G44(P) A quality improvement project for safe and standardised central line insertion on PICU

2019 ◽  
Author(s):  
A Thompson ◽  
A Webster ◽  
E Zizkova ◽  
M Burmester
Keyword(s):  
Quality Improvement ◽  
Central Line ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Central Line Insertion ◽  
Line Insertion

The Effect of Education on Chlorhexidine Use in the NICU

2017 ◽  
Vol 36 (5) ◽  
pp. 294-305 ◽  
Author(s):  
Janet Delong Pettit ◽  
Elizabeth Li Sharpe
Keyword(s):  
Quality Improvement ◽  
Education Program ◽  
Clinical Care ◽  
Central Line ◽  
Quality Improvement Project ◽  
Care Process ◽  
Improvement Project ◽  
Percent Correct ◽  
Central Line Insertion ◽  
Quasi Experimental

AbstractBackground: Neonates are at greater risk for central line–associated bloodstream infection (CLABSI) because of prolonged vascular access for nutrition and medications. Skin antisepsis using chlorhexidine gluconate (CHG), particularly the formulation with alcohol (CHG/alcohol), during central line insertion and maintenance activities is a key clinical care process associated with CLABSI reduction. One area of ongoing confusion for many clinicians is whether to adhere to the manufacturer’s recommendations that CHG remain on the skin following the procedure to promote persistent microbicidal effects or to foster product removal in hopes of preventing skin-related complications.Purpose: Determine the effect of a targeted education program on the knowledge and attitudes of nurses who place peripherally inserted central catheters in the NICU regarding the use and removal of CHG antiseptic.Methods: A quasi-experimental presurvey/postsurvey quality improvement project (QI project) recruited participants from the electronic mailing list of a national neonatal nursing organization.Results: There was a statistically significant deficiency in knowledge or misinformation related to the use of CHG/alcohol on the presurvey assessment. Eight questions reflecting knowledge consistent with most recent evidence were answered correctly only 11.4–25.7 percent of the time, all of which were considered statistically significant. Following completion of the education program, a nearly 100 percent correct response rate on all but three postsurvey questions resulted.Conclusions: This quality improvement project demonstrated success in the ability to change knowledge surrounding the removal of CHG/alcohol from the skin of babies in the NICU following completion of a targeted education program and the effectiveness of targeted web-based educational programs.

scholarly journals Decreasing central-line blood draws by consolidation of phlebotomy timing: results of a quality improvement project

Critical Care ◽  
2014 ◽  
Vol 18 (Suppl 1) ◽  
pp. P87
Author(s):  
G Arteaga ◽  
S Tripathi ◽  
Y Ouellette ◽  
M Nemergut ◽  
G Rohlik ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Central Line ◽  
Quality Improvement Project ◽  
Improvement Project

The Effect of Education on Chlorhexidine Use in a Neonatal Intensive Care Unit

2017 ◽  
Vol 22 (3) ◽  
pp. 115-123 ◽  
Author(s):  
Janet Delong Pettit ◽  
Elizabeth Li Sharpe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Bloodstream Infection ◽  
Education Program ◽  
Neonatal Intensive Care ◽  
Central Line ◽  
Quality Improvement Project ◽  
Improvement Project

