{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T02:10:59Z","timestamp":1782007859949,"version":"3.54.5"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T00:00:00Z","timestamp":1667520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian Government Endeavour Executive Leadership Program","award":["Endeavour Executive Leadership Award"],"award-info":[{"award-number":["Endeavour Executive Leadership Award"]}]},{"name":"Blue Cross\/Blue Shield of Michigan and Blue Care Network"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Peripherally inserted central catheters (PICCs) are prevalent devices for medium-to-long-term intravenous therapy but are often associated with morbid and potentially lethal complications. This multi-center study sought to identify barriers and facilitators of implementing evidence-based appropriateness criteria to improve PICC safety and patient outcomes in a pay-for-performance model. Participating hospitals received an online toolkit with five recommendations: establishing a vascular access committee; implementing a clinical decision tool for PICC appropriateness; avoiding short-term PICC use (\u22645 days); increasing use of single-lumen PICCs; and avoiding PICC placement in patients with chronic kidney disease. Longitudinal online surveys conducted biannually October 2014\u2013November 2018 tracked implementation efforts. A total of 306 unique surveys from 34 hospitals were completed. The proportion of hospitals with a dedicated committee overseeing PICC appropriateness increased from 53% to 97%. Overall, 94% of hospitals implemented an initiative to reduce short-term and multi-lumen PICC use, and 91% integrated kidney function into PICC placement decisions. Barriers to implementation included: achieving agreement from diverse disciplines, competing hospital priorities, and delays in modifying electronic systems to enable appropriate PICC ordering. Provision of quarterly benchmarking reports, a decision algorithm, access to an online toolkit, and presence of local champion support were cited as crucial in improving practice. Structured quality improvement efforts including a multidisciplinary vascular access committee, clear targets, local champions, and support from an online education toolkit have led to sustained PICC appropriateness and improved patient safety.<\/jats:p>","DOI":"10.1371\/journal.pone.0277302","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T17:30:57Z","timestamp":1667583057000},"page":"e0277302","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Barriers and facilitators for implementing peripherally inserted central catheter (PICC) appropriateness guidelines: A longitudinal survey study from 34 Michigan hospitals"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8875-7523","authenticated-orcid":true,"given":"Gillian","family":"Ray-Barruel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Horowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Flanders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet","family":"Chopra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,4]]},"reference":[{"issue":"2","key":"pone.0277302.ref001","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1086\/657942","article-title":"Peripherally inserted central venous catheter-associated bloodstream infections in hospitalized adult patients","volume":"32","author":"MC Ajenjo","year":"2011","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"9","key":"pone.0277302.ref002","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1086\/671737","article-title":"The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis","volume":"34","author":"O Chopra V","year":"2013","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"9889","key":"pone.0277302.ref003","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S0140-6736(13)60592-9","article-title":"Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis","volume":"382","author":"V Chopra","year":"2013","journal-title":"Lancet"},{"issue":"15","key":"pone.0277302.ref004","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1001\/jama.2012.12704","article-title":"The problem with peripherally inserted central catheters","volume":"308","author":"V Chopra","year":"2012","journal-title":"JAMA: Journal of the American Medical Association"},{"issue":"8","key":"pone.0277302.ref005","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.amjmed.2012.04.010","article-title":"Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence","volume":"125","author":"V Chopra","year":"2012","journal-title":"Am J Med"},{"issue":"12","key":"pone.0277302.ref006","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1111\/imj.14780","article-title":"Catheter-related thrombosis incidence and risk factors in adult cancer patients with central venous access devices","volume":"50","author":"ML Ellis","year":"2020","journal-title":"Intern Med J"},{"key":"pone.0277302.ref007","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.thromres.2022.02.024","article-title":"Risk of VTE associated with PORTs and PICCs in cancer patients: A systematic review and meta-analysis","volume":"213","author":"P Wang","year":"2022","journal-title":"Thromb Res"},{"issue":"4","key":"pone.0277302.ref008","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1017\/ice.2021.141","article-title":"Do antimicrobial and antithrombogenic peripherally inserted central catheter (PICC) materials prevent catheter complications? An analysis of 42,562 hospitalized medical patients","volume":"43","author":"AJ Ullman","year":"2022","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"10","key":"pone.0277302.ref009","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1681\/ASN.2013070759","article-title":"The