation plan:
To achieve high rate of positive patient outcome and high quality of care for patients in
the Royal Hospital, it has been planned to develop several implementation strategies to
successfully adapt PICCs in clinical setting. While preparing implementation plan for PICC use,
main attention has been given to factors that would facilitate minimizing errors and achieving
positive patient outcome with the use of product. The following are the implementation
strategies/recommendation to successful integration of PICC in the acute care unit of the Royal
hospital and recommendations has been listed in order of priority:
1. Consider selection of suitable device and addressing challenges with the use of
product: To ensure that PICC is implemented in Royal hospital without any risk of
patient safety issue, it is planned to consider the proper insertion and maintenance of
PICC, identify suitability of device for patients receiving different therapy and address
patient and staffs factors leading to risk of difficulties. Following this recommendation is
important because Ma et al., (2018) have indicated that PICC use may not be beneficial
for patient unless it is maintained in an appropriate manner. Teaching nursing staffs about
proper insertion technique and care of PICC is important as it may contribute to incidence
of malpositioned catheter. Chen et al. (2018) gives the support that malpositioned
catheter may contribute to pain and discomfort for patient and also lead to serious

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consequences. Hence, as the main rationale behind the use of PICC is to minimize risk of
complications for patients receiving long-term intravenous therapy in the Royal hospital,
it is recommended to teach staffs regarding proper insertion and identification ideal
location for PICC. Education sessions related to catheter care and maintenance is
important to enhance nursing staff’s knowledge about effective management of the
catheter. In addition, it is also planned to recruit tem of trouble shooting experts so that
repair catheters instantly when staff’s may encounter challenges in insertion even after
education and training regarding proper care of the device. This recommendation is in
relevance with the knowledge translation principles too as the process will facilitates
creation of new knowledge and its application in target setting too (Marais & Meylaerts
2018).
The above recommendation has been give top-most priority because nursing staff’s skills and
knowledge related to proper use of device will determine the success of the product. The
common challenge that is faced during use of new device is that staff’s experience many barriers
to use. The review of evidence on the application of the device and barriers faced may help to
estimate barrier that existing staffs at the Royal Hospital may encounter after implementation of
devices. Harrod et al. (2016) investigated about PICC care practices and documentation by
conducting informal interviews with patients and their nurses. Variations in documentation was
observed and several barriers in improving practice and safety was observed. This included
inadequacy of information during care transition, limited availability of resources and gaps in
training and education. Hence, taking cue from this evidence, addressing these type of barriers
before the implementation of PICC will be necessary in the selected clinical setting.

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Development of a well-structured staff education plan will be necessary. This recommendation
should be implemented at least three months prior to implementation of the product.
2. Implement patient education sessions and improve information exchange: It is also
recommended to conduct patient education session at the setting before the use of PICC
because many patient related factor may also lead to ineffectiveness of the device.
Physicians or nurse managers at the hospital must be encouraged to explain patient and
guardian regarding the necessity of catherisation. Some of the common complications
that may occur due to the use of PICC may include occlusion of the PICC line, deep vein
thrombosis, thrombophlebitis and many other types of infection. As poor maintenance
tecgnique and failure to follow aseptic technique may contribute to issues for patient,
patient and family education has been included as one of the standards of practice for
Oncology Nursing Society. Effective patient education would help to provide the infusion
therapy safely and reduce risk of PICC related complications. Patient educating in the
setting should focus on rationale for using PICC and increasing awareness about when to
contact health care staffs if complications occurs after PICC use (Petroulias, 2016). This
recommendation is the second-most important priority area as both patient and staffs
factor will guarantee success of the implementation plan.
3. Adapt control measures and adapt environmental risk associated with the use of
product: The third most important priority area in the implementation plan is controlling
environmental risk in relation to the use of PICC. Focussing on this area would help to
modify the other additional risk factors in the setting. This recommendation is important
because aseptic technique is important while inserting PICC line. Hence, environmental
control measures like pulled curtains and closed door should be included in the procedure

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involving PICCs in the selected setting. This has been prioritized in the Department of
Health Guidelines for PICC too (Department of Health 2018).
4. Develop appropriate location and resources for using the product: Considering
availability all resource related to a process or product is also a vital factor for effective
application of the intervention in target setting. To promote use of PICC in Royal
hospital, it will be necessary to set up sterile fields before insertion procedure. In
addition, all necessary medical supplies needed during the procedure should be available
in a trolley for nursing staffs. The staffs should be encouraged to keep them in close
proximity. This would promote patient safety and control likelihood of infection. The
NICE guidelines for care and maintenance of PICC mentions having all equipments
related to aspectic technique in close proximity while inserting PICC lines (NICE 2014).
5. Implementation of adequate record keeping: The fifth and the last recommendation is t
maintain appropriate record and documents related to number of PICC procedure
completed in the Royal Hospital. The documentation should focus recording time and
date of insertion, name of operator, length of line on addition and elimination, location,
observation site and skin preparation solution used. The advantage of maintaining such
document is that these records can be reviewed and analyzed when any patient risk event
arise due to PICC use. The record can give vital data related to the cause of PICC related
complication. This step should be implemented one month prior to introduction of PICC.
Conclusion:
To conclude, the main purpose of this briefing report was to suggest the utility of PICC
use in long-term care facility and maximize the effectiveness of the device by the development
of appropriate care and maintenance strategy for the use of PICC. As the critical review of

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evidence has revealed that PICC use may also lead to complication, hence focusing on
appropriate implementation and maintenance of care of PICC is vital to ensure that nursing staffs
present in the acute care ward of Royal hospital provide high quality care. Following the above
mentioned recommendation is vital for Clinical Procurement Team of the hospital to support
nursing staffs to effectively use PICC procedure in daily practice.

