Thread by @vineet_chopra

🧵 “How can I improve #PICC safety in my hospital?”

I’ve received many questions like this following the recent publication of our @BMJ_Qual_Saf paper showing how we did this in 50+ hospitals.

qualitysafety.bmj.com/content/early/…

Today, we released the formula (Thread)

@BMJ_Qual_Saf First, head over to improvePICC.com and click on “Implementation” in the top menu - this will take you to the Roadmap for Quality Improvement.

@BMJ_Qual_Saf Then, pause for a moment.

You’re about to go on a journey - a #qualityimprovement journey.

Look for your markers, prepare yourself for change!

@BMJ_Qual_Saf The journey begins with two phases, or tiers.

Tier 1: These are foundational steps you need to put in place to improve #PICC #appropriateness and #ptsafety.

As Avedis Donabedian has taught us, You cannot tackle problems with structure. Here is the structure.

@BMJ_Qual_Saf Your Tier 1 Steps begin with convening a hospital-wide vascular access committee.

Some tips:
1\ Bring all stakeholders, specialties and groups together

2\ Have a designated committee lead

3\ Review data - you have to know where your gaps are to improve

@BMJ_Qual_Saf Step 2:

Use a #decisiontool to improve outcomes. I’m biased of course, but #MAGIC was what we used in @HMS_MI and it worked!

Matters less what tool you use, matters more that you use something #evidence-based for decisions

Have your committee agree on the tool!

@BMJ_Qual_Saf @HMS_MI Focus on three areas:

1\ Short-term PICC use (<5 days)
2\ Unnecessary multi-lumen catheter use
3\ PICCs in #CKD

There is little debate that these are the right things to do - among all groups. So get to it!

@BMJ_Qual_Saf @HMS_MI Give your Tier 1 steps time.

Change doesn’t happen overnight

There will be pain, frustration.

But the key is you are talking, using data to make decisions, and committing to come together to improve care.

Remember the proverb!

@BMJ_Qual_Saf @HMS_MI Once you have Tier 1 in place, now start looking at complications

Thats where you move to Tier 2

@BMJ_Qual_Saf @HMS_MI Tier 2 provides in depth strategies for preventing:

#CatheterOcclusion
#CLABSI
#DVT and VTE

@BMJ_Qual_Saf @HMS_MI Tier 2 offers #evidence-based strategies, starting from low-tech, low-effort, low-cost to progressively more challenging and capital intensive steps.

You should start to see improvement in early steps, but remember, you have to stay committed!

@BMJ_Qual_Saf @HMS_MI A few final thoughts:

#QI is not easy, it takes a village

You need a system - the Tiers and Path we have provided gives you one

We are all learning, so please bring back what you experience and learn here

Remember, it’s all about #ptsafety. Thats why we must do this.

-Fin-

Pinging key #safety leaders and stakeholders:

@AVATAR_grp @Claire_AVATAR @eliowa @CarlosdelRio7 @ISaveThatLine @TheIHI @ins1org @sanjaysaint @Atul_Gawande @SocietyHospMed @SHEA_Epi @CDCgov @acphospitalist @ACPinternists @IDSAInfo @FutureDocs @PeterPronovost