Date of Award

Spring 2023

Project Type

Thesis

College or School

CHHS

Department

Nursing

Departments (Collect)

Nursing

Program or Major

Evidence Based Practice

Degree Name

Master of Science

First Advisor

Pamela S. Kallmerten

Second Advisor

Julie Bushey

Abstract

Background Implanted ports are frequently used for central venous access in the adult oncology population. Maintaining patency of these ports is important for continuing uninterrupted treatment and supportive care for oncologic patients. Historically, heparin solution has been used as a locking solution for implanted ports to prevent occlusion. However, evidence shows that 0.9% sodium chloride (normal saline or NS) as a lock solution is equally effective as heparin solution at maintaining implanted port patency and poses less risk to patients.

Local Problem In an ambulatory adult oncology clinic serving Seacoast New Hampshire, a gap was identified between clinical practice where implanted ports were locked with heparinized saline, and evidence-based best practice, which recommends NS as a safer alternative locking solution.

Methods In this Gap Analysis quality improvement, project the clinical environment was assessed using the Agency for Healthcare Research and Quality (AHRQ) Gap Analysis Tool, Strengths, Weaknesses, Opportunities, Threats (SWOT) Analysis and stakeholder feedback. These tools were utilized to identify barriers to implementation of evidence-based best practice.

Interventions Guided by these assessments, a trial run of eliminating heparin saline as a locking solution is implemented in the clinical environment.

Results Both staff and patients positively receive the practice change. Several incidental findings were noted including the importance of emphasizing push-pause instillation technique of NS to optimize clearance of the catheter in nursing education and a cost-savings benefit of this practice change due to the elimination of prefilled heparin saline syringes.

Conclusions The objectives of investigating the efficacy of NS compared with heparin as a locking solution for implanted ports and implementing this practice change in the clinical environment were both met in this Gap Analysis project. The third objective, to present findings as evidence for policy change, was not met during this project though it is outlined as a next step. Through this Gap Analysis, the lack of a clearly defined process for quality improvement at the organization is identified.

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