Abstract Background: Neonates are at greater risk for central-line-associated bloodstream infection due to prolonged vascular access for nutrition and medications. Skin antisepsis using chlorhexidine gluconate (CHG), particularly the formulation with alcohol (CHG/alcohol), during central line insertion and maintenance activities is a key clinical care process associated with central line-associated bloodstream infection reduction. One area of ongoing confusion for many clinicians is whether to adhere to the manufacturer's recommendations that CHG remain on the skin following the procedure to promote persistent microbicidal effects, or to foster product removal in hopes of preventing skin-related complications. Purpose: Determine the effect of a targeted education program on the knowledge and attitudes of nurses who place peripherally inserted central catheters in the neonatal intensive care unit regarding the use and removal of CHG antiseptic. Methods: A quasiexperimental presurvey/postsurvey quality improvement project recruited participants from the electronic mailing list of a national neonatal nursing organization. Results: There was a statistically significant deficiency in knowledge or misinformation related to the use of CHG/alcohol on the presurvey assessment. Eight questions reflecting knowledge consistent with most recent evidence were answered correctly only 11.4%–25.7% of the time, all of which were considered statistically significant. Following completion of the education program, a nearly 100% correct response rate on all but 3 postsurvey questions resulted. Conclusions: This quality improvement project demonstrated success in the ability to change knowledge surrounding the removal of CHG/alcohol from the skin of babies in a neonatal intensive care unit following completion of a targeted education program, and the effectiveness of targeted web-based educational programs.

scholarly journals The development of a nurse-driven protocol for the safe administration of vasopressors through peripheral intravenous catheters

2018 ◽  
Vol 4 (1) ◽  
pp. 36 ◽  
Author(s):  
Laura Padrone ◽  
Janet Galiczewski ◽  
Bernadette Amitrano ◽  
Seth Koenig ◽  
Mangala Narasimhan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Tissue Injury ◽  
Subcutaneous Tissue ◽  
Central Line ◽  
Quality Improvement Project ◽  
Team Approach ◽  
Evidence Based ◽  
Central Venous ◽  
Improvement Project ◽  
Strict Adherence

Aim: The purpose of this quality improvement project was to develop a nurse-driven protocol to provide a safer, quicker, and less complication-prone alternative for the administration of vasopressors.Background: The use of vasopressor medication is a common life saving intervention used to achieve hemodynamic stability in critically ill patients. Vasopressor infusions are routinely administered through central venous catheters (CVC) for fear that extravasation into subcutaneous tissue will result in ischemic injury. There are many potential complications of obtaining central venous access for vasopressor use, including pneumothoraces, arterial punctures and hematomas.Design: Quality improvement project.Methods: An interdisciplinary team developed a written protocol for the administration of vasopressors through peripheral intravenous (PIV) catheters based on the available scientific evidence. Key components of this quality improvement project were patient safety, a team approach and skilled monitoring of the infusion site. Critical care nurses were responsible for the line insertion, maintenance and identification of possible extravasation. All catheters placed were confirmed by ultrasonography and if extravasation of medication was suspected, the extravasation protocol was followed without delay.Results: The protocol developed was utilized in a study by Cardenas-Garcia et al. (2015). Extravasation occurred in 19 of 734 patients (2%) without any tissue injury following the use of the extravasation protocol. This evidence-based protocol for peripherally administered vasopressors decreased central line use and the potential complications from the placement of CVCs. Strict adherence to this evidence-based nurse-driven protocol was essential for the safe administration of vasopressors via PIV access.Conclusion/Clinical relevance: Peripheral administration of vasopressors has many beneficial implications for nursing practice. A nurse-driven protocol for peripheral vasopressors can eliminate the need for CVCs, which will reduce the incidence of central line-associated blood stream infections and decrease the number of central line days. This also may eliminate potential complications from CVC placement. Lastly, peripherally administered vasopressors may prevent a delay in treatment often experienced with placement of a central line.

Implementation of Lean Daily Management: A Vascular Access Team Quality Improvement Project to Enhance Nurses’ Workflow and Patient Outcomes

2020 ◽  
Vol 25 (3) ◽  
pp. 18-27
Author(s):  
Michele Schlauch ◽  
Pam Rogers ◽  
Rhonda Pyne ◽  
Cathy Tomchik ◽  
Carol Ellis ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Vascular Access ◽  
Cost Savings ◽  
Central Line ◽  
Quality Improvement Project ◽  
Fiscal Year ◽  
Substantial Cost Saving ◽  
Improvement Project ◽  
Clabsi Rate

