Table 3.

Themes, Codes and Illustrative Examples of Statements From Focus Groups and Semi-structured Interviews

Theme	Code	Example(s)
Lack of information during the transition process	Upon admission	Moderator: Are you [nurses] notified that a patient who has a PICC is being admitted?
		Unit Nurse Manager: About 50% of the time.
		Frontline Nurse 1: Not the floor nurses.
		SNF Administrator: During the referral process, information does not always come with the patient.
	Information difficult to find or absent	Moderator: How do you find information regarding the PICC?
		Frontline Nurse 2: If you looked in the chart, you wouldn’t find it. There are a lot of notes to look through.
		Frontline Nurse 3: And we have to go through admission fast so we don’t have time to search through the notes.
		Moderator: Do you also take measurements of the line?
		Frontline Nurse 1: We measure after we pull it out, but there is no way to confirm the whole measure. It’s really hard to find it. You don’t have time to go through [the notes] and look.
		Frontline Nurse 4: I make a note of what it was measured at [after it’s pulled out] in case there are any complications later.
	Orders may vary between hospital and SNF doctors	Moderator: How do you decide if a patient no longer needs a PICC?
		Frontline Nurse: We don’t really have a big part of that. For the most part the [SNF] doctor takes care of that. We have no way of knowing when the PICC should be removed.
Lack of information within the SNF	Impact on work load	Moderator: Have any of you ever had more than one patient with a PICC at a time?
		Frontline Nurse 3: She (pointing to another nurse) will have three and I won’t have any.
		Frontline Nurse 7: It’s definitely not evenly divided.
		Frontline Nurse 1: I don’t have time to listen if a patient needs to say something.
		Frontline Nurse 5: We are more task oriented…
		Moderator: Are patients with PICCs considered in your staffing decisions?
		SNF Administrator: No, not really. But we do get more PICCs than we do Ortho (Orthopedics) patients.
Inconsistent availability of resources	PICC supplies	Moderator: Will [PICC] kits come with a patient’s name on it?
		Frontline Nurse: Yeah, but sometimes you have to use another patient’s kit because we are low on stock and no one had re-ordered or re-stocked.
	Outside care services	Moderator: When do you call the [care services nurse]?
		Unit Nurse Manager: The process is, we flush it ourselves…if that doesn’t work, than we call the [care services nurse. We communicate that in our notes especially if [the patient] missed a dose of antibiotics.
Perceived gaps in training and education	Current training opportunities	Moderator: What types of training or education is offered for PICC care?
		Frontline Nurse 1: Just what we went through in nursing school.
		Frontline Nurse 2: Every year we have an evaluation. I can’t remember the last time someone watched me do it [PICC care] though.
		Moderator: What types of training or education is offered for PICC care?
		Unit Nurse Manager: Skills fair is once a year, but it’s not mandated.
	Need for training	Moderator: Is there anything else you would like to talk about?
		Frontline Nurse: Across the board, a lot of people don’t know how to draw [blood] off the PICC.
		Moderator: Is there anything else you need to provide care for patients with PICCs?
		Unit Nurse Manager 1: We need updates, [education] on sterile procedures.
		Unit Nurse Manager 2: How and when to correctly saline flush.