Implementation of a Documentation System of Evidence-Based Processes for the Insertion of Central Venous Catheters

Abstract

ISSUE: Evidence-based guidelines are established for the prevention of central line associated bloodstream infections. Record review did not provide a reliable consistent means of determining if established practices occurred. Documentation was scarce if present at all and typically stated only that a line was inserted. PROJECT: Critical Care Unit (CCU) Nursing Staff were currently required to complete pre-procedure pause or time out documentation form for insertion of central lines; an additional form was not well received. CCU Staff reviewed the IHI and CDC documentation tools and felt them too lengthy. Infection Control worked with CCU Staff to solicit suggestions for documentation resulting in staff recommending and developing their own form that incorporated the IHI components, time out, hair removal, and multiple other indicators. Their efforts resulted in development of a documentation tool that would provide accurate consistent information of processes in place before, during and after central line insertions. The documentation tool would be beneficial to staff, quick, and incorporate other already required indicators, such as procedural pause. The use of check boxes resulted in less narrative for staff and easier acceptance. The tool also served as a reminder of important components related to positive outcomes for patients with central lines, particularly for areas performing line insertions infrequently. To educate staff as to the importance of following and documenting the established processes, storyboards were developed, discussion with staff by the CCU Manager and ICP occurred. A copy of completed forms is faxed to infection control as one means of data collection. This allows monitoring of compliance with time out, hand hygiene, type of catheter used, proper hair removal if indicated, and IHI Central Line Bundle with the exception of daily review for necessity of line. Random review for compliance with all components of the IHI Central Line Bundle is still conducted as recommended by IHI; one central documentation area in the medical record evidences all but one of the bundle components. Data collection is quicker and study results are made available to staff via their information board in real time. Results are tracked for compliance with all items on the documentation tool not just IHI Central Line Bundle. RESULTS: Collaboration resulted in the development and implementation of a documentation tool that is user friendly, efficient, eliminates narrative and allows quick retrieval of information. Physicians requested a preprinted sticker for their progress notes to streamline their documentation as well. LESSONS LEARNED: Solicitation of staff involvement in formulating change is essential for success; do not duplicate existing processes, incorporate them. Start small, and then extend to other clinical settings.