NR 324 Week 5 Home PICC Antibiotic Teaching Plan Example

Teaching Plan: Six Weeks of Home IV Antibiotics Through a PICC Line for a 52-Year-Old Hotel Night Auditor

Student Name

College of Nursing, Chamberlain University

NR 324: Adult Health I

Instructor Name

Month Day, Year

Teaching Plan: Six Weeks of Home IV Antibiotics Through a PICC Line for a 52-Year-Old Hotel Night Auditor

The Learner Before the Disease

Mr. V. is 52 and works nights as a hotel night auditor, 11 p.m. to 7 a.m., five nights a week. He was admitted with an infection in his right knee joint that needed surgical washout, and he goes home in two days with a peripherally inserted central catheter (PICC) in his left upper arm and six weeks of intravenous cefazolin, given every 8 hours from a small pre-filled pump that empties by itself over 30 minutes. A home infusion nurse will visit once a week to change the dressing and draw blood; everything else he does himself, three times a day, for 42 days.

What he brings: he reads well and likes written steps, but needs reading glasses, which he left at home. He has never handled any medical equipment. His hands are steady. He lives with his 16-year-old son, who is home in the evenings. His work hours mean one of his three daily doses falls during his shift, at about 3 a.m., in the hotel's back office. He says he is "a bit squeamish" about the line and has not looked at it yet. English is his first language. The Infectious Diseases Society of America guideline on outpatient intravenous antibiotic therapy emphasizes that patients or caregivers who give their own doses need structured teaching and an assessment of whether they can do it safely (Norris et al., 2019).

Ordered by What Is Dangerous

The first thing taught is what would do the most harm if it went wrong. A central line is a direct path from the outside world to the bloodstream, so infection of the line is the most dangerous failure, and hand hygiene and cleaning the connection come first. Next is flushing, because a blocked line means missed doses and a trip to the emergency department. Connecting the pump comes third, because it is the easiest step and the least dangerous if done slowly. Keeping the dressing dry and recognizing warning signs come last, but still before discharge. Guidelines for preventing catheter-related infections name hand hygiene and scrubbing the access hub with an antiseptic before each use among the core measures (O'Grady et al., 2011).

Objectives, Written as Performances

1. Before touching the line, Mr. V. washes his hands with soap for 20 seconds or uses the alcohol gel, and lays out his supplies on a clean paper towel on a cleared table.

2. He scrubs the needleless connector at the end of the line with an alcohol pad for 15 seconds, twisting, and lets it dry for 5 seconds without touching it, before every connection.

3. He flushes the line with a 10-milliliter prefilled saline syringe, using a push-pause motion, before and after each dose, and stops and calls if he feels resistance.

4. He connects the pump, opens the clamp on the pump tubing, checks that the pump is going down after 10 minutes, and disconnects and flushes when it is empty.

5. He covers the arm with a plastic sleeve before showering and keeps the dressing dry.

6. He names the signs that mean calling the infusion nurse the same day, fever of 100.4 degrees Fahrenheit or higher, redness, pain or drainage at the insertion site, swelling of the left arm or hand, and the one that means calling 911: sudden shortness of breath or chest pain.

Methods and Sessions

Session 1, today at 2 p.m., covers Objectives 1 to 3 on a practice arm with an identical connector, then on his own line with the nurse beside him, because he has not yet looked at it and handling a model first lowers the squeamishness. He is given the steps printed at 18-point size, each step beside a photo of hands doing it, because his glasses are at home; his son is asked to bring them tonight. Session 2, tonight at 7 p.m., with his son present, covers Objective 4 during a real dose, and Mr. V. does every step while the nurse watches and talks only if a step is about to go wrong. His son learns to recognize the warning signs in Objective 6, because he will be in the house during the evening dose.

Session 3, tomorrow at 6 a.m., is the dose he will usually give at home before sleeping, done entirely by him. Session 4, tomorrow at 2 p.m., covers Objectives 5 and 6 and plans the 3 a.m. work dose: a clean area in the hotel office, a small zipped bag with the supplies, a phone alarm, and the infusion pharmacy's 24-hour number saved in his phone. If the work dose cannot be managed safely, the plan is to ask the infectious disease team whether the dose times can shift to 6 a.m., 2 p.m. and 10 p.m., so that all three happen at home.

Evaluation

Each objective is evaluated by watching him do it, not by asking whether he understood. A 12-item checklist based on the large-print steps is used at Sessions 2 and 3; any missed item is taught again and watched again. He is ready for discharge when he completes two consecutive doses with no missed items and no prompting. Objective 6 is evaluated by teach-back: he tells the nurse, as he would tell his son, what each warning sign is and whom he calls. Bastable (2019) describes return demonstration as the method best suited to evaluating psychomotor skills, and here it is the only evidence that he can do this alone at 3 a.m. in a hotel office.

The home infusion nurse receives a copy of the completed checklist, so the first home visit starts from what Mr. V. can already do and where he needed repeated teaching, rather than from the beginning.

One risk is left open on purpose. Mr. V. may manage perfectly in hospital and still skip the hub scrub at 3 a.m. when he is tired and a guest is waiting at the front desk. The plan cannot remove that risk, but it can make the scrub the one step he never skips by teaching it first, practicing it most, and asking him to say out loud, at each session, why it matters. The home infusion nurse will ask him to show the scrub at every weekly visit, because a skill done 126 times alone drifts, and the weekly visit is the only point at which anyone will see it.

References

Bastable, S. B. (2019). Nurse as educator: Principles of teaching and learning for nursing practice (5th ed.). Jones & Bartlett Learning.

Norris, A. H., Shrestha, N. K., Allison, G. M., Keller, S. C., Bhavan, K. P., Zurlo, J. J., Hersh, A. L., Gorski, L. A., Bosso, J. A., Rathore, M. H., Arrieta, A., Petrak, R. M., Shah, A., Brown, R. B., Knight, S. L., & Umscheid, C. A. (2019). 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clinical Infectious Diseases, 68(1), e1-e35. https://doi.org/10.1093/cid/ciy745

O'Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., Lipsett, P. A., Masur, H., Mermel, L. A., Pearson, M. L., Raad, I. I., Randolph, A. G., Rupp, M. E., & Saint, S. (2011). Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52(9), e162-e193. https://doi.org/10.1093/cid/cir257