Qualitative Analysis of Central and Midline Care in the Medical/Surgical Setting

Article · November 2012with242 Reads
DOI: 10.1097/NUR.0b013e31826e3f2a · Source: PubMed
Abstract
: Community hospital medical-surgical nurses have a limited understanding of the complexities of preventing central line-associated bloodstream infections (CLABSIs). The purpose of this study was to look at the phenomenon of central line care from a human perspective and to develop an understanding of the lived experience as it relates to nursing care. : A qualitative, phenomenology framework was applied for this study. : The study was performed at a seasonally fluctuating, 400- to 600-bed community hospital in southwest Florida. : Fifteen full-time medical-surgical bedside registered nurses, 8 working the 12-hour day shift and 7 working the 12-hour night shift, were interviewed. : Experiences from recorded, 45-minute, in-depth telephone interviews from nurses assigned to 4 medical-surgical units, with the greatest CLABSI frequency, were analyzed. : Findings identified myriad challenges when it comes to administering proper technique and preventing CLABSIs. The themes, time and locus of responsibility, patient population and unit, and variations in experience with CLABSIs, are illuminated. : Nurses have strong feelings and suggestions for organizations to consider in reducing infection rates. Line care education should focus on the relationship of the nurse to understanding CLABSIs, education on line care, supplies, and charting/documentation. : The revealed nature and meaning of the human experience of the central line dressing change and skill actions, identified by the nurses, were brought to the CLABSI committee, and a plan was formed. Six months after implementation of the plan, based on the nurses' lived experiences, the rate of infections has dropped 64%.
  • [Show abstract] [Hide abstract] ABSTRACT: Catheter-related bloodstream infection is a major cause of patient morbidity, mortality, and cost for patients undergoing hemodialysis. Healthcare personnel have control over central venous catheter care in the healthcare setting, but patient practices in the home environment may play a role in catheter-related infections. This qualitative study investigated hemodialysis catheter-related care in the home environment and developed an understanding of the experience of catheter care for which patients were responsible. The themes that emerged from the data were perceptions of catheter care practices, feelings of freedom, fear, a few frustrations, and patient empowerment. The findings from the analysis provide a snapshot of the variability in catheter care practices in the home as self-reported by the patients undergoing hemodialysis before and after involvement in a protocol that eliminated the dressing over the catheter insertion site and taught participants ways to care for the site during showering. The data may be used to inform care that decreases catheter-related infections, to describe the impact of showering on catheter-related infections, and to influence patient adherence to best practices through enhanced patient empowerment, comfort, control, and perceptions of personal hygiene.
    Article · Dec 2013
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    Article · Aug 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: This study examined nurses' adherence to policies regarding needleless connector changes using a novel, day-of-the-week, color-coded label compared with usual care that relied on electronic medical record (EMR) documentation. Design: This was a prospective, comparative study. Setting: The study was performed on 4 medical-surgical units in a seasonally fluctuating, 715-bed healthcare system composed of 2 community hospitals. Sample: Convenience sample was composed of adults with central lines hospitalized for 4 or more days. Methods: At 4-day intervals, investigators observed bedside label use and EMR needleless connector change documentation. Control patients received standard care-needleless connector change with associated documentation in the EMR. Intervention patients, in addition to standard care, had a day-of-the-week, color-coded label placed on each needleless connector. To account for clustering within unit, multinomial logistic regression models using survey sampling methodology were used to conduct Wald χ tests. A multinominal odds ratio and 95% confidence interval (CI) provided an estimate of using labels that were provided on units relative to usual care documentation of needleless connector change in the EMR. Results: In 335 central line observations, the units with labels (n = 205) had a 321% increase rate of documentation of needleless connector change in the EMR (odds ratio, 4.21; 95% CI, 1.76-10.10; P = .003) compared with the usual care control patients. For units with labels, when labels were present, placement of labels on needleless connectors increased the odds that nurses documented connector changes per policy (4.72; 95% CI, 2.02, 10.98; P = .003). Conclusions: Day-of-the-week, color-coded labels cued nurses to document central line needleless connector change in the EMR, which increased adherence to the needleless connector change policy. Implications: Providing day-of-the-week, color-coded needleless connector labels increased EMR documentation of timely needleless connector changes. Timely needleless connector changes may lower the incidence of central line-associated bloodstream infection.
    Article · Feb 2016
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  • [Show abstract] [Hide abstract] ABSTRACT: Background: The purpose of this quality improvement project was to determine the effect of providing feedback to managers and bedside nurses on the nurses' central line-associated bloodstream infection (CLABSI) contributing factors, found on visual and documentation audits. Methods: This nonexperimental, quality improvement project was conducted in a 715-bed, 2-campus acute care community hospital health care system in Southwest Florida. The intervention consisted of providing confidential feedback on central line audits deviations, through the systematic delivery of unit case reports and personalized nurse report cards. Analysis of central line audit deviations and subsequent report cards was undertaken. Results: Of the 620 lines visually audited from 14 nursing units, over 16 weeks, 113 lines (19.2%) failed the audit. Each line triggered an electronic medical record audit, which identified 628 CLABSI contributing factors. Subsequently, nurse managers received 113 unit case reports and 487 bedside nurses received report cards. Over time, the frequency of CLABSI contributing factors decreased (rho = -0.12, n = 620, P = .003). Conclusions: Central line audit analysis, providing unit case reports to nursing managers and 1-on-1 personalized nurse report cards, has shown an increase in compliance with established guidelines for the management of central lines.
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Article
January 2017 · American Journal of Infection Control · Impact Factor: 2.21
    Background: The purpose of this quality improvement project was to determine the effect of providing feedback to managers and bedside nurses on the nurses' central line-associated bloodstream infection (CLABSI) contributing factors, found on visual and documentation audits. Methods: This nonexperimental, quality improvement project was conducted in a 715-bed, 2-campus acute care community... [Show full abstract]
    Article
    February 2016 · Clinical nurse specialist CNS · Impact Factor: 0.99
      Purpose: This study examined nurses' adherence to policies regarding needleless connector changes using a novel, day-of-the-week, color-coded label compared with usual care that relied on electronic medical record (EMR) documentation. Design: This was a prospective, comparative study. Setting: The study was performed on 4 medical-surgical units in a seasonally fluctuating, 715-bed... [Show full abstract]
      Article
      December 2013 · Journal of Infection Prevention
        Catheter-related bloodstream infection is a major cause of patient morbidity, mortality, and cost for patients undergoing hemodialysis. Healthcare personnel have control over central venous catheter care in the healthcare setting, but patient practices in the home environment may play a role in catheter-related infections. This qualitative study investigated hemodialysis catheter-related care... [Show full abstract]
        Article
        September 2016 · Journal of the Association for Vascular Access
          The Association for Vascular Access (AVA) is an organization of health care professionals founded in 1985 to support and promote the specialty of vascular access. The mission of AVA is to distinguish the vascular access specialty and define standards of vascular access through an evidence-based approach designed to enhance health care. There is little guidance for multidisciplinary... [Show full abstract]
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