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Improving the Appropriate Use of Central Lines in the Cardiovascular Intensive Care Unit
Using a Central Line De-escalation Algorithm to Reduce CLABSI
The goal was not about avoidance or blind removal, but an “authentic” assessment of central line necessity based on clinical need.
A nurse led interprofessional group was united through the Clinical Effectiveness Leadership Training (CELT) program with the goal of improving patient safety and quality of care and reducing Central Line Blood Stream Infection (CLABSI) cases on cardiovascular ICU (CVICU) units.
With ongoing efforts to reduce CLABSIs geared toward central line bundle compliance, avoiding central lines use, and prompt removal, the CLABSI CELT Team identified an opportunity for an "authentic" assessment of central line necessity based on clinical need.
The project focused its’ efforts on the daily central line need assessment for patients with a clear de-escalation pathway to improve the clinical appropriateness of central lines. A standardized method of appropriately assessing central lines on clinical indication as well as a clear de-escalation pathway to avoid prolonged use was developed. From February 7th to March 7th, 2022, the team piloted the use of the Central Line De-escalation Algorithm (CLDA) on J4 ICU.
Success Outcomes and Impact of the Central Line De-escalation Algorithm workflow:
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The average central line prevalence went down to 1.1, which was a 15% improvement and statistically significant (p<0.0001).
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J4 went five months without a CLABSI case since the de-escalation pathway algorithm pilot stabilized in February 2022.
This interprofessional team was assembled from key stakeholders from Nursing, Infection Prevention, Nursing Quality and Professional Practice and Clinical Improvement, Cardiovascular team, and Cardiovascular Surgery Team.
Positive feedback on this new workflow:
• “Systematic way of assessing lines, eliminating subjectivity of how we look at central lines, and guidance on when to de-escalate” – CV Surgery NP
• “It gave us structure to have a conversation we wanted to have” – J4 Staff
Thank you to all the team members for your leadership and support to improving safety and quality of care for our patients.
Dr. Javier Lorenzo, Yuliya Behey, Joy Goor, Danielle Smith, Sean Lau, Joy Octaviano, Jason Cooler, Hee Jeong Kim, Karen Feril, Molly Rodriquez, Rey M. Avelino, Staci LeBeau, Chris Tofanelli, Richard Giardina, Barbara Mayer, Karen McIntyre
Submitted by: Joy Octaviano MS, RN, CNS, AOCNS, OCN
Improving Patient Experience for Tracheostomy Patients on H1 Unit.
The nurses and ancillary staff on unit AAU H1 are committed to making a positive impact in advancing patient care. One of H1’s major achievements in 2022 was the adoption of using a device called a heat moisture exchange (HME) for the patients who have a tracheostomy.
The use of an HME in tracheostomized patients reduces heat moisture loss which contributes to less mucus production, less coughing and improvements in respiratory function. The HME also improves patient mobility, rehabilitation, and sleeping comfort.
H1 trialed the HME with eight patients from January 16, 2022, to February 15, 2022. Out of the eight patients, six preferred the HME over traditional bulky and noisy humidification set-ups, and expressed they were more comfortable and slept better on the HME device. Due to the results of the trial, H1 nurses continued to use the HME from January 2022 to present day. Currently, a total of 71 patients have preferred and have successfully used the HME on H1.
In addition to improved quality of life, the use of HME devices reduced inpatient and outpatient costs for tracheostomy patients. HME devices are substantially more cost effective than multiple single-item parts of traditional humidification set-ups.
With the successful HME trial on H1, the tracheostomy device was made available hospital wide. The initiative improved the patient experience and safety, quality of care, and reduced health care costs.
HME Trial Successful Outcomes:
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75% patients in HME trial preferred HME over mist machine. 100% of these patients were satisfied.
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H1 nurses reported less room clutter, decreased patient fall risk, and less home tracheostomy set up time with the use of the HME device.
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Calculated inpatient cost reduction when utilizing a HME is over 50% with an estimated annual cost reduction of $100,000.
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Calculated outpatient cost reduction of 66%.
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Reduced educational requirements for training to function and use HME.
Submitted by: Maribeth Cambridge, RN, MS, CCRN, Caritas Coach®
Patient Care Manager H1 ENT/Plastic Surgery/Breast Oncology/Pain