Fiscal Year Non-PICCLine Days
Infection Rate /1000 Line Days
Cohorts Beginwith Start of FY
(Learners = Residentsand APCs)
2006 15,004 3.4
2007 15,138 2 A (n=56)
2008 14,136 2.5 B (n=61)
2009 19,463 1.4 C (n=70)
2010* 15,781 0.8 D (n=61)
References:1.Barsuk,J.H.,etal.CritCareMed,2009,37(10):2697-2701.2.Evans,L.V.,etal.(abstract)AcadEmergMed,2009,16(s1):s6.3.Leung,J.,etal.AnnofEmergMed,2006,48(5):540-547.4.Milling,T.J.,etal.CritCareMed,2005,33(8):1764-1769.5.Pronovost,P.,etal.NEnglJMed,2006,355(26):2725-2732.
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CLA
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MonthsCL CL LCL UCL A Lower bound A Upper bound B Lower bound B Upper bound
CL = Control Limit
Impact of an Interprofessional Central Venous Catheter Insertion Training Program
Lehigh Valley Health Network, Allentown, Pennsylvania
Background:
James P. Orlando, Ed.D; Andrew Miller, DO; William Bond, MD, MS; Valerie Rupp, RN, MSN; Bryan Kane, MD; Cindy Umbrell, RN, MSN; Michael Pasquale, MD; Elizabeth Verheggen, PhD; Elliot J. Sussman, MD, MBA
EvidencesuggeststhatcentralvenousCatheter(CVC)insertiontraining,1,2theuseofultrasoundguidance,3,4andcompliancewiththeInstituteforHealthcare(IHI)centrallinebundle5improvepatientoutcomes.
Objectives:ReduceCVCcomplicationsincludingcentrallineassociatedbloodstreaminfections(CLAB).
Methods:TheCVCcourseisrequiredofallresidentswhoplacecentrallinesatLVHNuponentryintoresidency.Apre-courseelearningmodulewithvideovignettessetsbehavioralandcollaborativeexpectationsamongallproviderssurroundingtheprocedure.Thecourseincludes:ahalf-daypracticalportionwithmanikinpractice,ultrasoundfortargetvesselverification,andachecklistbasedcompetencyevaluation.Nursesparticipateinthecourseandensurethatthebedsidechecklist,whichincludestheIHIbundle,isusedasitwouldbeatthebedside.Assessmentsincludedpostcoursesurveys,focusgroups,pre/post/delayedknowledgetests,andregistrydatathattrackscompliancewiththeIHIbundleandCLAB.
Results:Focusgroupsconfirmedtheneedforacheckoffrunandthatnursesarehelpingensuresterileconditionsandchallengingresidentsonthenumberofneedlestickattempts.StatisticalqualitycontrolmeasureswereusedtotracktheeffectofthetrainingprocessontheCLABrateforCVCs(peripherallyinsertedcentralcatheters,PICClines,excluded)whichimprovedfrom3.4to0.8per1000linedays(t-test,P=0.001).Reducedvariabilityinthedownwardtrendingratewasreflectedbythestandarddeviationdecreasingfrom1.45pre-trainingto0.40post-training.
Conclusion:TheCLABratewassuccessfullyreduced.Checkoffcompetencyrunsandnursecollaborationinthechecklistareplausiblecontributingfactorstosuccess.
Next Steps:Centrallinetrainingparadigms,includingbedsidechecklists,interprofessionaltrainingprotocols,andregistrymethodsforperformancetrackingrequirerefinementandbroaderapplication.
SQC Control Chart for CLAB Rate
*FYtoApril2010
The CVC Course
Collaborative BedsideChecklist
CPOE Order Set
•Behaviorandcommunicationaroundtheprocedure
•Technicalaspectsofmaintainingsterilefield
•Technicalaspectsofinsertion,complications,indications,contraindications
•Understandingtheprocesssurroundingandpostinsertion
SQC Range Chart for CLAB Rate(Variability)
