Use of Electronic Medical Record–Enhanced Checklist and Electronic Dashboard to Decrease CLABSIs

Abstract

OBJECTIVES: We hypothesized that a checklist enhanced by the electronic medical record and a unit-wide dashboard would improve compliance with an evidence-based, pediatric-specific catheter care bundle and decrease central line-associated bloodstream infections (CLABSI). METHODS:We performed a cohort study with historical controls that included all patients with a central venous catheter in a 24-bed PICU in an academic children' s hospital. Postintervention CLABSI rates, compliance with bundle elements, and staff perceptions of communication were evaluated and compared with preintervention data.RESULTS: CLABSI rates decreased from 2.6 CLABSIs per 1000 line-days before intervention to 0.7 CLABSIs per 1000 line-days after intervention. Analysis of specific bundle elements demonstrated increased daily documentation of line necessity from 30% to 73% (P , .001), increased compliance with dressing changes from 87% to 90% (P = .003), increased compliance with cap changes from 87% to 93% (P , .001), increased compliance with port needle changes from 69% to 95% (P , .001), but decreased compliance with insertion bundle documentation from 67% to 62% (P = .001). Changes in the care plan were made during review of the electronic medical record checklist on 39% of patient rounds episodes. CONCLUSIONS:Use of an electronic medical record-enhanced CLABSI prevention checklist coupled with a unit-wide real-time display of adherence was associated with increased compliance with evidencebased catheter care and sustained decrease in CLABSI rates. These data underscore the potential for computerized interventions to promote compliance with proven best practices and prevent patient harm. Pediatrics 2014;133:e738-e746 AUTHORS:

Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe

“…[19][20][21] Third, the introduction of selfevaluation checklists, in general, can improve compliance with best clinical practice. 22 And finally, the HBB QIC progress boards placed in each unit provided a constant reminder to the staff of the quality improvement effort. Displaying data on implementation progress at each nursing station, in each delivery unit, allowed for constant review of and identification of potential problems in the implementation of the QIC, which has also been demonstrated in other quality improvement studies.…”

“…Displaying data on implementation progress at each nursing station, in each delivery unit, allowed for constant review of and identification of potential problems in the implementation of the QIC, which has also been demonstrated in other quality improvement studies. 20,22 A cost-effectiveness evaluation of an HBB program in a hospital of Tanzania revealed that HBB is a low-cost intervention. 23 The HBB QIC as implemented in our study is also an affordable intervention.…”

Electronic Health Record Adoption and Rates of In-hospital Adverse Events

“…[19][20][21][22][23] Electronic health records have been used for electronic surveillance to automatically identify patients at risk 19 and to create checklists and dashboards to monitor unit-wide central line-associated bloodstream infections. 20 Computerized physician order entry and CDS have been shown to reduce catheter-associated urinary tract infections through electronic reminders and alerts that facilitate improved catheter management [21][22][23] and to reduce the risks of falls and pressure ulcers through electronic integration of protocols and risk assessments. 24,25 Beyond the direct effects on safety, EHRs can also indirectly reduce overall adverse event rates by enabling quality improvement initiatives.…”

Is Zero Central Line–Associated Bloodstream Infection Rate Sustainable? A 5-Year Perspective

“…In addition, we acknowledged the importance of checklist compliance as a validated and effective tool in the CLABSI reduction process. 17,25,26 Thus, 3 areas of vulnerability were targeted:…”