Texas
Regional Template: CLABSI Workgroup
Organization: Children’s Health
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The Texas Regional Hospitals
•Baylor Scott & White McLane Children’s Medical Center
•Children’s Health, Children’s Medical Center
•Children’s Memorial Hermann Hospital
•Cook Children’s Medical Center
•Covenant Children’s
•Dell Children’s Medical Center of Central Texas
•Driscoll Children’s Hospital
•Medical City Children’s Hospital
•Texas Children’s Hospital (Houston)
•The Children’s Hospital of San Antonio
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CLABSI Rounding Expectations
Bedside Staff:
•
Join the observer in the room for
rounding
Resolve any non-compliant elements in
real-time.
Educate families on appropriate care of
the CL.
Knowledgeable about prevention bundle
practices.
Know all available resources.
•
•
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•
Observers:
•
•
•
•
Real-time education to family and
bedside staff.
Check in with RN prior to going into the
room.
Engage bedside RN in discussion about
issues with the line or necessity.
Role model for best practice:
• Engage families
• Put gloves on to assess line
• Real-time feedback
Bundle Observation Script
Identify an RN who is caring for a patient with a central line
Ask nurse to show you in chart, documentation of:
___ 1. Was necessity of the line discussed in the past 2 completed shifts?
• Does the patient have a temporary or long term line?
Temporary: Intended for short term use (</= 30 days); Sutured in or stat lock
applied; Common locations – umbilical, neck, femoral
Long Term: Intended for long term use such as chemotherapy or TPN (> 30
days); Common types: IVAD, Broviac, and Tunneled
•
•
If Temporary, Ask nurse to show you documentation of discussion; (N/A if
admitted to hospital within last 24 hours)
If Long Term, Question is N/A ; go to the next question
___ 2. Are daily care elements documented within the past 24 hours?
• Is there documentation of a CHG order or documentation of contraindication to CHG?
• If CHG ordered, did the patient receive a CHG bath within the past 24 hours? (N/A if
admitted to hospital within last 24 hours)
Go to bedside with nurse and observe:
___ 1. Was the line maintained according to bundle?
• Dressing is clean, dry and occlusive
• Dressing and tubing dates of change are labeled appropriately
• Tubing is away from potential contamination (ostomy bag, diaper)
• Curos caps are covering all access points on all lines
___ 2. Assess for risk factors necessitating the need for a protective overlay/drape
*Risk factors may include: femoral line placement, line near excessive secretions or
emesis, line placed near ostomy, or patient with excessive stooling.
• If any risk factors are identified, is there a protective overlay/drape placed correctly?
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Leadership:
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•
•
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Set expectations and hold staff accountable
for minimum monthly observations.
Support observers:
• In their feedback to and
reinforcement of bundle elements
• Bedside staff integration
Data transparency through staff meetings.
Allocate resources to help observers be
successful.
Minimum Quantity of Monthly Observations
Unit/Department
>250 monthly line days
• Hem/Onc
• NICU
• D3
• C12
• C11
• D8
• D9
Audits/Month
50
76-250 Monthly line days
• C4
• D10
• C5
30
<75 Monthly line days
• C8
• C10
• C9
• B4
20
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CLABSI Interventions
2014-2015:
– Curos Caps
– Family Education
– CHG Bathing
2016:
– Re-established Rounding Process
– Safety Cards Pilot
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CLABSI Events
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CLABSI Best Practice
Recommendations
• Multidisciplinary bedside reviews
• Validation of reliability processes and data
– Does your data reflect what is happening at the
bedside?
• CHG Bathing
• Curos Caps
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CLABSI Requests for Assistance
• “Beyond the Bundle”
– Environment of care implications?
• How to sustain improvement & manage drift?
• Coordination & Collaboration between 3
separate hospitals
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QUESTIONS?
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