1. Texas Regional Template: CLABSI Workgroup Organization: Children’s Health

2. 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

6. Bundle Observation Script
CLABSI Rounding Expectations
Bedside Staff:
Observers:
Leadership:
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.
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
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.
Bundle Observation Script
Minimum Quantity of Monthly Observations
Unit/Department
Audits/Month
>250 monthly line days
Hem/Onc
NICU D3
C12
C11 D8 D9 50
Monthly line days C4
D10 C5 30
<75 Monthly line days C8
C10 C9 B4 20
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 (> 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?

8. CLABSI Interventions 2014-2015: 2016: Curos Caps Family Education
CHG Bathing
2016:
Re-established Rounding Process
Safety Cards Pilot

9. CLABSI Events

11. 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

12. CLABSI Requests for Assistance
“Beyond the Bundle”
Environment of care implications?
How to sustain improvement & manage drift?
Coordination & Collaboration between 3 separate hospitals

13. Questions?