Quality Improvement Plan to decrease CLABSI

Quality Improvement Plan, Resources and Conclusion

Introduction. Briefly review your practice problem and include a purpose statement.
• Evidence-Based Practice Plan Explanation
o Provide a detailed explanation of the evidence-based practice performance improvement plan that you will be use to address the practice problem.
o Support your plan with scholarly references
• Resources (completed in Week 5)
o Describe the resources needed to support the change in practice such as personnel time, supplies for staff education, cost of new equipment, or cost of software.
o Explain why each resource is necessary.
• Conclusion
o Discuss all key points addressed in this assignment.
It must include FADE model and Rapid Cycle improvement model Below is portions of my discussion posts for this class, and includes my organizations accurate CLABSI rate

The quality improvement project identified for my practicum experience is implementing peer-to-peer tutoring with a -nurse checklist to promote compliance with evidence-based central venous catheter care to reduce CLABSI rates. This checklist has proven to improve adherence across all aspects of the central line maintenance care (Kellish, Sabo…, 2018)
For this project, the FADE model will be used to implement the quality improvement project to improve Central Venous Catheter (CVC) care amongst nurses in the medical-surgical division of a Medical Center in New Jersey. The measurement for the project’s success will be measured by the reported CLABSI rates and the results of audits for compliance performed by nursing leadership and nurse champions. The participants of the quality improvement project are the nurse leaders, unit champions, and the infection control department.
the Medical Center reported a 2.23 per 1000 days CLABSI rate for the year 2020 (Quality Score card, 2021). The policy clearly states to perform daily CHG baths, alcohol-based swab caps on all unused access ports, and the practice of scrub the hub when accessing ports regardless of swab cap presence. However, the analysis of the discussions with leadership compliance was not consistent, and according to the infection control department and the scorecard, CLABSI’s remain.

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Solution

Project Plan

Introduction

Most of the adverse health conditions are acquired from the environment, away from the clinical setting. But against that hypothesis, various health risks are attached to the clinical processes of care, which may increase the prevalence of infection, endangering the lives of the patients. One healthcare risk that develops within the care processes is a central line-associated bloodstream infection (CLABSI). This is a laboratory-confirmed type of bloodstream infection only acquired within the site and the care processes and happens in 48 hours of central line placement (Haddadin et al., 2020). Approximately 250,000 bloodstream infections globally occur annually and are majorly related to intravascular devices. For example, trained nurses use the peripherally inserted central catheters (PICCs) at the bedside care, with the tip of the peripheral device being advanced into the central vein.

In the pathophysiology of the infection, non-tunneled catheters are proven to contribute to the highest cases of CLABSi because they have no tunnels important in creating a barrier for bacterial migration. According to Haddadin et al., 2020), the bacteria on the skin surface of a non-tunneled catheter migrate towards the intravascular space within 7 to 10 days of placement and thus infect the patient. The occurrence of CLABSIs beyond the ten days is due to contamination of the hub, which the healthcare provider primarily contributes through the use of contaminated hands, which is against the protocols and standards of healthcare practice. The quality improvement project identified for the practicum experience is implementing peer-to-peer tutoring with a -nurse checklist to promote compliance with evidence-based central venous catheter care to reduce CLABSI rates. This checklist has proven to improve adherence across all aspects of central line maintenance care (Sabo et al., 2018). For this project, the FADE model will implement the quality improvement project to improve Central Venous Catheter (CVC) care amongst nurses in the medical-surgical division of a Medical Center in New Jersey. The measurement for the project’s success will be measured by the reported CLABSI rates and the results of audits for compliance performed by nursing leadership and nurse champions. The participants of the quality improvement project are the nurse leaders, unit champions, and the infection control department. The Medical Center reported a 2.23 per 1000 days CLABSI rate for 2020 (Quality Scorecard, 2021). The policy clearly states to perform daily CHG baths, alcohol-based swab caps on all unused access ports, and the practice of scrub the hub when accessing ports regardless of swab cap presence. However, the analysis of the discussions with leadership compliance was not consistent, and according to the infection control department and the scorecard, CLABSI’s remain.

Literature Review

There are numerous controlled and analytic studies on the impact of a nurse checklist and a peer to peer tutoring in countering the problem of CLABSI in healthcare treatment procedures within the healthcare system. Le et al. (2020) conducted a controlled study to establish the impact of using the nurse-driven protocols and the nurse checklist to reduce the rates of CLABS infections in the healthcare system. The researchers captured the CLABSI rate per 1,000 CL days and calculated the ratio of the CL days to the patient days for twelve months before the intervention. The baseline intervention indicators included adherence to hygiene, the sterilizing technique for CL access and dressing change, cleaning the CL hub, and daily chlorhexidine bathing. In addition, the intervention had regular clinician training, poster reminders, and a bedside checklist, which ensured a higher adherence to nursing standards and protocols in preventing hospital-acquired infections through the central line treatment procedures. The results showed that the nurses in the intervention group improved on hygiene adherence from 54% to 82%, the sterile technique while dressing increasing from 60% to 94%, and 51% to 97% on sterile technique in CL access. The improvement adherence to nursing protocols for nine months led to a decreased prevalence of CLABSI from 12.7 to 3.0.

Sabo et al. (2018) conducted a study to establish the effectiveness of adherence to hygiene protocols and the checklist in reducing the prevalence of CLABSIs in the healthcare system. The intervention, which was done on a 24-bed pediatric inpatient unit for 13 months, included a checklist developed with all daily central line maintenance and care details. High levels of training on the adherence to healthy and hygienic protocols when handling the central line were done through demonstrative videos and other training modes. The participants showed a 94% understanding of the protocols and the checklist before the intervention. The intervention was implemented, and adherence to the central line maintenance care practices was for improved care and reduced prevalence of CLABSI in the healthcare facility. According to the study, there was a considerable improvement in adherence to central line maintenance care after the training and implementation of a standardized checklist in the pediatric inpatient care unit. This reduced the number of central line infections resulting from unhygienic conditions and practices by the nursing team.