upfront risks of vascular access complications","volume":"24","author":"LM Moist","year":"2013","journal-title":"J Am Soc Nephrol"},{"issue":"(6 Suppl","key":"pone.0277302.ref010","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.7326\/M15-0744","article-title":"The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a multispecialty panel using the RAND\/UCLA appropriateness method","volume":"163","author":"V Chopra","year":"2015","journal-title":"Ann Intern Med"},{"issue":"11","key":"pone.0277302.ref011","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1136\/bmjqs-2019-010463","article-title":"Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data","volume":"29","author":"AA Verma","year":"2020","journal-title":"BMJ Qual Saf"},{"key":"pone.0277302.ref012","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ijnurstu.2017.03.001","article-title":"The relationship between perceived role and appropriate use of peripherally inserted central catheters: A survey of vascular access nurses in the United States","volume":"71","author":"SL Krein","year":"2017","journal-title":"Int J Nurs Stud"},{"issue":"4","key":"pone.0277302.ref013","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1002\/jhm.2525","article-title":"The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) initiative: A summary and review of peripherally inserted central catheter and venous catheter appropriate use","volume":"11","author":"SC Woller","year":"2016","journal-title":"J Hosp Med"},{"issue":"1","key":"pone.0277302.ref014","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jamainternmed.2021.6844","article-title":"Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: A multicenter study","volume":"182","author":"L Swaminathan","year":"2022","journal-title":"JAMA Intern Med"},{"issue":"2","key":"pone.0277302.ref015","doi-asserted-by":"crossref","first-page":"76","DOI":"10.12788\/jhm.2847","article-title":"Patterns and predictors of short-term peripherally inserted central catheter use: A multicenter prospective cohort study","volume":"13","author":"D Paje","year":"2018","journal-title":"J Hosp Med"},{"issue":"4 Suppl 2","key":"pone.0277302.ref016","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.ajkd.2019.12.001","article-title":"KDOQI Clinical practice guideline for vascular access: 2019 update","volume":"75","author":"CE Lok","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"pone.0277302.ref017","first-page":"11297298211025897","article-title":"PICC line management among patients with chronic kidney disease","volume":"2021","author":"BP Oza-Gajera","year":"2021","journal-title":"J Vasc Access"},{"issue":"1","key":"pone.0277302.ref018","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1136\/bmjqs-2021-013015","article-title":"Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals","volume":"31","author":"O Chopra V","year":"2022","journal-title":"BMJ Qual Saf"},{"issue":"4","key":"pone.0277302.ref019","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1136\/bmjqs-2017-007342","article-title":"Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria","volume":"27","author":"L Swaminathan","year":"2018","journal-title":"BMJ Qual Saf"},{"issue":"5","key":"pone.0277302.ref020","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.2214\/AJR.20.23704","article-title":"Effects of the MAGIC guidelines on PICC placement volume: Advanced practice provider and physician trends among Medicare beneficiaries from 2010 to 2018","volume":"216","author":"WS Lindquester","year":"2021","journal-title":"AJR Am J Roentgenol"},{"issue":"8","key":"pone.0277302.ref021","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1016\/j.ajic.2020.06.060","article-title":"Reduction of peripherally inserted central catheter (PICC) line infections through the implementation of a midline catheter program","volume":"48","author":"PD Nolan","year":"2020","journal-title":"Am J Infect Control"},{"issue":"1","key":"pone.0277302.ref022","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s11606-015-3567-0","article-title":"Implementation processes and pay for performance in healthcare: A systematic review","volume":"31","author":"KK Kondo","year":"2016","journal-title":"J Gen Int Med"},{"issue":"Suppl 1","key":"pone.0277302.ref023","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/NAN.0000000000000396","article-title":"Infusion Therapy Standards of Practice, 8th Edition","volume":"44","author":"LA Gorski","year":"2021","journal-title":"J Infus Nurs"},{"key":"pone.0277302.ref024","unstructured":"Michigan Hospital Medicine Safety Consortium (HMS). HMS PICC Toolkit nd. Available from: https:\/\/mi-hms.org\/hms-picc-toolkit."},{"issue":"2","key":"pone.0277302.ref025","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qual Res Psychol"},{"issue":"12","key":"pone.0277302.ref026","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1136\/bmjqs-2015-004411","article-title":"SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process","volume":"25","author":"G Ogrinc","year":"2016","journal-title":"BMJ Qual Saf"},{"issue":"10","key":"pone.0277302.ref027","doi-asserted-by":"crossref","first-page":"e2017659","DOI":"10.1001\/jamanetworkopen.2020.17659","article-title":"Association of infectious disease physician approval of peripherally inserted central catheter with appropriateness and complications","volume":"3","author":"O Vaughn VM","year":"2020","journal-title":"JAMA Network Open"},{"issue":"6","key":"pone.0277302.ref028","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1089\/sur.2021.046","article-title":"Applying implementation