NR451 RN Capstone Course
Term and Year
Eliminating CLABSIs Through Specialized IV Care
Central line-associated bloodstream infections (CLABSIs) are a major area of concern for inpatient care, resulting in thousands of deaths, and billions of dollars in preventable medical cost per year (CDC, 2016). As such, it is important, both with regard to medical responsibility, and with regard to controlling the cost and effectiveness of healthcare to implement policies and procedures that fully prevent, or meaningfully reduce the incidence of CLABSIs in the clinical setting. One means of doing so is to establish specialized IV teams to manage and control central lines, in order to reduce and eliminate risk factors.
Change Model Overview
The change model which will be used to implement the recommended change is the John Hopkins Nursing Evidence-Based Practice Process. This process is designed to use problem solving to make clinical decisions, in a meaningful and evidence based way. The three step processed, commonly referred to as PET, uses practice questions, evidence and translation to create practices that are based on latest research, and actively translating the research into patient care actions (Dearholt & Dang, 2012).
Practice Question
Step 1: Recruit Interprofessional Team
The recruited team will include the leader, the charge nurse, and three regular duty nurses, at a rate of one per shift.
Step 2: Develop and Refine the EBP Question
Can in the incidence of CLABSIs be meaningfully reduced among patients in the unit with a central line, by implementing specialized IV care, carried out by an assigned team who focus on IV care, instead of allowing it to be a part of regular car protocol managed by ward nurses?
Step 3: Define the Scope of the EBP
According to the Agency for Healthcare Research and Quality (AHRQ, 2013) CLABSI occurs at a rate of 5.3 per 1000 catheter days, with an overall mortality of 18 percent, which may peak as high as 35 percent. This means that roughly 28,000 patients per year die because of complications related to CLABSIs (AHRQ, 2013). This is significant because it comes at great cost of life, and financial risk for medical care agencies, and because the condition is completely preventable if the proper precautions are in place.
Steps 4 and 5: Determine Responsibility of Team Members
Leader will design the team, and the implementation protocol for the team, as it will be applied to IV care. The leader will also perform statistical analysis of the outcomes, in order to measure the effectiveness of the protocols over time.
The charge Nurse, will be in charge of managing the team and ensuring that protocols are followed, and over see any unforeseen issues with the protocol, or individual patients.
Three regular duty nurses, one for each of the three primary eight-hour shifts in the clinical setting, will actively carry out IV care for patients, according to the protocol.
Evidence
Steps 6 and 7: Conduct Internal/ External Search for Evidence and Appraisal of Evidence
There is significant research that supports the use of preventative protocols to reduce the risk of and incidents of blood stream infections among patients with central lines (AHRQ, 2011). Quality guidelines and safety policies are recommended by the CDC, AHRQ, and National institute of health regarding central line care and the risk of CLABSIs. There is also Quantitative evidence that the implementation of these guidelines through clearly outlined initiatives works.
Steps 8 and 9: Summarize the Evidence
CLABSI’s have a very real impact on patient care, and anticipated outcomes. In addition to having a mortality rate of 18%, they increase hospitalization by an average of 13 days per patient when they develop, translating to a cost of $45,254 per incidence of fully preventable financial loss (AHRQ, 2011). As such, prevention is paramount, and has been demonstrated as meaningfully effective. In ICUs alone, the use of cultural changes designed to actively aim at reducing CLABSIs, like the program herein recommended for implementation, has demonstrated that within 15 months of implementation, CLABSI rates could be reduced by 35 percent (AHRQ, 2011).
Step 10: Develop Recommendations for Change Based on Evidence
It is therefore recommended that a team of nurses be assigned solely to IV care, as it relates to central line monitoring and maintenance to prevent CLABSIs. Change procedure will be based on the Checklist for the prevention of Central Line Associated Blood Steam Infections, as developed by the CDC (2011).
Translation
Steps 11, 12, and 13, 14: Action Plan
The first step is to educate all staff members in the causes, and prevention of CLABSIs, while also establishing a clear protocol that routine care of CLABSIs including flushing lines, changing dressings, caring for caps and tubing, and ensuring that lines are functioning properly, and are still necessary, will be left to the care and discretion of the specialized team. The team will then take over all care of the lines. Success will be calculated as a percentage of reduction, based on the baseline calculated at the time of initiation, and being regularly calculated for the cohort each month over a 15 month period (AHRQ, 2011).
Steps 16 and 16: Evaluating Outcomes and Reporting Outcomes
The desired outcome is a reduction of at least 35 percent over the first 15 months of implementation. It will be measured according to the percentage in cases, as it relates to the baseline.
Steps 17: Identify Next Steps
Next steps will be to increase implementation to the whole medical system, in the clinical setting, rather than a single department. Changes may be made in implementation, beyond the first 12 months, in order to increase effectiveness.
Step 18: Disseminate Findings
Bi-monthly meetings will be used to disseminate the findings to the staff.
Conclusion
CLABSI’s have a very real impact on patient care, and anticipated outcomes, as well as increasing the cost of care. However, they are fully preventable with the use of preventative care, The implementation of the above care plan is designed to decrease the incidence of CLABSI, protecting both patients and the hospital form negative outcomes.
References
AHRQ (2011). A National Patient Safety Imperative: A Progress Report on the National On the Cusp: Stop BSI Project. Retrieved from http://www.ahrq.gov/sites/default/files/publications/files/onthecusp.pdf
AHRQ (2013). Tools for Reducing Central Line-Associated Blood Stream Infections. Retrieved from http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/clabsitools/clabsitools.pdf
CDC. (2011). Checklist for Prevention of Central Line Associated Blood Stream Infections. Retrieved from http://www.cdc.gov/HAI/pdfs/bsi/checklist-for-CLABSI.pdf
CDC (2016). Central Line Associated Bloodstream Infections. Healthcare Associated Infections. Retrieved from http://www.cdc.gov/HAI/bsi/bsi.html
Dearholt, S., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Models and guidelines. Indianapolis, IN: Sigma Theta Tau International.