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References:
Brownson, R. C. (2017). Dissemination and implementation research in health: translating
science to practice. Oxford University Press. Retrieved from:
https://books.google.co.in/books?
hl=en&lr=&id=ycM9DwAAQBAJ&oi=fnd&pg=PP1&dq=Dissemination+and+impleme
ntation+research+in+health:
+translating+science+to+practice.&ots=bnN7RFJ0aK&sig=eudAmQThUQc2y0N6DikTj
T5iG3E#v=onepage&q=Dissemination%20and%20implementation%20research%20in
%20health%3A%20translating%20science%20to%20practice.&f=false
Chen, W., He, L., Yue, L., Park, M., & Deng, H. (2018). Spontaneous correction of misplaced
peripherally inserted central catheters. The international journal of cardiovascular
imaging, 1-4. https://doi.org/10.1007/s10554-018-1321-5
Chopra, V., Montoya, A., Joshi, D., Becker, C., Brant, A., McGuirk, H., Clark, J., Harrod, M.,
Kuhn, L. and Mody, L., 2015. Peripherally inserted central catheter use in skilled nursing
facilities: a pilot study. Journal of the American Geriatrics Society, 63(9), pp.1894-1899.
doi: 10.1111/jgs.13600
Cooper, A. L., Kelly, C. M., & Brown, J. (2017). Exploring the patient experience of living with
a peripherally inserted central catheter (PICC): A pilot study. Australian Journal of
Cancer Nursing, The, 18(1), 10. Retrieved from:
https://search.informit.com.au/documentSummary;dn=163161687343520;res=IELHEA

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Department of Health. (2018). Peripherally inserted central venous catheters (PICC). Retrieved
from: https://www.health.qld.gov.au/__data/assets/pdf_file/0032/444497/icare-picc-
guideline.pdf
Harrod, M., Montoya, A., Mody, L., McGuirk, H., Winter, S., & Chopra, V. (2016). Challenges
for nurses caring for individuals with peripherally inserted central catheters in skilled
nursing facilities. Journal of the American Geriatrics Society, 64(10), 2059-2064.
doi: 10.1111/jgs.14341
Keogh, S., Flynn, J., Marsh, N., Higgins, N., Davies, K., & Rickard, C. M. (2015). Nursing and
midwifery practice for maintenance of vascular access device patency. A cross-sectional
survey. International journal of nursing studies, 52(11), 1678-1685.
https://doi.org/10.1016/j.ijnurstu.2015.07.001
Ma, D., Cheng, K., Ding, P., Li, H., & Wang, P. (2018). Self-management of peripherally
inserted central catheters after patient discharge via the WeChat smartphone application:
A systematic review and meta-analysis. PloS one, 13(8), e0202326. doi:
10.1371/journal.pone.0202326
Marais, K., & Meylaerts, R. (Eds.). (2018). Complexity Thinking in Translation Studies:
Methodological Considerations. Routledge. Retrieved from:
https://books.google.co.in/books?
hl=en&lr=&id=i_l0DwAAQBAJ&oi=fnd&pg=PT7&dq=Complexity+Thinking+in+Tran
slation+Studies:+Methodological+Considerations.
+&ots=UOYGu5x3nD&sig=1ft60mqGt55hchzF_kFcRSnfSRc

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NICE 2014. Guidelines for the Care and Maintenance of a Peripherally Inserted Central
Catheter (PICC). Retrieved from:
https://www.nice.org.uk/guidance/mtg34/resources/guidelines-for-the-care-and-
maintenance-of-a-peripherally-inserted-central-catheter--velindre-cancer-centre-pdf-
4481503170
Nunes, M. D. R., Ferreira, G. R., Silva-Rodrigues, F. M., Rodrigues, B. M. R. D., de Araújo
Pacheco, S. T., & Nascimento, L. C. (2016). Knowledge and Care related to Peripherally
Inserted Central Catheter (PICC) in Pediatrics and Neonatology Nursing: an Integrative
Review. International Journal of Nursing, 3(2), 1-8. DOI: 10.15640/ijn.v3n2a1
Park, K., Jun, H. J., & Oh, S. Y. (2016). Safety, efficacy, and patient-perceived satisfaction of
peripherally inserted central catheters in terminally ill cancer patients: a prospective
multicenter observational study. Supportive Care in Cancer, 24(12), 4987-4992.
Retrieved from: https://link.springer.com/article/10.1007/s00520-016-3360-6
Petroulias, P. L. (2016). The Relation Between Patient Education And Picc Line Occlusion.
Retrieved from:
https://pdfs.semanticscholar.org/b134/cecf118d196bddb0639ed833f346d59fb1d9.pdf
Rickard, C. M. (2018). How Does Your PICCOMPARE? A Pilot Randomized Controlled Trial
Comparing Various PICC Materials in Pediatrics. Journal of hospital medicine.
DOI: 10.12788/jhm.2847