Challenges for Nurses Caring for Individuals with Peripherally Inserted Central Catheters in Skilled Nursing Facilities.
To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs.



Exploratory, qualitative pilot study.



Two community based SNFs.



Residents with PICCs, frontline nurses (RNs, LPNs), unit nurse managers, and SNF administrators.



Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach.



Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety.



Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety.
Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan.
Molly
M
Harrod
Geriatric Research, Education and Clinical Center, University of Michigan, Ann Arbor, Michigan.|Division of Geriatric and Palliative Care Medicine, University of Michigan, Ann Arbor, Michigan.
Ana
A
Montoya
Geriatric Research, Education and Clinical Center, University of Michigan, Ann Arbor, Michigan.|Division of Geriatric and Palliative Care Medicine, University of Michigan, Ann Arbor, Michigan.
Lona
L
Mody
Patient Safety Enhancement Program, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Helen
H
McGuirk
Patient Safety Enhancement Program, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Suzanne
S
Winter
Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan. vineetc@umich.edu.|Patient Safety Enhancement Program, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan. vineetc@umich.edu.
Vineet
V
Chopra
D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods / Q000451:nursing / Q000523:psychology; D003144:Communication Barriers; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D020380:Needs Assessment; D009732:Nursing Care / Q000592:standards / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000458:organization & administration / Q000592:standards; D010360:Patient Transfer / Q000592:standards; D058996:Quality Improvement; D011788:Quality of Life; D012866:Skilled Nursing Facilities / Q000458:organization & administration / Q000592:standards
communication; nursing care; peripherally inserted central catheter; skilled nursing facility