Safe passage campaign to prevent catheter-related bloodstream infections (CR-BSIs) in a tertiary neonatal intensive care unit (NICU)

ISSUE: Inconsistent use of the Center for Disease Control and Prevention (CDC) guidelines for prevention of CR-BSIs as well as lack of clear, concise communication between members of the healthcare team can result in CR-BSIs. Due to fluctuating CRBSI rates, a multiphased “safe passage” campaign was launched in our 50-bed NICU to address both issues.

PROJECT: A teamwork and safety culture survey was conducted to provide a baseline measure. This was followed by a central line education and competency program. Each clinician received his or her own copy of a unit-produced DVD entitled “Safe Passage” which demonstrated hand hygiene, maximal sterile barrier precautions, and appropriate catheter site care. Once viewed, competency observation was required. Communication strategies consisted of coaching sessions for nurses and utilization of a standardized clinical communication tool known as SBAR (situation-background-assessment- recommendation/request). The tool helps set the expectation that relevant clinical information is going to be communicated each time the patient is discussed.

RESULTS: More than 60% of eligible participants responded to the survey. Over half indicated a positive climate. Low-scoring items pertained to problem resolution and inability to express disagreement. Most clinical staff viewed the DVD and successfully completed the competency. Additional variations in central line management were discovered and eliminated as a result of the program. Coaching sessions for 60 nurses were conducted using theater-based communication tools for “finding-your-voice.” Sessions consisted primarily of role play around difficult clinical scenarios and challenging communications. Participation was followed by individual action plans and selection of a “buddy” for feedback and support. Evaluations have been extremely positive. SBAR scenarios pertaining to central line care and management were written. The scenarios were tested with and without the use of the tool. Communication tended to be more concise and factual and less narrative when the tool was used. Individual nurse training using the tool begins in February.

LESSONS LEARNED: Eliminating variation in the use of CDC central line guidelines and successful nurse-physician communication is critical for the safe, efficient, and effective patient care. This project outlines a multifaceted, practical approach that we plan to replicate and spread to other areas of our organization.