Nursing Interventions and Education Lead to Quality Outcomes in Transplant and Cellular Therapy Patients

Abstract

Topic Significance & Study Purpose/Background/Rationale There are significant risks associated with central line associated blood stream infections (CLABSI), catheter associated urinary tract infections (CAUTI), Clostridium difficile (C. diff) and falls in the transplant and cellular therapy population. Our hospital has a nursing-led shared governance program. Each is involved in one of four unit-based councils that focus on Evidence-based Practice, Development, Quality, and Research. Quality Council focuses on monitoring initiatives implemented to improve patient care of the transplant and cellular therapy (BMT) patient population. This is done primarily through audits to ensure patient safety and quality outcomes. Nurse and Certified Nursing Assistant (CNA) education is planned and implemented by Development Council when new initiatives require education and when re-education is needed to meet desired outcomes. Quality and Development councils on the BMT unit have most recently focused on interventions regarding prevention of CLABSI, CAUTI, C. diff, and falls. Methods, Intervention, & Analysis To decrease CLABSI and CAUTI, daily CHG bathing was implemented with CNA education and ownership over daily compliance. Mirror cling hand hygiene instructions were placed on the bathroom mirrors to remind patients of proper technique. This unit initiated the Buddy System for central line dressing changes to prevent CLABSI. This provides accountability for nursing staff ensuring proper technique is being followed by allowing for a sterile nurse and a clean nurse. Fall prevention interventions include reviewing a fall contract with patients on admission, signs encouraging patients to call for assistance, and a post-fall patient interview. Findings & Interpretation CLABSI rates decreased by 50% in the first six months after implementing the Buddy System and CHG bathing. There was a slight increase in infections during the spring of 2018. It was found through nursing audits that patients were often noncompliant with CHG bathing with minimal staff follow-up. Re-education with teach-back was completed with staff on how to more effectively teach patients the importance and correct technique of CHG bathing. CLABSI infections decreased by 50% after re-education and remain low. CAUTI numbers on the unit have remained at zero for 28 months. C. diff has remained low during the past eight months. Fall rates have decreased with no major or moderate injuries in over 24 months. Discussion & Implications Including staff RNs and CNAs in the development and implementation of quality-related interventions and education can have a significant impact in improving patient outcomes including CLABSI, CAUTI, C. diff and falls.