Apart from the studies by Sabo et al. (2018) and Le et al. (2020), who concentrated on training and the checklist, Drews et al. (2017) incorporated the engineering of a central-line maintenance kit in reducing the CLABS infections within the healthcare microsystem. The study used a non-randomized observational, interventional, prospective, and clinical research design. The study uses a pre-post analysis in assessing the impact of using a maintenance kit in the ICU to prevent a high prevalence of CLABSI. The results from the observational study concluded that an engineering-based kit guided by the human factors improved the adherence of the standard and best nursing practices in reducing the prevalence of CLABSI. The application of the human factors design in collaboration with training and checklist adherence.

Plan of the Intervention Program

The implementation of the intervention uses the FADE model in achieving the desired health care results. The FADE model involves focus, analysis, develop and execution as the elements of the implementation process.

Focus

The main goal of the healthcare center is to reduce the prevalence of CLABSI from 2.23 to zero in enhancing the quality of care and avoiding other hygiene-related complications. The patients with catheters and central line procedures highly depend on the nurse for their wellbeing, and thus the nurses should help in reducing the contamination levels during the CL procedures.

Analyze

In performing a quality improvement for the CL patients, the study needs to first establish the level of understanding and practice of the key hygiene standards for improved and safe care. Therefore, the team will develop a survey tool to conduct a pre-intervention study to establish the knowledge level on hygiene protocols in preventing CLABSI and other related infections such as CAUTIs. The tool will be given to the nurses through the management and in one day during a meeting. The nurses will be required to answer their understanding of chlorhexidine bathing, the sterilizing technique for CL access and dressing change, cleaning the CL hub, and general hygiene. The nurse will also answer on the level of practice of every particular element of hygiene.

Develop

The analysis will provide the educational needs of the nurses and thus assist in developing an interventional curriculum for extensive training on the nurse protocols needed to reduce the CLABSIs in the hospital. The intervention team must meet severally to analyze the results and establish an inclusive curriculum and training that will effectively cover the needs of the nurses in the quality improvement process. Expert reviewers will be called to provide additions in revising the curriculum before being submitted to the Clinical Practice Council and management for approval. According to Ross et al. (2019), the implementation of a quality improvement project in a healthcare facility should seek the approval and support of the top management.

Execute

The execution of the program is set to begin after the approval stage by the management. The management will communicate the project’s implementation plan to the stakeholders, who are the subordinate managers and nurses, through emails and internal memos on the notice boards. The execution will involve the nurses under the supervision and monitoring of the departmental heads. An external healthcare professional will train the nurses on the required healthcare practices that will improve the safety of the patients against CLABSIs. Continuous monitoring and evaluation of the nurses will be done every month to establish understanding and adherence to the practices. This will be through observation and the use of a constructed appraisal tool on the quality improvement process.

Resources Needed For the Change

Implementation of peer-peer tutoring and the maintenance checklist in the healthcare facility requires various resources—the main resource required for the intervention the personnel time with every aspect requiring additional focus. The intervention requires time for training sessions which should be regular to ensure consistency and a higher level of understanding. The nurses will have to use more time on a single patient than the time of intervention in monitoring and observing the required levels of hygiene. More funds are required to increase the supplies of materials such as cleaning detergents, sterilizing agents, gloves, and other hygienic components of a maintenance kit. The use of the supplies will be higher than normal, and therefore the project will require additional funds for the supplies. The other resource required is funding for the facilitation of the training and monitoring programs. The hospital trainers require communication aids such as internet connectivity, training manuals, and incentives for an effective training and monitoring exercise.

Conclusion

In conclusion, the intervention against the risk of CLABSI through training and the use of a bedside checklist is approved through various evidence-based research studies. The plan for intervention will adopt the FADE model, which involves focusing on reducing the rate of CLABIs to a prevalence of 0 from the current prevalence of 2.3, analysis of the current understanding of the nurse-driven protocols, development of a curriculum for study, and execution of the plan. Collaboration between the members of the microsystem is highly required for effective training and implementation of the program. The management is important in ensuring the availability of resources needed for the intervention.

References

Drews, F. A., Bakdash, J. Z., & Gleed, J. R. (2017). Improving central line maintenance to reduce central line-associated bloodstream infections. American Journal of Infection Control, 45(11), 1224–1230. https://doi.org/10.1016/j.ajic.2017.05.017

Haddadin, Y., Annamaraju, P., & Regunath, H. (2020). Central line-associated bloodstream infections (CLABSI). StatPearls [Internet].

Le, T., Thanh, H. N., Quang, M. N. N., Tran, C. N. T., Thanh, H. N. T., Le Quoc, T., … & Vasquez, A. (2020). Strengthening Adherence to a Central-Line–Associated Bloodstream Infection Prevention Bundle in a Surgical ICU in Vietnam. Infection Control & Hospital Epidemiology, 41(S1), s392-s392.

Ross, J., Stevenson, F., Dack, C., Pal, K., May, C., Michie, S., … & Murray, E. (2018). Developing an implementation strategy for a digital health intervention: an example in routine healthcare. BMC health services research, 18(1), 1-13.

Sabo, K. B., Sickbert-Bennett, E. E., Kellish, A. A., & Smith-Miller, C. A. (2018). Assessing nurses’ adherence to a central line maintenance care checklist on a pediatric inpatient unit. American journal of infection control, 46(2), 221-222.