Electronic health record solutions to reduce central line-associated bloodstream infections by enhancing documentation of central line insertion practices, line days, and daily line necessity - 31/03/16
, Darlene D. Porter, BSN, RN, PHN c, Margaret O'Brien, BSN, RN d, Scott Rudkin, MD c, Brian Lambertson, BSN, RN c, Dennis Hoang, PharmD c, Amish A. Dangodara, MD e, Susan S. Huang, MD, MPH a, bHighlights |
• | Current reporting of CLIP compliance is artificially inflated. |
• | Using CVC placement as a denominator is a truer measure of CLIP compliance. |
• | EHRs can improve capture of CVC line days, decreasing CLABSI rates. |
• | EHRs enable compliance with daily documentation of line necessity. |
Abstract |
Background |
Central line-associated bloodstream infections (CLABSIs) continue to cause preventable morbidity and mortality, but methods for tracking and ensuring consistency of CLABSI-prevention activities remain underdeveloped.
Methods |
We created an integrated electronic health record solution to prompt sterile central venous catheter (CVC) insertion, CVC tracking, and timely line removal. The system embedded central line insertion practices (CLIP) elements in inserter procedure notes, captured line days and new lines, matching each with its CLIP form and feeding back compliance, and enforced daily documentation of line necessity in physician progress notes. We examined changes in CLIP compliance and form submission, number of new line insertions captured, and necessary documentation.
Results |
Standard reporting of CLIP compliance, which measures compliance per CLIP form received, artificially inflated CLIP compliance relative to compliance measured using CVC placements as the denominator; for example, 99% per CLIP form versus 55% per CVC placement. This system established a higher threshold for CLIP compliance using this denominator. Identification of CVCs increased 35%, resulting in a decrease in CLABSI rates. The system also facilitated full compliance with daily documentation of line necessity.
Conclusions |
Integrated electronic health records systems can help realize the full benefit of CLABSI prevention strategies by promoting, tracking, and raising the standard for best practices behavior.
Le texte complet de cet article est disponible en PDF.Key Words : Central venous catheter, Checklist
Plan
| An abstract of this study was presented at IDWeek 2013, San Francisco, California, Oct 2-6, 2013. |
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| This work was funded by UC Irvine Health. SMC was supported by the UC Irvine Medical Scientist Training Program. |
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| Conflicts of Interest: None to report. |
Vol 44 - N° 4
P. 438-443 - avril 2016 Retour au numéro
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