Nurse Driven CVC Rounding Utilized to Improve Bone Marrow Transplant Patient Outcomes

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Topic Significance & Study Purpose/Background/Rationale Central venous catheters (CVC) are frequently used in Bone Marrow Transplant (BMT) patients. BMT RNs are responsible for the care of CVC during a patient's hospitalization. CVC require dressing changes, needless connector changes, and frequent line entries. Patients with a CVC are at risk for acquiring a catheter line associated bloodstream infection (CLABSI). Due to BMT patients having compromised immune systems and altered gut integrity, the risk for acquiring a CLABSI is exponentially higher. Methods, Intervention, & Analysis A nurse led BMT unit based team was formed which became known as BMT CVC Representatives. CVC Representatives function as resources for team members, patients, and families. A CVC Representative rounds weekly on all patients on the BMT unit. Along with assessing the status of CVC dressings, activities include monitoring chlorhexidine (CHG) bathing (including education on CHG bathing to team members, patients, and families), monitoring passive disinfection devices, identifying patients with potential for CLABSI and assisting in crafting interventions for CLABSI prevention, mitigating potential CVC complications, and participating in CLABSI huddles. Findings & Interpretation BMT CVC Representatives are able to foster frontline engagement and identification of interventions that align with the goal to delivering exceptional and safe care. The interventions practiced at the bedside are critical to the patients' overall health and achievement of quality outcomes. The team is able to collaborate in mitigating patient specific solutions when dealing with challenging CVC care situations. BMT CLABSI infection rate continues to be a focus with the CLABSI rate at 2.00 BSI per 1,000 catheter line days at the end of fiscal year 2019 as compared to 2.65 BSI per 1,000 catheter line days at the end of fiscal year 2018. Discussion & Implications There has been an increase in awareness of CVC care which directly effects the BMT patient's health and outcomes. With weekly rounds the BMT CVC Representatives are able to be a resource for the team, patients, and families. They are a constant advocate for CHG bathing and other CLABSI prevention interventions.