Training Forum
Lines and Devices Pressure Injury Prevention and Wound Management Optimisation
• Go Live - Tuesday 30 July• Affected iView sections need to be documented back on paper
for ~2 days (TBC)• Implementation plan being discussed with digital hospital teams• Non-production (CERT) build due to be complete after 12 July• Demonstrations to key clinical stakeholders TBC (after 12 July)• Reporting and Dashboard updates (to be managed locally)
Timeline and Implementation
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Central resources for HHS ieMR sites: • Statewide Fact Sheets and QRG’s
• Statewide training materials
• Change management and communication documents
• Implementation plan
Site Requirements: • In-services- to be managed by local HHS
• Site specific training materials- to be updated by individual sites
• Site specific QRG’s- to be updated and uploaded by individual sites
Training Approach
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Optimisation
Lines and Devices
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• Peripheral, Central and Subcutaneous Lines aligned
• Addition of Midline dynamic group• Care Compass (Activity View) and Interactive
View aligned • Interactive View simplified • New reference text • New automated care tasks to prompt best
practice
Overview
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Improved clinical workflow • Less clicks per assessment • Less documentation time • Automated care planning orders placed• Direct navigation from orders in Care Compass to assessments • Consistent with Clinical Guidelines
Decreased risk/incidents of Blood Stream Infections • Increased compliance with removing cannulas exceeding recommended dwell time• Increased compliance with assessment and documentation of assessments monitoring for signs of phlebitis• Reduction in associated cost incurred by HHS
Decreased FTE hours spent manually adding removal sites • Vascular surveillance teams
Benefits
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• PIVCs with dwell times exceeding guidelines increase the patients risk of developing blood stream infections (BSI)
• The current clinical guidelines recommends that peripheral cannulas are not left insitu for greater than 72-96 hours
• or under 24 hours for PIVCs from QAS, external facilities or inserted in an emergency situation (eg MET/RRT call)
• Clinical audits of QLD hospitals demonstrate missing documentation, very few removal tasks and overdue PIVCs
Background Peripheral IV cannula dwell times
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Peripheral IV CannulasiView updates:• Long cannula catheter type available for patients less than 16 years of
age
• iView order of questions have been updated
• Updated responses
• Removal of unnecessary data fields- improved workflow
• New reference text
• Dressing score – intervention based assessments
• Automated PIVC line care (TDS) and removal/re-site orders
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Central Lines• New insertion confirmation details• Additional measurements • Paediatric specific needle sizes• Conditional logic has been applied to customise assessments
dependent on number of lumens• Dressing and patency scores – intervention based
assessments • New reference text
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Midline Catheters • New Dynamic Group (previously in Peripheral IV)
• Assessments and responses aligned with peripheral and central lines• Activity View and Interactive View aligned • Available on the Lines/Tubes/Drain Summary page • Reference text added to assist clinicians with midline use
• Automatic Midline Catheter Care task (TDS)upon insertion. Automatic ceasing upon removal.
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Subcutaneous Lines • Dynamic Group updated• Assessments and responses aligned with peripheral,
central and mid lines• Activity View and Interactive View aligned
• Creating dynamic group and documenting Activity will add to this page• Midline and Subcutaneous appear under Peripheral IV heading• Insertion Date/Time (and Duration) based off D/T of iView documentation
Lines/Tubes/Drains Summary mPage
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• Midline will be added to existing widget on Assessment tab of Patient Summary mPage
Lines, Tubes, and Drains widget
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Key Training Points• Line Insertion:
• Document Activity, Inserted by and Inserted in emergency situation
• Document once per encounter only
• mPage shows iView date/time of Activity = Insert new site or Present on admission/transfer
• Central Lines have additional insertion confirmation questions now
• Routine assessment/Line care:• to be completed from *INDICATION down to reduce possibility of duplicate removal tasks (in
PIVC)
• Light blue text has additional information (REF text)• Document Activity = Discharged with line insitu where appropriate• Line Removal
• Document Activity, Removal and Removal reason
• Inactivate dynamic group
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Key Training Points• Check your site’s policy with use of Central line PowerPlans
• NB some powerplans currently being updated with medication order sentences
• Ie Central Venous Line Adult, Central Venous Line Paediatric, PICC Adult, PICC Paediatric, Port Paediatric, Portacath Adult
• Modify/Discontinue orders as required• Modify line care order frequency as appropriate (eg change TDS to hourly for infusions)
• Cancel/discontinue Peripheral IV Care order after all PIVCs have been removed (vs Midlines should auto cancel)
• Cancel/Discontinue Peripheral IV Removal/Re-site if PIVC has been removed prior to system generated date/time
Detailed changes
Lines and Devices
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• Changes to:- Catheter type- Order of information (laterality before site)- Simplification of site options- Removal of catheter size: 21 gauge
PIVC dynamic group:
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• Questions Re-Ordered• Addition of:
Ultrasound used (competent staff only)Dressing score
• Removal of:Dressing condition
• Capitalisation of Indication: *INDICATION Visual cue for line care documentation
• Wording changes: Inserted in emergency situation (To reflect insertion during eg MET/RRT call as this question is not in relation to being inserted when the patient is in the Emergency Department)
• Rename Line status to Line patency
Summary of PIVC changes
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Currently in PROD
NEW design
• Change to ActivityResponses:
- Addition of Discharged with line insitu
PIVC (cont)
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• PIVC Activity• and Orders:
• Peripheral IV Care• Peripheral IV Insertion• Peripheral IV Removal/Re-site
New reference text
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• Inserted by: Removal of free text response
• Addition of Ultrasound used (competent staff only)
PIVC (cont)
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System generated automated tasks for PIVC care:• Improving assessment and monitoring compliance to reduce incidents of undetected phlebitis (TDS)
• Generated from documenting Activity = Insert new site or Present on admission/transfer
• One order/task (even if multiple PIVCs) ∴requires manual cancelling when all PIVCs removed
System generated automated tasks for Adult PIVC removal:• Dynamic group label within order comments – separate removal tasks for each PIVC
• Improving removal compliance to reduce incidents of PIVCs exceeding recommended dwell time and increased likelihood of BSI’s.
