Preventing CLABSI Bundle Enhancements


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Preventing CLABSI Bundle Enhancements

  1. 1. Preventing CLABSI g Bundle Enhancements Providence H lth C P id Health Care Vancouver BC, Canada Jocelyn Hill – Nurse EducatorIV Therapy and Home Infusion Programs May 2011
  2. 2. The IssueAccording to the Institute for Health Improvement andSafer Health Care Now, the prevention of CLABSI Initiative Nowincludes strict adherence to the:1.1 Insertion Bundle2. Maintenance BundleWe were challenged with HOW to facilitate compliance tothe bundles and ensure positive outcomes = prevention ofCLABSI.
  3. 3. Challenges gChallenges identified:• N standardized education f iinsertion and maintenance No t d di d d ti for ti d i t• No standardized documentation or communication for the health care team• Not having supplies readily available• Not knowing where different supplies are located (i.e. for resident physician staff who rotate through areas)• Too many options for supplies (i.e. chlorhexidine gluconate in 0.05 %, 0.5% % 0 5% and 2% concentrations and various drape sizes on shelves)• No standardized, consistent method to obtain data for CLABSI rate (denominator data = # of catheter days)
  4. 4. The Interventions/Enhancements1. Standardized, readily available online modules for education2. Standardized, readily available electronic documentation for central line insertions3. Standardized CVC kit and cart4. Standardized,4 Standardized readily available data entry/collection of # of catheter days through electronic kardex
  5. 5. # 1 – Online Modules for EducationStandardized, readily available online modules for education• For insertion and care & maintenance• Available to all staff within health authority (free of charge)• Comprehensive, detailed with short video clips• Pre and post tests• Computer system allows for tracking of staff and completed tests
  6. 6. # 2 – Electronic DocumentationStandardized, readily available electronic documentationforf centrall line iinsertions t li ti• E-doc on computer accessible to all staff• Screenshots detailed but short and concise• Mostly tick boxes with some free text options• Allows for tracking of inserters and units where patients are
  7. 7. # 3 - Standardized CVC Kit and CartThe CVC Kit- Work of large group: physicians, nurses and clinical supplies coordinator- Collaboration with manufacturer of CVC catheter- Kit contents: head cover, safety scalpel, safety sharps, full body d f ll b d drape, t transparent dressing f site td i for it- “Force the function” = essential contents
  8. 8. The CVC Cart• Needed to be readily available and portable on unit (on h l ith drawers) ( wheels with d )• Stocked with: – Sterile gloves, various sizes – Masks, various types – Chlorhexidine 2% with 70% alcohol – swab sticks, single use (no bottles) – Pre-filled syringes for priming/flushing of CVC lumens – Sterile caps
  9. 9. # 4 – Electronic Kardex / Workload Measurement Standardized, readily available data entry/collection of # of catheter days through electronic k d f f th t d th h l t i kardex • Needed a sustainable, more accurate, solution for manuall d t collection b one person “d i rounds data ll ti by “doing d with a clipboard” • Daily check if patient on unit has a central line • Allows for data collection and extraction, as well as direct link to Infection Control staff
  10. 10. The Results• With the use of the computer system, it is possible to track compliance and use of the online education modules, electronic documentation and electronic kardex/workload measurement tool.• The use of the standardized CVC kits and carts are essentially “forced functions” – staff have no choice, y , but to use what is made readily available to them during a procedure.
  11. 11. Engaging OthersKey stakeholders:• Clinical educators• IV Team• Q lit I Quality Improvement tt team• Infection Control team• Physicians who insert C C CVCs• Clinical Supplies Director• Executive Sponsor – Vice President of Organization• Risk Management
  12. 12. Engaging Others (continued) g g g ( )• The process for all 4 interventions were led by the educator f IV Therapy for th organization d t for Th f the i ti• Risk Management and Clinical Supplies Director were th most supportive d t relevance t the t ti due to l to their areas.• It was most difficult to engage physicians due to time constraints, commitment expectations and political/power issues
  13. 13. Greatest Learnings / Largest Challenges• In a world of evolving and advancing computer technology, we learned that not everyone in the healthcare setting adapts or accepts this technology in the same way.• We assumed as clinical leaders that electronic documentation and data entry would be easy to implement and welcomed by staff – not the case!• I regards to standardizing a CVC catheter kit for iinsertion In d t t d di i th t f ti – not every physician uses the same “tools” or does the same thing during the p g g procedure.
  14. 14. What else did we learn? Change processes TAKE TIME to develop, plan and implement
  15. 15. Your Best Advice• Ensure you have the most appropriate and committed stakeholders at the table for planning and implementation.• Without the expertise leadership and commitment expertise, commitment, the challenges will be even more difficult to overcome.
  16. 16. Sustaining Change• Computer system checks every month to make sure new staff have completed the online education modules (gap – capturing present staff)• Random surveys through the computer to check for compliance of electronic documentation and kardex (gap – still has to be done manually)• Checking of supplies on CVC carts – it is assumed that if the supplies are being used up and having to be replaced, then proper supplies are used for CVC insertion procedure (gap – this is an assumption)