Highlights Abstract Background: The process for patients to receive a peripherally inserted central catheter (PICC) has been unclear, allowing for delays in care and discharge and increased costs. To address these problems, a vascular access team implemented the Lean process. The purpose was to evaluate the effect of an ultrasound initiative to insert peripheral intravenous lines (IVs) and midlines and modification of PICC insertion hours on the nurses’ workflow and patient outcomes. Methods: This quality improvement project used retrospective data analysis. Patients’ data from fiscal year (FY) 2010 to FY 2019 was analyzed using descriptive statistics, independent t tests for continuous data, and a Poisson regression for count data. Results: After the ultrasound initiative, the volume of PICC insertions decreased by 20%, which represents a significant reduction. The mean cost also decreased from $171,681 to $147,620. Although there was no substantial cost saving, the total cost was reduced by 14%. After implementation of ultrasound guidance for peripheral IV and midline access, the central line–associated bloodstream infection (CLABSI) rate dropped by 70%. The estimated treatment cost for CLABSI significantly decreased from $481,600 to $156,800. After implementation, the total estimated cost savings was $1,624,000. Modified PICC insertion hours resulted in significantly reduced mean hours from order time to insertion. Conclusions: Standard work and process improvements using the Lean process were effective. The ultrasound initiative decreased unnecessary PICC insertions, reduced cost, and decreased the CLABSI rate. Modified PICC insertion hours enhanced the nurses’ work by reducing the average time from PICC order to placement.

QIM19-146: A Multidisciplinary Approach to Conquer Central-Line Associated Blood Stream Infections: Establishing the Continuum of Prevention

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-146
Author(s):  
Christine Wallace ◽  
Jennifer Sullivan ◽  
Erin Supan
Keyword(s):  
Best Practice ◽  
Multidisciplinary Approach ◽  
Nursing Practice ◽  
Gap Analysis ◽  
Blood Stream ◽  
Central Line ◽  
Comprehensive Cancer Center ◽  
Improvement Project ◽  
Central Line Insertion ◽  
Line Insertion

Background: Central line associated blood stream infection (CLABSI) rates have been above the benchmark for our academic medical center that includes a comprehensive cancer center. In response, a 20% CLABSI reduction rate was set by the hospital Chief Medical and Associate Chief Nursing Officers. A multidisciplinary group convened to standardize central line insertion and maintenance practices. Product review showed 20 different central line insertion kits and 6 different dressing kits throughout the system. Hospital central line policy focused solely on nursing practice and there was not a policy including provider practice regarding central line insertion. A gap analysis determined dressing and insertion site integrity was compromised in 53% of our patients, including visible blood under 38% of the dressings, with oncology patients having some of our highest rates of bleeding. Objective: The purpose of this quality improvement project was to collaborate amongst disciplines to review practice, products, and policy for central line insertion and maintenance. We aimed to systematically improve practice across the central line continuum of prevention. Methods: A multidisciplinary team evaluated and defined current and best practice for policy and product changes. Implementation of best practice checklists included a team checklist to be used during insertion of every central line in the intensive care units and checklists that detailed practice steps in accordance with the updated central line policy. Central line dressing change prototypes were designed, products were compared, and approval for a standardized kit to support practice occurred. A new antimicrobial and hemostatic dressing was selected for line care to improve site integrity. The number of central line insertion kits was reduce by half and dressing kits were reduced to just one standard kit for the hospital system. Results: CLABSI rates have decreased from 7.43 cases/month to 3.6 cases/month following. Trends post-product rollout and repeat gap analysis data will be included at time of presentation. Conclusion: Reduction of CLABSI requires a multidisciplinary approach focusing simultaneously on best practices for central line insertion and maintenance. Best evidence for provider and nursing practice needs to be bundled in a comprehensive policy with checklist and products to support the standardization. Clinician evaluation and input on choosing products is critical to positive patient outcomes.

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