The Central HAC Team: Advancing the Culture of Safety Through Practice Observations.

Abstract

Background: At SickKids, central line-associated blood stream infections (CLABSIs) remain one of the most prevalent hospital acquired conditions. Despite implementation of evidence-based prevention bundles, adherence remains a challenge and obtaining reliable bundle adherence data is complex. An innovative approach to address gaps in practice was developed. Objectives: A centralized hospital acquired conditions team consisting of nurse leaders was created to improve bundle adherence and data reliability. The team partners with local leadership to reinforce the CLABSI maintenance bundle organization wide. The team completes observations, provides just-in-time feedback to nurses, and obtains reliable bundle adherence data. Methods: The team developed a defined model to complete observations: identify, coordinate, observe, feedback, document, and collaborate. Feedback is provided using error prevention strategies. Observations are electronically documented and visualized in real-time to trend results. The team identifies data-driven opportunities to inform priorities. Results: Since September 2018, the team has completed nearly 1500 practice observations with an observed 45% CLABSI reduction and a statistically significant centerline shift (Fig. 1). To evaluate team effectiveness, 118 nurses completed a survey. Seventy-eight percent of respondents agreed feedback was clear and 59% felt it helped improve their practice. Bundle adherence data comparing the team to local unit observers remains variable; however, education of local champions is improving reliability. Conclusions/Implications: The centralized approach for providing just-in-time feedback is an effective method to promote evidence-based practice and drive CLABSI maintenance bundle adherence. This method improves understanding of common failure modes to target improvements. Preliminary evaluation highlights how the team impacts safety culture and improves patient outcomes through practice observations.Fig. 1.: The Hospital for Sick Children Statistical Process Control Chart displaying hospital CLABSI rate comparative to the Solutions for Patient Safety network from August 2018 to February 2022. CLABSIs = central line-associated blood stream infections.