Author Of 2 Presentations
CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTION (CLABSI) EVENTS REVIEW: UTILIZING APPARENT CAUSE ANALYSIS TO IMPROVE PROCESSES
Abstract
Background
CLABSIs are conditions with great morbidity and costs. Hospitals that performed in-depth review of CLABSI events to improve processes reduced CLABSI rates. At Children’s Hospital of Eastern Ontario (CHEO) the high CLABSI rates led to a quality improvement initiative that included apparent cause analysis of all CLABSI events.
Objectives
To identify contributing factors to CLABSIs at CHEO PICU, NICU and inpatient units to guide process improvement.
Methods
A team constituted of a physician, the local nurse educator, a vascular access expert, and an infection control professional systematically reviewed all inpatient CLABSI events for a period of 14 months. The team interviewed providers and reviewed charts to identify standard of care deviation and unusual circumstances related to central line care.
Results
Between November 2017 and December 2018, CHEO inpatient units had a total of 10269 line-days. NICU had 10 CLABSI events, PICU 5, Hematology and Oncology Unit 14, and other inpatient units 5. Line care documentation was incomplete in 9 cases. Gaps in care were identified in 6 events and 2 were deemed as serious safety events. Skin breakdown at the line site, frequent visits to the operating room, active resuscitation utilizing PICC line were some of the contributing factors identified
Conclusion
Processes for documentation, management of skin breakdown at the site, line repair and others were reviewed and disseminated. Central line access and care training was offered for the operating room providers. These changes contributed to a downward trend in the CLABSI rate from 3.62, before intervention, to 2.85, in its last 6 months.
OPTIMIZING ASSESSMENT OF PAIN, AGITATION AND WITHDRAWAL IN THE PICU: A QUALITY IMPROVEMENT INITIATIVE TO REDUCE IATROGENIC WITHDRAWAL
Abstract
Background
Iatrogenic withdrawal syndrome (IWS) is a frequent serious complication in pediatric critical care. In 2016, at the Children’s Hospital of Eastern Ontario, IWS affected more than 80% of high-risk patients; a higher incidence than usually reported in the literature.
Objectives
This quality improvement project aimed to decrease the incidence of IWS in patients intubated and ventilated in our PICU.
Methods
A series of interventions to decrease exposure to opioids and sedatives were adopted: education; a new pain scale; and optimization of assessment and documentation of pain, agitation and withdrawal symptoms. The variables collected by electronic medical record (EMR) reports and bedside audits were monitored on control charts.
Results
From a total of 382 intubated and ventilated patients, admitted from January 2017 to September 2018, 151 patients were assessed for IWS with using the Withdrawal Assessment Tool, version 1 (WAT-1). The figure 1 shows the incidence of IWS in assessed patients and the percentage of intubated patients assessed for IWS. Initially, the high incidence of IWS decreased with education until October 2017 when started to increase again. This coincides with the implementation of a new EMR system which prompted a steep increase in the percentage of patients assessed for withdrawal, showing that the initial incidence of IWS was underestimated. Unplanned extubation, severe pain or undersedation were not affected by the interventions
Conclusion
The incidence of IWS was reduced by 20% after 2 years of improvements. The next steps will include embedding the sedation and analgesia protocol in order sets through EMR.
Presentation files
-
Tatiana Sampaio OPTIMIZING ASSESSMENT OF PAIN 1 20.06.2019 03:31
-
Tatiana Sampaio OPTIMIZING ASSESSMENT OF PAIN 18.06.2019 19:49
Video on Demand
Presenter of 2 Presentations
CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTION (CLABSI) EVENTS REVIEW: UTILIZING APPARENT CAUSE ANALYSIS TO IMPROVE PROCESSES
Abstract
Background
CLABSIs are conditions with great morbidity and costs. Hospitals that performed in-depth review of CLABSI events to improve processes reduced CLABSI rates. At Children’s Hospital of Eastern Ontario (CHEO) the high CLABSI rates led to a quality improvement initiative that included apparent cause analysis of all CLABSI events.
Objectives
To identify contributing factors to CLABSIs at CHEO PICU, NICU and inpatient units to guide process improvement.
Methods
A team constituted of a physician, the local nurse educator, a vascular access expert, and an infection control professional systematically reviewed all inpatient CLABSI events for a period of 14 months. The team interviewed providers and reviewed charts to identify standard of care deviation and unusual circumstances related to central line care.
Results
Between November 2017 and December 2018, CHEO inpatient units had a total of 10269 line-days. NICU had 10 CLABSI events, PICU 5, Hematology and Oncology Unit 14, and other inpatient units 5. Line care documentation was incomplete in 9 cases. Gaps in care were identified in 6 events and 2 were deemed as serious safety events. Skin breakdown at the line site, frequent visits to the operating room, active resuscitation utilizing PICC line were some of the contributing factors identified
Conclusion
Processes for documentation, management of skin breakdown at the site, line repair and others were reviewed and disseminated. Central line access and care training was offered for the operating room providers. These changes contributed to a downward trend in the CLABSI rate from 3.62, before intervention, to 2.85, in its last 6 months.
OPTIMIZING ASSESSMENT OF PAIN, AGITATION AND WITHDRAWAL IN THE PICU: A QUALITY IMPROVEMENT INITIATIVE TO REDUCE IATROGENIC WITHDRAWAL
Abstract
Background
Iatrogenic withdrawal syndrome (IWS) is a frequent serious complication in pediatric critical care. In 2016, at the Children’s Hospital of Eastern Ontario, IWS affected more than 80% of high-risk patients; a higher incidence than usually reported in the literature.
Objectives
This quality improvement project aimed to decrease the incidence of IWS in patients intubated and ventilated in our PICU.
Methods
A series of interventions to decrease exposure to opioids and sedatives were adopted: education; a new pain scale; and optimization of assessment and documentation of pain, agitation and withdrawal symptoms. The variables collected by electronic medical record (EMR) reports and bedside audits were monitored on control charts.
Results
From a total of 382 intubated and ventilated patients, admitted from January 2017 to September 2018, 151 patients were assessed for IWS with using the Withdrawal Assessment Tool, version 1 (WAT-1). The figure 1 shows the incidence of IWS in assessed patients and the percentage of intubated patients assessed for IWS. Initially, the high incidence of IWS decreased with education until October 2017 when started to increase again. This coincides with the implementation of a new EMR system which prompted a steep increase in the percentage of patients assessed for withdrawal, showing that the initial incidence of IWS was underestimated. Unplanned extubation, severe pain or undersedation were not affected by the interventions
Conclusion
The incidence of IWS was reduced by 20% after 2 years of improvements. The next steps will include embedding the sedation and analgesia protocol in order sets through EMR.
Presentation files
-
Tatiana Sampaio OPTIMIZING ASSESSMENT OF PAIN 1 20.06.2019 03:31
-
Tatiana Sampaio OPTIMIZING ASSESSMENT OF PAIN 18.06.2019 19:49