Orientation to a new job can be an anxiety-producing experience, particularly when the job is specialized, such as that of an infusion therapy nurse at a comprehensive cancer center. With a team approach and using a variety of teaching/learning strategies, as well as individualizing the education plan on the basis of the learner, the orientation process at The University of Texas M.D. Anderson Cancer Center has evolved. The current orientation program fosters the initial development of nurses who, in time, are recognized as experts in infusion therapy.
Since its inception in early 2000, Vanderbilt University's Peripherally Inserted Central Catheter (PICC) Service has experienced a high level of success as measured by high proficiency rates and increasing patient procedures each year, low complication rates during and after PICC placements, and an increasing scope of influence within the Vanderbilt University Medical Center and Children's Hospital, the surrounding community, and in the Southeastern United States. Primary drivers of the PICC Service's continuing success include consistent applications of technique and technology, a data-driven approach to assessing the program's progress, and appropriately managing customers' expectations and needs. Over the past five years, data were collected on more than 12,500 PICC placements performed in this specialized nursing program. Retrospective analyses of the data demonstrate an increasing rate of successful placements (from 87.2% to 92.4%) since the program's inception in 2000 to late 2004. Furthermore, the choice of PICC technology has had a significant impact on the odds for occlusion or infection. The Vanderbilt PICC Service provides a model by which other programs can be established, maintained, and expanded into advanced practice.
Background: Catheter-related blood-stream infection (CRBSI) is a serious and costly complication associated with central venous catheters. Nursing interventions that focus on decreasing bacterial colonization at the insertion site could decrease infection rates. Method: This retrospective study examined CRBSI in patients requiring peripherally inserted central catheters (PICCs) for total parenteral nutrition. One hundred and ninety-two patients with 235 catheters and an average dwell time of 11.5 days participated. Nursing interventions included a chlorhexidine-impregnated sponge dressing and a double skin scrub prior to insertion. Conclusion: The results of the study show that the interventions did not reduce CRBSI in the target population but the double skin scrub did decrease CRBSI in the general PICC population.
A knowledgeable, skillful staff of health care providers is critical to enhance clinical outcomes for patients; however, there can be much confusion about the processes used by educators to support and develop staff. Although adult-learning principles should be used, it is also important to remember that not all clinical performance problems require an educational approach. Published literature of educational programs that have been documented to reduce catheter-related complications is reviewed along with key concepts of learning needs assessment, transfer of learning, and staff development resources.