Multipronged, Multidisciplinary, Nurse Driven Line Rounding: Reducing Blood Stream Infections
Topic of Interest
Quality Initiatives
Interprofessional Collaboration
Abstract
A new patient population with pulmonary artery catheters (PACs) was introduced to a progressive cardiac unit. Central line (CL) days increased from 1544 to 2688 and central line associated blood stream infections (CLABSI) increased to 1.86.
Clinical Nurse Specialist (CNS) identified an opportunity to elevate nursing professional practice to improve quality of patient-centered care and patient safety, through evidence-based central line bundle adherence and dressing inspection. The team consulted with interprofessional collaborative partners, nursing experts, clincial nurses (CNs) at all levels, and partnered with patients and families. The engagement of all individuals made a pivitol improvement in infection prevention.
A multipronged, multidisciplinary nurse driven rounding process was designed to critically assess dressing placement, quality of catheter insertion site, communication between nurses, providers and patient education. This resulted in rounding on all patients with a CL three times a week under the guidance of the CNS and internal experts. Peer feedback and mentoring was provided in real time to CNs and through a weekly email with visual examples of CL dressings that were compromised. The email promoted autonomy as it provided rationale for how the integrity of CLs were compromised, and tips for interventions to implement.
Nurse driven rounds decreased CLABSI to 0.0 despite continued increase in CL days. Sharing knowledge and real time learning with colleagues increased CNs autonomy as they were able to independently identify when a CL dressing needed changing. Of the 1,071 CLs assessed 265 (24.7%) of the dressings required immediate interventions due to compromised integrity. The team partnered with patients during rounds providing education on the importance of CLABSI prevention. Patient satisfaction outperformed in 14 of the 16 domains and met the magnet standard, “communication with nurses” in the 99th percentile, which can be attributed to CL rounding and patient education.
Nurse driven evidence-based practice CL management and standardized rounding resulted in improved patient outcomes. Engagement of CNs and patients ensures continuity of care in the clinical practice setting. This process can be individualized to any care delivery system and is budget neutral.