Michigan Appropriateness Guideline for Intravenous Catheters and the Impact on Utilization and Infection Ratios in Peripherally Inserted Central Catheters

Problem Statement: Adult patients are at increased risk for central line-associated bloodstream infections when central line utilization rates are increased and are inserted inappropriately, based on patient criteria. Purpose: Determine if utilization of the Michigan Appropriateness Guidelines for Intravenous Catheters (MAGIC) will reduce central line utilization ratios (focusing on peripherally inserted central catheters (PICC)) and reduce risk of central line-associated bloodstream infections among an adult population in the Trauma Surgical Care Unit (TSCU) and Medical Intensive Care Unit (MICU) at a tertiary care center in the South Carolina Pee Dee Region. Methods: The Plan Do Study Act (PDSA) quality improvement model was used to determine if implementing MAGIC reduced utilization and infection ratios in the TSCU and MICU at a tertiary care center (Moran, K. et al., 2019). Patients 18 years and older, in the TSCU and MICU prompted for central line placement were included in this DNP project. The intervention included the implementation of MAGIC, prior to insertion of a central line, to determine the appropriateness. Analysis: Pre and Post implementation standard utilization ratios (SUR) and pre and post standard infection ratios (SIR) were compared and no statistically significant change was identified. PICC insertions did decrease during the pilot but did not impact the SUR or SIR in the TSCU and MICU. Implications for Practice: MAGIC will assist the PICC insertion team, bedside staff, physicians, and medical residents to determine if a PICC line is appropriate for the patient prior to insertion. This may reduce the risk of inappropriate insertion, decrease inappropriate utilization, and decrease the risk of infection leading to cost reduction of treating a patient for a hospital-acquired infection from a PICC line