EP10b
Staffing and Resources EP10
Provide one example, with supporting evidence, when nurse(s) collaborated with the Nurse AVP/Nurse Director to evaluate data to meet an operational need (not workforce related).
Example b: Decreasing Central Line Utilization in the Surgical Intensive Care Unit
Operational Need
Acquisition of a new ultrasound machine.
Evaluation of Data and Collaboration between Nurse Director and other Nurses
The Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) Intensive Care Units (ICU) held a Unit Based Council (UBC) meeting in October 2023, including clinical nurses from the Surgical ICU (SICU) and Medical ICU (MICU). Attendees included Trish Nicholas, BSN, RN, Nurse Manager, SICU; Sheila Clemons, BSN, RN, Nurse Manager, MICU; Logan Jenkins, BSN, RN, CCRN, Clinical Nurse SICU; Heather Evans, RN, Clinical Nurse MICU; and Renee Fechuch, MSN, RN, Clinical Director of Nursing.
Fechuch reviewed quality data with the UBC, including the increase in central line utilization rates in the SICU. Preventing central line-associated bloodstream infections (CLABSI) is essential to providing safe, high-quality patient care. The number one way to prevent CLABSIs is to not have a central line at all. Fechuch collaborated with the nurse members of the UBC to discuss current trends and ways to decrease overall central line utilization rates. In September 2023, the central line standard utilization ratio (SUR) was 0.882, which was the highest it had been since the beginning of the year.
Fechuch stressed the importance of obtaining a peripheral intravenous line (PIV) when appropriate to reduce central line utilization. The UBC nurse members discussed this issue and identified a barrier to starting PIVs: the lack of access to the equipment needed to start PIVs due to the number of bedside procedures that are completed in the SICU. Many bedside procedures require the use of an ultrasound machine for visualization, which resulted in nurses leaving in central lines longer than necessary because they did not have the ultrasound machine to assist in starting a PIV. In addition, many patients in the SICU require a midline or Accucath, which is inserted using an ultrasound, due to multiple infusions. (Evidence EP10b-1, UBC Meeting Minutes, Roster, and SICU CVL Utilization Data)
Operational Need Addressed
After the ICU UBC meeting, Fechuch took the feedback from the UBC clinical nurses to Teresa Lambert, MBA, BSN, RN, Vice President of Patient Care Services and Assistant Chief Nursing Officer (role of CNO) on October 18, 2023. Lambert immediately approved the acquisition of another ultrasound machine. Fechuch collaborated with GE Healthcare to obtain a quote for the acquisition of a new ultrasound machine. (Evidence EP10b-2, Quote)
On November 29 and 30, 2023, the vendor completed education with the nurses and physicians from the SICU. (Evidence EP10b-3, Inservice Education Material and Roster) The ultrasound machine arrived on December 1, 2023, and the SICU began using it that week. (Evidence EP10b-4, Ultrasound Asset Sheet)
ICU nurses collaborating with Fechuch, Clinical Director of Nursing, to meet the operational need to obtain an ultrasound machine led to a decrease in the central line utilization rate in 1st Quarter 2024 (January-March). (Evidence EP10b-5, SICU Utilization Rates Jan-March 2024)
Data are received from Trish Gould, BSN, RN, CIC, CPHQ, Infection Prevention Nurse, who receives it from the National Healthcare Safety Network (NHSN). Fechuch shared this information at the May 15, 2024 Safety Huddle in the SICU, which included the SICU clinical nurses. Fechuch thanked the clinical nurses for their collaboration and strong work in decreasing the central line utilization rates.