Triad Partnership: Hero’s for Zero CLABSI’s
Patricia Rainey, MSN, APRN-BC, CPNP-PC, AGCNS-BC, ACCNS-AG; Aaron Preston, BSN, RN, CIC; Deborah Ott, DNP, APRN-BC, CRNI, VA-BC
DuShon Cooper-Edwards, MHA, RN; Julianne Kubes MPH; Doris Wong, MSN, RN, ACCNS-AG; Joanne Lindsey, MSN, RN, NP-C
Nicole Franks, MD; Elizabeth Overton, MSPH
Aim Statement: To reduce CLABSI rate to Zero, standardize the process for care and maintenance of central lines, increase collaboration with VAT
team, and decrease Alteplase usage in the Medical Hematology/Oncology inpatient population over a period of 1 year.
Background
Analysis
Actions/Tests of Change
• CLABSI (Central Line Associated Blood
Stream Infection) prevention strategies
within unit were inconsistent.
• An opportunity was recognized for
collaboration with multiprofessional
clinicians to create more consistency in
evidence-based practice application and
establish shared responsibility.
• Team Zero Hero’s formed to improve
patient care, improve processes, increase
collaboration and decrease CLABSI rate.
Apparent cause Analysis showed:
• Unclear who is responsible for port
accessing
• Inconsistent measuring of bundle
compliance
• Staff overwhelmed by port access
requests outside of unit
• Unclear objectives for central line
management between unit leadership,
staff, and facility leads
• High utilization of Alteplase on unit
• Team Zero Hero meetings to plan, implement and continually improve processes and
collaboration
• CLABSI champion and VAT team performed Audits and provided Real Time feedback to staff
to correct deficiencies, shared in UPC and Huddles
• UPC meetings to update unit and gain buy in from staff
• Collaboration with Oncology Physician and Outpatient Clinic leadership to collaborate on
shared patients to establish standardized evidence-based practices across the patient
continuum (implementation of CHG patch for outpatients admitted to unit).
• Education to all nurses included temporary and travelers on new processes.
• Shared progress, success and results with team in huddles, leadership meeting
Baseline Conditions
Measures
Results
Unit 71: 1.63
Facility: 0.69
• <= 2mg IV Alteplase doses given/ 1,000
central line days
• Central line infections/ 1,000 central line
days
• VAT consults/1,000 central line days
• Compliant
observations
maintenance
bundle/total observations
References
Lower rate of
consults for Vascular
Access Team than
rest of facility
.
Acknowledgements
Association of Vascular Access: Best Practices in Adult Peripheral Vascular
Access,
Resource Guide (1st ed.). Herriman, UT: AVA, 2013.
Bard Access (2015). Powerport advantage. Retrieved from Bard access
http://www.powerportadvantage.com/clinicians.html
Baskin JL, Reiss U, Wilimas JA, et al. 2012. Thrombolytic therapy for central
venous catheter
occlusion. Hematological. 97(5):641–50.
Center for Disease Control and Prevention (CDC). 2016. Central Line –
associated
bloodstream infections. Retrieved from www.cdc.gov/hai/bsi/bsi.html
Ethicon. 2017. Biopatch protective disk with chg. Retrieved from
www.ethicon.com/healthcare/biopatch
Hill J, Broadhurst D, Miller K, et al. 2013. Occlusion Management Guideline for
Central
Venous Access Devices (CVADs). Vascular Access. 7(Suppl 1):1-34.
Infusion Nurse Society: Policies and Procedures for Infusion Nursing (3nd ed.).
Norwood, MA:
Infusion Nurses Society, 2016.
Infusion Nurses Society. Infusion Nursing Standards of Practice. 2016. Journal of
Infusion
Nurses. 34(1S):S1-110.2
Acknowledgements: Judith Rivera, ASN, RN, VABC; Brad Dewulf, ASN, RN, VABC; Anitte Dorcent, RN BSN; Donna Goodwin, BSN, RN; Lucy Finney, BSN, RN; Terri Adams, ADN, RN
Maggie Kim, BSN, RN; Darlene Thomas, DNP, RN;Precious Nnadi, BSN, RN ; Tracey Avery, BSN, RN, VABC;Faithful Ndemera, ADN, RN