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The Texas Regional Hospitals

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Presentation on theme: "The Texas Regional Hospitals"— Presentation transcript:

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

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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?

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

9 CLABSI Events

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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?


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