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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.
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Article Info
Publication History
Abstract ID 52093Tuesday, June 21
Identification
Copyright
© 2005 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