• Patients greater than 16 years only
Automated PIVC Tasks (ED and Inpatients)
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• Lines inserted by an Ambulance or External facility should be removed/re-sited by 24 hours post insertion*
• Lines inserted during an emergency situation (i.e. MET call) should be removed/re-sited by 24 hours post insertion*
• Lines inserted within Own facility should be removed/re-sited 72-96 hours post insertion** (hours dependent on hospital policy)
• It is important that this is documented for every PIVC inserted ONCE in order for the removal rule to fire appropriately
Automated Adult PIVC removal tasks
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• Line patency and Site condition: removal of free text option
PIVC (cont)
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• Change to Line Care responses with the addition of Administration set changed
PIVC (cont)
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• Phlebitis score (now clearer)
Reference Text
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• Addition of Dressing Score with reference text
PIVC (cont)
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• Change to Site Care responses
PIVC (cont)
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• Site check (now clearer)
Reference Text
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Intended for paediatric use
• Changes to:- Central IV access type
- Addition of Intraosseous- Removal of Interosseous
- Order of information (laterality before site)
Central line dynamic group
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• Re-ordering of questions• Addition of:
External catheter lengthInternal catheter lengthTotal catheter lengthDressing scoreLumens present (conditional logic)
• Removal of:Centimeter marking at insertion siteDrainage
• Wording changes:Tip position confirmed by
Central line changes
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Currently in PROD
New Design
• Activity responses updated inline with PIVC• Addition of Discharged with line insitu
Central line (cont.)
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• Additional question when Activity = Insert new site
• Venous trace on CVL transduction
• Radiographic confirmation renamed to Tip position confirmed by
• Responses updated
Central line (cont.)
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• Additional Portacath needle sizes• ½ inch• 5/8 inch
Central line (cont.)
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• Indication field moved and renamed to *INDICATION for consistent routine assessment/line care documentation
• Updated responses
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Central line (cont.)
• New Site Care responses
Central line (cont.)
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• Dressing score added in line with PIVC• Same reference text
Central line (cont.)
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• New Lumens present field• Additional responses will show upon documentation
Central line new conditional fields
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• New responses and REF text for Lumen patency score• New responses for Lumen activity
Central line new conditional fields
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• New dynamic group (previously part of Peripheral IV dynamic group)
Midline dynamic group
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• Introduction of specific Midline section• Aligned with Peripheral IV and Central Line
documentation updates and design • Addition of:
External catheter lengthInternal catheter lengthTotal catheter lengthDressing score
• Removal of:Dressing condition
• Wording changes: Inserted in emergency situation (To reflect that this question is not in relation to a line being inserted when the patient is in the Emergency Department)
Midline changes
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Currently in PROD
NEW design
• Activity responses align with CVL and PIVC
• Addition of Discharged with line insitu
Midline (cont.)
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• Inserted by aligning with other lines
Midline (cont.)
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• Generated from single field of Activity = Insert New Site or Present on admission/transfer
• Only one Midline Catheter Care order will exist in the encounter
• TDS (0800, 1400, 2000)• System to automatically discontinue order once Activity =
Discontinued
Automatic Midline rule (ED and Inpatients)
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• Measurements aligned with Central lines
• Mid arm circumference• External catheter length• Internal catheter length• Total catheter length
• Unit of measure = cm
Midline (cont.)
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• Renamed Indication to *INDICATION to be in line with PIVC/Central Lines (and assist as a visual cue with line care documentation)
Midline (cont.)
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• Line care aligned with other lines
Midline (cont.)
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• Site condition aligned with other lines
Midline (cont.)
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• Site care aligned with other lines
Midline (cont.)
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• Dressing score aligned with other lines
• REFerence text
Midline (cont).
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• Lumens present (max = 2 lumens) and subsequent questions with conditional logic as per Central Lines
• REF text with Lumen patency score as per Central Lines
Midline (cont.)
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• Changes to:- Catheter type- Order of information (laterality
before location)- Simplification of site options
Subcutaneous Line dynamic group
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• Re-Ordering of questions• Addition of:
Inserted byDressing score
• Removal of:DressingDressing conditionDressing activityPatencyEquipment Procedure result Number of attempts
• Rename Line status to Line patency
Subcut changes
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Currently in PROD
NEW design
• Change to Activity Responses:
- Addition of Discharged with line insitu
Subcut (cont.)
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• Updated Line removal options in line with Central Lines• Inserted by: Removal of free text response
Subcut (cont.)
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• Line patency: removal of free text option
• Site condition: aligned with other lines
Subcut (cont.)
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• Line care addition of Administration set changed
• Site care responses updated
Subcut (cont.)
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• Dressing score added with REF text
Subcut (cont.)
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Contacts
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Care Delivery team [email protected] Lee Care Delivery SME (Allied Health), eHealth QueenslandKylie Short Care Delivery SME (Allied Health), eHealth QueenslandBraden O’Callaghan Care Delivery SME (Nursing), eHealth QueenslandJenny Cooper Care Delivery SME (Nursing), eHealth QueenslandKerri Holzhauser Nursing Director eHealth Mentor, Metro South HealthDannica Bell ieMR Nursing SME, QCHHeather Reid ieMR Nurse Manager, QCHArchana Rakop Senior Application Specialist, DAS ieMR
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