Joint Topic: Error Prevention — Decreasing CLABSI through inter-specialty nurse rounding (201-1)

3:30 – 4:30 pm Thursday, October 28

Central lines are integral in the delivery of chemotherapy and supportive care for pediatric oncology patients. However, central lines are associated with increased morbidity and mortality, especially in immunocompromised children. After a spike in central line–associated bloodstream infections (CLABSIs) in our hospital, our harm prevention department required weekly checks of every central line.

Oncology leaders felt their patients needed more surveillance and instituted an advanced rounding structure in which an oncology nurse trained as a vascular access specialist (VAS) checked central lines, dressing, and hygiene compliance for every patient daily. A group of experts in oncology clinical nursing partnered with the hospital’s VAS team to improve their knowledge and expertise in central line care. The experts rounded daily with a VAS nurse to orient to the VAS role. After 6 months, the newly trained oncology VAS nurses began rounding on central lines every day. The oncology VAS team comprises a core group of 10 nurses. The team conducts rounds 7 days a week and completes extended rounds in partnership with the medical team on three patients daily. This provides an opportunity for a partnered check of the catheter and a discussion of line necessity and infection prevention strategies. The rounding team meets with a hospital VAS nurse weekly to discuss complex patients and line complications. Line-related care recommendations are documented in a VAS note in the electronic health record to improve communication between teams and across shifts. Since the start of VAS rounding, we have seen an 18% decrease in the rates of central line infections within the oncology department. The consistent presence of this core group has empowered patients, families, and staff to ask questions and offer feedback during rounding. The culture within the oncology department has shifted from retrospective review of recent line infections to prospective identification of risk to prevent future infections.