Rapid cycle development of a multifactorial intervention achieved sustained reductions in central line-associated bloodstream infections in haematology oncology units at a children’s hospital: a time series analysis

Abstract

Stress to a complex system caring for high-risk patients can challenge CLABSI rates. Identifying key processes and executing them reliably can stabilise outcomes during times of system stress.

When Is Parenteral Nutrition Appropriate?

“…Clinical guidance and monitoring can be embedded into the electronic health record or through the development of web‐based PN ordering systems 22 . Rapid‐cycle hospital‐based quality and safety improvement projects, which aim to implement and measure change in 3 months or less, can produce significant improvements, such as the reduction in CLABSIs reported in a British hospital using this methodology 23 …”

Token economy to improve adherence to activities of daily living

“…The token economy intervention provided the clinical team with a clear and standardized process by which fundamental positive reinforcement was provided to patients increasing ADL adherence as well as promoting patient activation, self‐management, and family engagement . Medical teams have previously relied on nurse or provider specific interventions including persistent encouragement and reminding when refusing to complete ADL, increasing the likelihood of patient‐provider conflict and undermining patient autonomy …”

Between the guidelines: SQUIRE 2.0 and advances in healthcare improvement practice and reporting

“…The article by Dandoy et al 5 adds an additional chapter to the developing story of healthcare improvement practice and reporting by relating one group's response to an observed failure of a previously successfully CLABSI-prevention bundle. The description of this highly developed group's investigation and rapid-cycle improvement response to changes in previously stable CLABSI rates suggests potentially translatable improvement ‘hardware,’ such as requiring two people for dressing changes or requiring baths, oral care and out-of-bed activities.…”

“…A laudable component of the report by Dandoy et al 5 is that the authors resist the temptation (often an irresistible temptation in the early ‘checklist school’ of QI) to condense their success into a simple formula. The narrative of their work is most informative from a ‘meta’ perspective, reading the authors as characters within their own context.…”

“…The important story that Dandoy et al 5 contribute is ultimately the story that gets told implicitly: that of the power of context in determining response to changes in performance. For those seeking empiricism, the task of improvement storytelling can seem daunting, but doing it well acknowledges that the crucial problems of improvement work are often complex, and may be better approached through narrative as opposed to paradigmatic thinking 1.…”