Advancing the Practice of Vascular Access


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Advancing the Practice of Vascular Access

  1. 1. Advancing the Practice of Vascular Access Major Nurse Carmen Silvia Margalejo Raffín RN, ICN, RN ICN ICC Argentina
  2. 2. We have an "Advancing the Practice of Vascular Access" Best Practice that we want to shareReducing CRBSI rates by: • Education formal and hands-on • Implementing care and maintenance bundles • Evaluating products that improve patient care
  3. 3. Reduce central-line associated bloodstream infection rate an ant trail…• Central Military Hospital “Cir My Dr Cosme Argerich” Cir Argerich• Major Nurse Silvia Margalejo Raffín, RN, ICN, ICC Secretary Elect of the Directive Board and Coordinator of the Guidance Committee of the Argentinian Association o Infection Control Nurse ( Co ee o e ge a ssoc a o of ec o Co o u se (ADECI) C) Member of Committee of Healthcare Association Infections of Argentinian Society of Infectology• Date/timeframe o p oject Ja ua y - December 2011 ate/t e a e of project: January ece be 0
  4. 4. 2010 CRBSI First intervention The Issue• We identify our issue across the Infection Control data during the surveillance of CRBSI No significal change• We choose this issue because in spite of the ene feb mar abr may jun jul ago sep oct nov dic implementation of bundles and insertion checklist the rates of infection didn’t improved• Our conclusion was that patients presents CRBSI after 5 days that the catheter was inserted.• We hope to achieve best practices compliance Upgrading the practice De Vuelta a lo esencial 3M 2007
  5. 5. Second intervention The Intervention January 2011 ene feb mar abr may jun jul ago sep oct nov dic• First, we observed nurses techniques to try to identify where they would be failing.• We detected, we have serious problems with IV site care and stabilization• First step was to change the kind of dressings and teach how to use it• The second will be change iodopovidone for chlorhexidine• It all will happened at the Critical Care Unit working together with staff nurses. ith t ff
  6. 6. The ResultsWe were here We are here We want to be here We begin to improve our rate … Slowlyene feb mar abr may jun jul ago sep oct nov dic ene feb mar abr• The staff are really involved with the changes, they like the new product, they say that is easier to use. p y y• Administration says we are reducing cost.
  7. 7. Engaging Others g g g• The surveillance carried out at the critical Care Unit, I analyzed the data, data I made a project and had a meeting with the chief of the Unit and of Nursing to present the problem and a possible solution.• All the process is driven by the Chief of Nursing of the Unit and I, we have the support of the Chief of the Unit, the Department of Nursing and the Medical Director• Young staff engaged quickly but we had difficulty with some of the quickly, staff that always resist to changes
  8. 8. Greatest Learnings / Largest Challenges g g g• Obstacles: – It is difficult to make a focus when it isn´t the head focus – Finding a leader, when it isn´t your unit – Make changes when you “don´t belong” to this unit Prepare every  thing before begin • Therefore: the procedure… – We need to remember “old lessons” – Hands-on Infection Control Nurse – We need to work together
  9. 9. Your Best AdviceI am the Infection Control Nurse,my place iis the Infectology D l th I f t l Department. t tWhat I would advise?• First know where you are; don´t lose the objective First, don t objective, small changes would be great changes, do not rush• Take your time, see the nature…… be an ant……
  10. 10. Sustaining Change g g• We will measure our rate every day, seeing what is going on each month month.• We didn´t see any ‘back-sliding’ because it is early to see them, we are in the beginning of our p j g g project• We continue with education and supervise the protocol, we involved everyone from the Director to cleaning staff staff….