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The goal was to reduce Continuous Renal Replacement Therapy (CRRT)-related Central Line-Associated Bloodstream Infection (CLABSI) rates by introducing a just-in-time re-education toolkit for proper hemodialysis (HD) line care in adult Intensive Care Units (ICU).
CRRT requires specialized expertise delivered in the ICU setting with the support of HD nurses. Problem-solving when cartridges clot or clog requires ICU nurses to return the blood and notify HD to restart therapy. Current evidence supports the use of white CurosTM caps and TegoTM connectors when deaccessing lines in order to prevent CLABSIs, air emboli, and bleeding. A learning needs assessment revealed inconsistent understanding and application of these specific connectors and caps, posing potential safety risks.
For this performance improvement initiative, HD nurses collaborated with the ICUs to develop an education plan addressing proper HD line care in adult ICUs. First, information about HD line care, safety concerns, and re-education on evidence-based specialty connectors and caps were presented to multiple shared governance committees and key stakeholders. Education was reinforced by placing toolkits on all adult CRRT machines; including a laminated, educational quick reference card paired with the needed specialty connectors and caps. To support practice change, weekly audits with just-in-time education have been ongoing since project initiation.
CRRT-related CLABSI rates per 1,000 CRRT patient days were calculated across adult ICUs. Pre-intervention rates were at a concerning high of 4.27 in July 2018 and paralleled the initial observation of inconsistent, unsafe practice. The intervention phase began with planning (August-September 2018), followed by the implementation (October 2018-January 2019) including initial education, toolkit construction, and weekly audits with just-in-time education. Post-intervention rates fell to 0 in February and March of 2019 and continue to show the minimal incidence of CRRT-related CLABSI events with a bump to 3.26 in April 2019 and return to 0 in May 2019, indicating successful integration into practice. Data continues to be collected and analyzed as it becomes available.
The partnership between adult ICUs and HD nurses resulted in improved outcomes in patients receiving CRRT. Dissemination extended beyond the adult ICUs to create positive change at the organizational level through a reduction in CLABSI rates and enhanced staff education.
This poster is distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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VCU Health Nursing
Initial Poster Presented at 2018 Mid-Atlantic Interprofessional Leadership Conference, Richmond, VA