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 caredelivery@health.qld.gov.auChi-Keung 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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