Oncology FBI team helps promote a culture of safety

Monitoring infection rates and introducing interventions to eliminate central line-associated bloodstream infections (CLABSIs), a serious safety concern for hospitalized oncology patients, is one way nursing care can be advanced in complex health care environments that support a culture of safety, according to a presentation at the Oncology Nursing Society 36th Annual Congress.

Furthermore, changing a unit's culture from one of acceptance of these complications to one that does not tolerate harm to patients represents an opportunity that can be accomplished through interdisciplinary collaboration, said Mary Dougherty, MSN, RN, AOCNS®, Spectrum Health, Grand Rapids, Michigan.

To establish a process for tracking CLABSIs in the inpatient setting and shift the culture to support and promote safe care of central lines, the clinical nurse specialist partnered with the quality and infection control departments to establish a process for monitoring infection rates at the inpatient oncology unit level, and an interdisciplinary oncology fighting bloodstream infection (FBI) team was developed, said Dougherty.

The team established a process for sharing CLABSI rates on the unit level; created a mechanism for follow-up on each central line-associated bloodstream infection as a serious safety event; surveyed staff relative to gaps in both knowledge and practice from standard of care; and developed a maintenance bundle.

Based on a gap analysis from the staff survey and maintenance bundle, staff-led and patient education were developed specific to prevention of central line-associated bloodstream infections. A mandatory 1 hour inservice was held for all RNs, led primarily by staff RNs from the CLABSI team. A process was also created for attending to an ongoing “issues” list of questions related to central line care and documentation. Mitigation of barriers to practice included glove availability in patient rooms and redevelopment of a central line dressing change kit. In addition, a process was established to review individual CLABSIs as a “defect” on the unit level.

At the bedside, clinicians are able to verbalize their role in preventing CLABSIs as a serious patient safety event. In addition, each unit now “owns” each infection; therefore, the infections are viewed much differently than prior to the educational intervention.

CLABSI rates have declined since development of the team and reporting out infections at the unit level. “Through interdisciplinary collaboration, it is possible to create a culture shift from “acceptance” of CLABSI in this vulnerable population to “ownership: and accountability—one infection at a time,” Dougherty said. These results underscore that nurses need to understand their role in managing and preventing these potentially life-threatening complications of cancer therapy.

Next steps include benchmarks within all hospital medical/surgical units and with the National Database of Nursing Quality Indicators; establish a goal for CLABSI reduction with the interdisciplinary team; monitor maintenance bundle compliance; create a nimble process for ongoing questions and answers related to central line maintenance; and continue to refine a “defect” tool and process for communication.
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