Doctor of Nursing Practice
Sharon Bradley, DNP, MSN, RN, CCM, CPHQ, NE-BC
Ginger Gillette-Kent, MSN, ANP
Second Practice Mentor
Jillian Nichols, BSN, RN
Significance and Background: Best evidence supports central venous access device (CVAD) dressing changes occur every 7 days or sooner, if indicated. At a community hospital in New England, patients receive outpatient antimicrobial therapy via CVADs. It is vital that nurses adequately maintain CVAD dressings according to evidence-based protocols to reduce the risk of central line-associated bloodstream infection (CLABSI). CLABSIs, associated with increased morbidity, mortality, and health care costs, are largely preventable through proper CVAD maintenance. At the project site, a review identified that dressing changes were frequently changed beyond the 7-day parameter. Documentation and surveillance processes were identified as opportunities for improvement. The Joint Commission’s daily CVAD maintenance audit form (modified) was implemented. This quality improvement (QI) project is congruent with Quadruple Aim, as its outcomes focus on care, health, cost, and meaningfulness.
Purpose: Implement a daily central line maintenance audit form in an outpatient infusion center with the goals of improving adherence to CLABSI prevention protocol and quality of nursing documentation of CVAD maintenance.
Interventions and Setting: Setting: outpatient infusion center. Participants: adult patients with CVADS for daily antimicrobial treatment. The Model for Improvement including the Plan-Do-Study-Act cycle was utilized. Lewin’s Theory of Planned Change was utilized to guide project progression. Unfreezing: infusion staff queried on current practice; gaps in best practice identified. Moving: infusion educated about QI project followed by 3-month implementation period. Refreezing: DNP student assists in form incorporation into EMR.
Evaluation: Rates of CVAD dressing change before and after implementation were analyzed using descriptive statistics. Length of change intervals ranged from 1-11 days pre-implementation and 1-10 days post-implementation. Pre-implementation, the mean, mode, and median were each 7 days. Post-implementation, the mean, mode, and median were 6.1, 7, and 7 days, respectively. Discussion: Adopting a daily CVAD maintenance audit form will improve documentation and surveillance measures, with the goal of reducing rates of CLABSI. To make this intervention most effective and economical in accordance with Quadruple Aim, it is recommended that the form should be incorporated into the existing EMR.
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Christiana, S. E. (2023). Implementation of a daily central line maintenance audit form in an outpatient infusion center: A quality improvement project [Unpublished DNP project]. Sacred Heart University.
Available for download on Friday, May 10, 2024