Implementation of Institution-wide Central Venous Catheter Insertion Certification Program and COVID-19 Modifications (1090-004200) (To be presented during the session entitled, Research Abstract Oral: COVID-19)
Start time: Friday, January 22, 2021, 9:30 AM End time: Friday, January 22, 2021, 10:30 AM Session Type: Research Abstracts (Completed Studies)
In 2013, University of Iowa Health Care (UIHC) began a review of the full Healthcare Associated Infection (HAI) prevention portfolio and a subcommittee focused on reduction of central line-associated bloodstream infections (CLABSI) was formed. The purpose of this article is to share the process of developing a central venous catheter (CVC) insertion and maintenance program. Our objective was to design and implement an institution-wide standardized program of CVL insertion training and competency. The program includes standardization of insertion training process, equipment, supplies, documentation in the electronic health record (EHR) and checklist performance as well as the ability to track relevant data related to CVL insertion. The program has also been updated to accommodate modifications for COVID-19 policies.
The CVC program was initiated and implemented throughout the health system by team of health care providers, administrators, project managers, and support staff. A needs assessment survey was utilized to determine location of CVC insertion and provider information. The survey revealed high variation in supplies, process, and education. Supplies were standardized in a custom supply kit. Processes were standardized by requiring an assistant to observe for breaks in sterile technique and to complete a procedural checklist. Education including simulation was developed for practitioners and assistants. All practitioners performed a video recorded proficiency test on a CVC insertion model and were assessed on 27 metrics. Learners were given modifications to the metrics when COVID-19 precautions were implemented. All proficiency tests were assessed by faculty experts in CVC insertion. The UIHC Center for Procedural Skills and Simulation (CPSS) trained CVC inserters and observers.
Education and proficiency testing were implemented on a pilot unit in December 2015 and the remainder of the institution was onboarded over the following 18 months. Proficiency testing results were made available to clinical leaders in an interactive Tableau dashboard. A standardized grading form measured completion of all critical steps with emphasis on patient safety. Failure to complete the top three critical metrics required retraining and retesting. Preliminary data showed a 29% decrease in early CLABSI comparing 6 months before and after implementation was completed. Currently all new practitioners are required to certify in CVC insertion before performing the procedure clinically. CVC testing and training continue with COVID-19 modifications.
A CVC insertion certification program can be implemented in a major academic medical center and improve patient outcomes. COVID-19 modifications are possible for CVC insertion procedures.
Co-Presenter: Dr. John Keech, MD, VA Medical Center About the co-presenter: I am the Director of the Center for Procedural Skills and Simulation at the University of Iowa Hospitals and Clinics
Disclosure: No financial relationships with ineligible companies.