Building a Better Health Service


Nurse Led Service Improves Patient Experience in Waterford

Prior to the establishment of the a new nurse-led PICC line insertion service for haematology and oncology patients in University Hospital Waterford, lines were typically inserted by a consultant interventional radiologist.
This often resulted in longer waiting times for patients and more time in hospital.
The peripherally inserted central catheters (PICC) line insertion service uses 3CG technology.

In planning the project, an analysis and bench marking of the pre-existing PICC line insertion service was completed. The project team then developed a comprehensive business case to support the development of a nurse-led PICC line insertion service which was approved by the Medical Directorate Leadership Team and Executive Management Board and governance arrangements were put in place.

Protocols, referral pathways, patient pathways, data collection tools and audit process agreed. A standard operational procedure was developed.

Two oncology clinical nurse specialists (CNS's) and one haemotology clinical nurse specialist completed a training programme and competency assessment and a pathway was developed with the community intervention team to carry out PICC line flushes in the patients home. These occur within 24 hours post line insertion.

Following this, a weekly PICC line insertion clinic commenced.

The patient no longer has to wait for extended periods of time to have a PICC line inserted. This greatly decreases the anxiety patients experience while they are waiting to begin chemotherapy treatment. Other impacts include:

patients also spend less time in hospital by not being admitted to a surgical day ward
wait times for insertion of PICC lines were reduced
patients commenced cancer treatment in a timely manner
Total savings were estimated to be €47, 860. A database has been developed to gather all the relevant evidence which will allow for a full audit after 12 months.

The service won a Health Service Excellence award for Excellence in Quality Care in 2017.