Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

Vanderbilt University, Нашвилл, Michigan, United States
Quality and Safety in Health Care (Impact Factor: 2.16). 09/2005; 14(4):295-302. DOI: 10.1136/qshc.2004.013516
Source: PubMed

ABSTRACT Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices.
A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers.
Adult medical intensive care unit (MICU).
Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff.
An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs.
The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low.
Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real time.

Download full-text


Available from: Kathie Wilkerson, May 19, 2015
  • Source
    • "1999). Second, despite contacting authors to obtain the actual checklists, although a number did provide these (Wall et al. 2005; Lobo et al. 2005; Costello et al. 2008), a few studies were excluded because of a lack of response from the authors. Despite these limitations, this study has a number of strengths. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Central venous catheterization is a complex procedural skill. This study evaluates existing published tools on this procedure and systematically summarizes key competencies for the assessment of this technical skill. Using a previously published meta-analysis search strategy, we conducted a systematic review of published assessment tools using the electronic databases PubMed, MEDLINE, Education Resource Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica, and Cochrane Central Register of Controlled Trials. Two independent investigators abstracted information on tool content and characteristics. Twenty-five studies were identified assessing a total of 147 items. Tools used for assessment at the bedside (clinical tools) had a higher % of items representing "preparation" and "infection control" than tools used for assessment using simulation (67 ± 26% vs. 32 ± 26%; p = 0.003 for "preparation" and 60 ± 41% vs. 11 ± 17%; p = 0.002 for "infection control", respectively). Simulation tools had a higher % of items on "procedural competence" than clinical tools (60 ± 36% vs. 17 ± 15%; p = 0.002). Items in the domains of "Team working" and "Communication and working with the patient" were frequently under-represented. This study presents a comprehensive review of existing checklist items for the assessment of central venous catheterization. Although many key competencies are currently assessed by existing published tools, some domains may be under-represented by select tools.
    SpringerPlus 01/2014; 3:33. DOI:10.1186/2193-1801-3-33
  • Source
    • "Mode of delivery of education not specified – eight studies (Price et al. 2002; Rosenthal et al. 2003; Gnass et al. 2004; Misset et al. 2004; Berriel-Cass et al. 2006; Goeschel et al. 2006; Young et al. 2006; Capretti et al. 2008). . Ten studies also used other interventions in addition to education, such as the use of a bundle (including a checklist) (Frankel et al. 2005; Wall et al. 2005; Berriel-Cass et al. 2006, Pronovost et al. 2006; McKee et al. 2008), a stepwise intervention (Bhutta et al. 2007), or other additional interventions (Bishop-Kurylo 1998; Rosenthal et al. 2003; Tsuchida et al. 2007; Lobo et al. 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Up to 6000 patients per year in England acquire a central venous catheter (CVC)-related bloodstream infection (Shapey et al. 2008 ). Implementation of Department of Health guidelines through educational interventions has resulted in significant and sustained reductions in CVC-related blood stream infections (Pronovost et al. 2002), and cost (Hu et al. 2004 ). This review aimed to determine the features of structured educational interventions that impact on competence in aseptic insertion technique and maintenance of CV catheters by healthcare workers. We looked at changes in infection control behaviour of healthcare workers, and considered changes in service delivery and the clinical welfare of patients involved, provided they were related directly to the delivery method of the educational intervention. A total of 9968 articles were reviewed, of which 47 articles met the inclusion criteria. Findings suggest implications for practice: First, educational interventions appear to have the most prolonged and profound effect when used in conjunction with audit, feedback, and availability of new clinical supplies consistent with the content of the education provided. Second, educational interventions will have a greater impact if baseline compliance to best practice is low. Third, repeated sessions, fed into daily practice, using practical participation appear to have a small, additional effect on practice change when compared to education alone. Active involvement from healthcare staff, in conjunction with the provision of formal responsibilities and motivation for change, may change healthcare worker practice.
    Medical Teacher 01/2010; 32(3):198-218. DOI:10.3109/01421591003596600 · 2.05 Impact Factor
  • Source
Show more