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FAQ/HELP 1. Why use an online line insertion procedure note? 2. Who created this site? What's going on here? What's this all about? 3. I don't get one of the questions on the form? What information am I supposed to supply?
FAQ 1. Why use an online line insertion procedure note? There are two goals behind providing this procedure note. First, we wanted to provide a quick way to document a line insertion completely and legibly, in order to improve our overall documentation in the hospital, and to assist anyone who is trying to insert a similar line in the same patient in the future. Plus, after you use the form a couple of times, it is actually quicker than writing out a note by hand. The other reason this form was created is to assist in data collection regarding line insertion in our hospital. There are several efforts being undertaken to reduce line associated infections and complications, but before we know what can be addressed, we need to know how, where, and by whom lines are being inserted in our hospital. By using this form, your responses are collected automatically (and anonymously) and incorporated into a database that will help us to address quality improvement efforts appropriately. In the end, you are helping to improve patient safety in our hospital. 2. Who created this site? What's going on here? What's this all about? This form was created by a group of internal medicine residents, in collaboration with the St. Paul's ICU staff, as part of a quality improvement initiative aimed at improving patient safety in the ICU. Catheter related blood stream infections have been well documented to be one of the major risks critically ill patients face in any hospital, and we would like to reduce the rate in our facility. Thanks for helping us achieve this goal, by using this online form. 3. I don't get one of the questions on the form? What information am I supposed to supply? Check out the help tips below. There is a tip explaining each of the questions on the form. You can also link directly to the individual tips by clicking the relevant link on the form itself.
MRN - please enter the 8 digit patient MRN, including leading zeros if necessary. This is the only required field on the page. Procedure - was this a new line, or did you rewire a line? Pick the right one. Side - right or left (the patient's, not yours). Pretty self-explanatory, really. Site - what vein (or artery) did you put the line in? Or try to put the line in? Pick one. Line type - what type of line did you insert? Pick one. Department - where was the patient when the line was inserted (not what department you usually work in)? Pick one. Insertor is a - who inserted the line - MSI, resident, staff, or nurse? Or someone else altogether? Pick one, or write in your alternate answer. Specialty - what specialty is the insertor trained in, or training in? Pick one, or write in your alternate answer. Procedure was - was the line inserted electively (i.e. under controlled conditions, no major time pressure), urgently (i.e. time was a factor, the line needed to be in within a half an hour or so), or during a code blue (immediate access required to facilitate resuscitation of a critically ill patient)? Pick one. Sterile precautions - choose the sterile precautions you employed. Why are we so interested in this? Well, published evidence shows that by using all the sterile precautions in the list, as well as using a full body drape, the rate of catheter related line infections can be reduced by as much as 6 times!! So, we are not only interested in what you are using, but also want people to realize these are pretty effective measures, and if you didn't use them all this time, maybe you will next time. Draping - did you drape around the area with the small drape in the kit, or did you use a torso drape that covered about half the patient, or did you use a large drape that covered pretty well the full body? Pick one. Ultrasound probe - did you use ultrasound assistance to place the line (a.k.a. the Sono-site)? If so, did you use it prior to the actual procedure to locate the vessel, or did you use it during the procedure to follow the progress of the needle into the vessel? Pick one. Sutured in place/Sterile dressing - did you suture the line in place? Did you cover the insertion site with a sterile dressing? Pick yes or no. Number of pokes, and number of passes - a "poke" is defined as an instance of the needle piercing the skin. A "pass" is when the needle was advanced under the skin probing for the vessel. Therefore, each poke could have multiple passes. If you document three pokes, there should be three separate digits for the number of passes. For example, if you put '3' in the first text box (pokes), then in the second text box, you should have three separate numbers, like this - '3,2,1' - indicating that when you first put the needle through the skin, you advanced and retracted it three times, when you next put it through the skin you advanced and retracted it two times, and on the last poke, you accessed the vessel the first time you advanced the needle. Complications - did you encounter any complications when placing the line? If yes, what were they? For example, "unable to advance the wire" would be a complication. Or "carotid artery punctured with finder needle". That kind of thing. Comments - anything else about the line insertion you would like to document? For example - "Anomalous anatomy prevented the vein from being accessed." Or maybe - "2 operators attempted access of the vein - the second was successful". Pretty much anything else that you think should be documented, especially if it will be helpful to anyone trying to place a line in this patient in the future. Generate printable procedure note button - clicking on this button does two things. First, it takes your responses on the form and turns them into a custom procedure note that you can print and place in the chart. This takes the place of the usual procedure note that you would normally write. It is automatically updated with the date and time, it is detailed, and it is legible. The second thing it does is e-mail your responses to an independent data collector to facilitate research on line placement in our hospital. The data does not carry any identifying information from the person filling out the form, so you can feel comfortable in being honest with your responses. It does carry the patient's MRN, so that we can track back and see if anything we are doing as a team is having an impact on the rate of line infections. All data is strictly confidential, and no information collected on the form will ever be released or commented on without being de-identified first. Reset button - clicking on this button erases your responses, and returns the form to it's default state.
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