Purpose:
To increase patient safety during central line insertion by having a nurse observer document key behaviors of physicians during central line placement in a large teaching hospital.
Significance:
Use of proper sterile technique for central line insertion can be problematic. Observation of physicians placing central lines by a staff RN using a checklist improves adherence to CDC recommended guidelines for central line placement.
Background/Design:
In response to staff reporting anecdotal incidences of central lines being placed under suboptimal conditions, the unit's CNS and infection control practitioner, with the support of the nurse manager and the medical director, implemented a checklist (based on a CDC form) for the bedside nurse to fill out at the time of central line insertion.
Methods:
In an observational study of physician practice by RN's, an RN fills out a checklist each time a central line is placed. The physician is given the opportunity to see the checklist prior to starting the procedure.
Findings:
This is an ongoing process. What we have improved so far: (1) More subclavian lines are now placed as recommended by the CDC. (2) Physicians are placing fewer femoral lines as this is not a preferred site. (3) There is improved adherence for using recommended skin preparation. What we have confirmed is that we have continued adherence to CDC guidelines for: (1) full sterile drape, (2) sterile gown and gloves, (3) mask/eye shield and head covering for line insertions, and (4) hand hygiene.
Conclusions:
This study, which began in 2005, is still in process. By observing central line placement, nurses feel empowered to facilitate safe practice by using a checklist that can be shown to the physician prior to starting the procedure. We expect that by focusing more on the actual process of central line insertion and placing less focus on the blood stream infection rates, we will see a decline in our blood stream infection rates.
Implications for Practice:
Observing techniques used for central line placement changes behavior by increasing adherence to CDC guidelines for central line placement.