1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship

Abstract

BackgroundNearly 40% of all peripherally inserted central catheter (PICC) placements may be inappropriate. Validated appropriateness criteria (Michigan Appropriateness Guide for Intravenous Catheters or MAGIC) were developed to improve patient safety and decrease adverse events from PICC line use. Recent studies have demonstrated the impact of MAGIC implementation with success but involve multimodal interventions that may not be sustainable. We evaluated the effect of a nursing-driven MAGIC-derived triage tool online utilization.MethodsWe conducted a quasi-experimental before and after study evaluating the effect of a MAGIC-derived triage tool including all patients for whom a PICC consult was ordered. The triage tool was implemented January 1, 2018 as part of the consult order and required providers to identify an indication for placement. All consults were reviewed by the IV Team Nurses who collaborated with ID providers when warranted. Providers were contacted if MAGIC criteria suggested alternate access was more appropriate and encouraged to either place a mid or peripheral line or to consider an oral medication. Rates of line utilization and line infections pre-intervention and post-intervention were compared.ResultsOverall, 242 consults for PICC lines were placed during the one year intervention period January 1, 2018 to December 31, 2018. Indications included: antibiotics (54%), TPN/chemo (21%) difficult access (17%), no response (8%). Thirty-five PICCs were averted directly related to the intervention. Appropriate indication of PICC placement with the tool was 88%. During this same time period, the line utilization ratio (lines/1,000 patient-days of care) decreased from a mean of 3.8 (range 3.3 to 4.2 for years 2015–2017) to 2.6, a 32% reduction (IIR 0.72; P < 0.05). Central line bloodstream infection rates (infections/1,000 line days of care) also decreased from a mean of 0.81 (range 0.56 to 1.18 for years 2015–2017) to 0.37, a 54% reduction (IIR 0.4; P = 0.10).ConclusionEven in a setting of low line infection and line utilization rates, further reductions in potential device harm can be achieved using point of care feedback tools. This intervention empowers nursing involvement in device stewardship, thus expanding the range of their involvement in stewardship activities. Disclosures All authors: No reported disclosures.