Submitters: Wendy Ungard, MSN, RN and Tony Zaya , BSN,RN,CPN
- Cincinnati Children’s Hospital
The Grand Central Line
One of the key quality improvement projects specifically involving nursing has revolved around decreasing infections related to patients with central lines (PICC’s and CVC’s). There was a significant spike in central line infections during fiscal year 2013, which led to every nurse at CCHMC to complete mandatory education in regards to central line care titled Prevention Standards. Central line infections are not only a topic for magnet data assessments, but also a consistent point mentioned daily during our morning huddle. The A4 South CVC Task Force has created supplemental interventions to the CCHMC Prevention Standards house-wide that show significant improvement in the reduction of infections over the last two fiscal years. The effectiveness of these interventions would be measured by comparison of not only consecutive fiscal years on A4 South, but also as compared to other units at CCHMC not currently practicing these supplemental interventions.
Plan-Do-Study-Act tests of change were used as multiple interventions were introduced during the process. These interventions involved the re-routing of the central line away from peri areas or ostomy bags, every patient that has a central line being required to use a securement device, trial and adoption of new securement device, observation by charge nurse or other trained individual on every central line dressing change and every patient having a PICC requiring a tubular dressing sleeve for dressing protection. Key drivers of these interventions are nurse buy-in, rn-to-rn acceptance of constructive criticism, accountability, establishment of expectations of supplemental interventions and leadership buy-in.
Conclusions of this study are still being evaluated as final data is not currently available. With data that is available, results have shown significant improvement. If results continue this trend, the supplemental interventions from A4 South would be presented and suggested for house-wide interventions to CCHMC Practice Council.
SMART AIM Statement
Specific – Among pediatric patients requiring central line access, does providing housewide staff education (prevention standards) need supplemental CVC line interventions to reduce central line infections as compared in consecutive fiscal years.
Measureable – Housewide central line infection data (prevention standards) will be compared to A4 South data (Prevention Standards + Supplemental Interventions)
Achievable – FY13 was recognized to have a large increase in central line infections. This is when the required prevention standard housewide education took place. Infections have still occurred in FY14, and it is achievable to reduce these infections, even if just by one.
Relevant –Central line infections are a constant focus and key driver for maget data as well as hospital improvement.
Time – Data to be compared between FY13 and FY14 – project to be completed shortly after July 1, 2014.
Findings/Synthesis of Results
A4 South had a total of eight central line infections during FY13 and this number has been reduced to one infection to date. Data currently being collected to compare hospital wide improvements. Overall synthesis of results will include FY13 infection data (hospital wide), FY14 Infection data (hospital wide improvement with prevention standards only) and FY14 infection data (A4 South improvement with prevention standards and supplemental interventions.