Article Text
PDF
Abstract
Background Central line associated blood stream infections (CLABSI) occur frequently in the paediatric oncology (PO) population increasing morbidity, mortality, and costs. Families in the home provide a large portion of PO external central line (CL) care with limited opportunities to develop skills that maximise best practice bundle adherence, key to infection prevention.
Objectives To achieve >90% of families with documented independence in CL flushing by 12 months.
Methods Plan-do-study-act cycles were used to test changes from April 2016-June 2017 after identifying drivers in a pilot (June 2015-March 2016) to develop a family-centred learning curriculum. This involved return-demonstration [teach-backs (TBs)] of CL skills in front of a nurse coach during routine clinic visits and use of CL care cognitive aids. Key interventions: culture change-new expectation of TB participation until independent; embedding TBs into routine care with a dedicated nurse champion; developing checklists to standardise content, approach, performance, and proficiency evaluation with documentation. Statistical process control charts tracked changes over time.
Results During the pilot, 12.9% (22/171) participated in the TB program and 4.7% (n=8) had documented independence. After April 2016, special cause variation shifted the centre line of families’ independent from 6% to 89%. Participation increased to 87.9% (181/206) with 82.5% (n=170) independent, sustaining the improvement at >90% since October 2016.
Conclusions Ensuring families’ independence with CL care in the home is a safety priority which can be achieved through a teach–back program embedded into routine care. Determining impact on families’ CL care-associated distress and ambulatory CLABSI rates is in process.
Statistical process control chart (p-chart) 3 sigma