science in surgical infection quality improvement","volume":"22","author":"JF Golob","year":"2021","journal-title":"Surg Infect (Larchmt)"},{"issue":"2","key":"pone.0277302.ref029","doi-asserted-by":"crossref","first-page":"e001155","DOI":"10.1136\/bmjoq-2020-001155","article-title":"Efficacy of an implementation package on documentation of central venous catheter insertions: an observational study","volume":"10","author":"E Linne","year":"2021","journal-title":"BMJ Open Qual"},{"issue":"4","key":"pone.0277302.ref030","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.ajic.2015.10.036","article-title":"Electronic health record solutions to reduce central line-associated bloodstream infections by enhancing documentation of central line insertion practices, line days, and daily line necessity","volume":"44","author":"KA Quan","year":"2016","journal-title":"Am J Infect Control"},{"issue":"3","key":"pone.0277302.ref031","doi-asserted-by":"crossref","first-page":"e738","DOI":"10.1542\/peds.2013-2249","article-title":"Use of electronic medical record\u2013enhanced checklist and electronic dashboard to decrease CLABSIs","volume":"133","author":"NM Pageler","year":"2014","journal-title":"Pediatrics"},{"issue":"6","key":"pone.0277302.ref032","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.ajic.2014.02.014","article-title":"A multitiered strategy of simulation training, kit consolidation, and electronic documentation is associated with a reduction in central line-associated bloodstream infections","volume":"42","author":"GB Allen","year":"2014","journal-title":"Am J Infect Control"},{"issue":"1","key":"pone.0277302.ref033","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/NAN.0000000000000450","article-title":"Developing a nurse-driven vascular access device order set using the electronic medical record","volume":"45","author":"BA Bechdel","year":"2022","journal-title":"J Infus Nurs"},{"issue":"1","key":"pone.0277302.ref034","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.13063\/2327-9214.1121","article-title":"Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium","volume":"2","author":"AW Collinsworth","year":"2014","journal-title":"EGEMS: The Journal for Electronic Health Data and Methods"},{"issue":"1","key":"pone.0277302.ref035","doi-asserted-by":"crossref","first-page":"10","DOI":"10.7326\/M18-2937","article-title":"Use of peripherally inserted central catheters in patients with advanced chronic kidney disease: a prospective cohort study","volume":"171","author":"D Paje","year":"2019","journal-title":"Ann Intern Med"},{"issue":"1","key":"pone.0277302.ref036","doi-asserted-by":"crossref","first-page":"42","DOI":"10.12788\/jhm.3097","article-title":"Less lumens-less risk: a pilot intervention to increase the use of single-lumen peripherally inserted central catheters","volume":"14","author":"D Bozaan","year":"2019","journal-title":"J Hosp Med"},{"issue":"4","key":"pone.0277302.ref037","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1001\/jamainternmed.2015.8402","article-title":"Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals","volume":"176","author":"V Chopra","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"1","key":"pone.0277302.ref038","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/1129729820916113","article-title":"Peripherally inserted central catheters inserted with current best practices have low deep vein thrombosis and central line\u2013associated bloodstream infection risk compared with centrally inserted central catheters: A contemporary meta-analysis","volume":"22","author":"GJ Schears","year":"2021","journal-title":"The Journal of Vascular Access"},{"issue":"12","key":"pone.0277302.ref039","doi-asserted-by":"crossref","first-page":"e14849","DOI":"10.1111\/ijcp.14849","article-title":"The state of vascular access teams: Results of a European survey","volume":"75","author":"N Cortes Rey","year":"2021","journal-title":"Int J Clin Pract"},{"issue":"8","key":"pone.0277302.ref040","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1136\/bmjqs-2020-011987","article-title":"Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study","volume":"30","author":"SL Krein","year":"2021","journal-title":"BMJ Qual Saf"},{"issue":"4","key":"pone.0277302.ref041","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/NAN.0000000000000328","article-title":"Implementation of a vascular access team to reduce central line usage and prevent central line-associated bloodstream infections","volume":"42","author":"TJ Savage","year":"2019","journal-title":"J Infus Nurs"},{"issue":"4","key":"pone.0277302.ref042","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/NAN.0000000000000373","article-title":"Implementation of a vascular access experience program to train unit-based vascular access champions","volume":"43","author":"L Goodfriend","year":"2020","journal-title":"J Infus Nurs"},{"issue":"1","key":"pone.0277302.ref043","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1136\/bmjqs-2021-013456","article-title":"Peripherally inserted central catheters: spreading the MAGIC beyond Michigan","volume":"31","author":"P Wilson","year":"2022","journal-title":"BMJ Qual Saf"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277302","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T17:31:45Z","timestamp":1667583105000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277302"}},"subtitle":[],"editor":[{"given":"Federica","family":"Canzan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,4]]},"references-count":43,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0277302","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,4]]}}}