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Becton, Dickinson and — Conference Presentation (April 2020)
22 slides from Becton, Dickinson and's conference presentation, April 2020
Slide 1: Presenter views disclaimer
These presentations were developed by the respective presenter(s), and the findings, interpretations, and conclusions contained or expressed with them do not necessarily reflect the views of BD. To the extent these presentations relate to specific products, such products should always be used in acc
Slide 2: Procedural standards and technologies for the PICC placement, guidelines and local policy
Procedural standards and technologies for the PICC placement, guidelines and local policy Serena Pagani Chief Nurse, Outpatient areas Humanitas Clinical and Research Center – IRCCS Rozzano, Milan Italy Edinburgh, 17th Jan 2020
Slide 3: Humanitas Research Hospital
Humanitas Research Hospital HUMANITAS 9 HOSPITAL IRCCS UNIVERSITY IN ITALY HIGHT SPECIALIZED JCI 2
Slide 4: The Lean
The Lean THE LEAN THINKING (TOYOTA PRODUCT SYSTEM) REDUCE MAKE PEOPLE WASTEFULNESS ACCOUNTABLE STANDARDIZED PROCESS = change = positive 3
Slide 5: Observation: Project «Chest X Ray? No thanks»
Observation …Project «Chest X Ray? No thanks» The project “Chest X Ray? No thanks” born in the lean thinking In Humanitas Hospital about 1200 PICCs are placed each year by specialized nurses To ensure correct catheter placement, until 2015 a Chest X-ray is performed for all patients. 4
Slide 6: Standard in checking TIP position
Standard in checking TIP position TIP position of a central venous access is crucial and should be verified before standing infusion Guidelines (ESPEN 2009 and INS 2016): - Chest X ray - CT scan - Trans-thoracic echocardiography - Trans-esophageal echocardiography Pro Cons Low false positive and fal
Slide 7: Quality from the patient's point of view
Quality from the patient’s point of view analysis of value flows critical issues another point of view It was necessary to set the process based on a pull instead of a push approach, using radiographic check only when necessary.
Slide 8: Standard procedures in Humanitas: the 2014-2015 experience
Standard procedures in Humanitas: the 2014-2015 experience We followed up patients who underwent PICC procedure in the period 2014- 2015 to evaluate: • Time for PICC • Time for transport in Radiology • Time for waiting for chest x-ray • Time for X ray • Time for report sign-out PICC Waiting for ches
Slide 9: Are there alternatives? analysis of processes
Are there alternatives? analysis of processes 1- Interviews with patients who underwent the procedure 2- Interviews with hospital staff (nurse, radiology technician, radiologist) 3- Analysis of patients clinical pathways Catheter placement: 1 hour Waiting time (radiographic control): >4 hours Value
Slide 10: There are alternatives!
There are alternatives ! Scientific literature has shown that the intracavitary ECG technique is a valid alternative. The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study. Pittiruti M, et al. J Vasc Access 2012; 13: 357-365 Study:
Slide 11: Devices in use
Devices in use Electromagnetic tracking Dedicated US system Advanced iECG Tip in superior Cava Automatic P wave detection Easy interpretation Audio clues
Slide 12: ECG evaluation in placing the tip
ECG evaluation in placing the tip External validation Tip in superior Cava Intracaval validation ECG showing maximum P-wave elevation, indicating tip position at the cavoatrial junction. The P-wave in the ECG is formed by the electrical activity of the atria. As the PICC is advanced in the sheath, t
Slide 13: The project in Humanitas
The project in Humanitas Pilot study To compare tip position by chest x-ray control versus ECG control Follow up analysis March 2015-March 2016 Patients 1200 Hypothesis Save waiting time for patients before therapy using the LEAN system ….But waiting time of patient was not the only MUDA…
Slide 14: The «Muda» of the process
The «Muda» of the process ▪ Movimentation of patients in Radiology Department ▪ Overprocessing of x-ray ▪ Radiation exposure ▪ Waiting time of patients before therapy of Radiologist for report of nurse who checks the availability of report before starting therapy
Slide 15: Patient characteristics after 6 months (600 PICC)
Patient characteristics after 6 months (600 PICC) Mean age 62 (19 – 92) Gender • Female 309 (51,5 %) • Male 291 (48,5 %) Clinical indication Indication for PICC • Chemotherapy 288 (48 %) 16% • Antibiotics/other 216 (36 %) • Parenteral therapy 96 (16%) 48% 36% Site of introduction • Basilic vein DX 1
Slide 16: Results after one year
Results after one year Tot 1200 pts have been succesfully monitored in both x-ray and ECG 1. 3.600 hours in waiting by patients 2. 1.200 chest x-rays performed Not value time 3. 91 hours for radiological report 4. 91 hours for X-ray PICC Waiting for chest x-ray Waiting for report 60 min 5 120 min 5
Slide 17: Yesterday vs today
YESTERDAY TODAY 1- PICC positioning 1- PICC positioning with ECG 2- Request for chest x-ray 2- Closing outpatient report 3- Waiting before going to Radiology 3- Authorisation to use the device 4- Transportation to Radiology 5- Waiting for exam 6- X-ray 1h 7- Waiting for response 8- Sign out x-ray re
Slide 18: Results: % x-ray for PICC
Results % x-ray for PICC 100% 100% 90% 80% 70% 60% 50% 40% 30% 20% 20% 13% 15% 10% 0% until Jun 2016 All 2016 2017 2018 Since 2016, every year more than 1000 patients have placed the PICCs in the clinic without performing chest X-RX, without complications 17
Slide 19: Advantage of the new approach: conclusion
Advantage of the new approach: conclusion This new approach has 1. Improved quality of patient care 2. Reduced patient stress PICC with ECG 3. Reduced movement of patients and hospital personnel 60 min therapy 4. Immediate control of tip position during the procedure 5. Reduction of waiting time bef
Slide 20: What's awaiting us?
What’s awaiting us? The time saved could pay off in terms of cost-effectiveness WORK IN PROGRESS Publish an article on an economy magazine before the end of 2020
Slide 21: Project presented and awarded
The project «Chest X ray? No thanks» has been presented to Humanitas Lean Congress 2016. In 2018 «Chest X ray? No thanks» has been awarded as Best project in healthcare category in «Lean Healthcare and Lifescience Award 2018» in Florence (Italy) In 2018 march has been pubblished in Harvard Business
Slide 22: Thank you for attention
Thank you for attention Whatever you think or dream of accomplishing initiates ... Boldness has genius, power and magic in it (W. Goethe)
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