2024 National Teaching Institute Evidence-Based Solutions Abstracts

Abstract

Kimberly DiMaria; C.S. Mott Children’s Hospital, Ann Arbor, MichiganSurvival after in-hospital cardiac arrest is associated with resuscitation team performance and adherence to American Heart Association (AHA) resuscitation algorithms. The primary aim was increased resuscitation team performance during simulation scenarios as evidenced by improved modified Clinical Performance Tool (mCPT) scores. The secondary aim was improved adherence to AHA resuscitation guidelines during actual code events. Process measures, including frequency of simulations, were used to determine proof of concept.In 2021, a review of resuscitation events in the cardiac progressive care unit (CPCU) revealed poor compliance with AHA guidelines. One of the most critical times of code performance in the CPCU is during the initial response, before code team arrival, which prompted development of a simulation intervention that focused on improving team performance during the initial stages of resuscitation. A single-center, prospective, interventional quality improvement project, First 5-Minute Drills, was developed to provide concise, repeated opportunities for CPCU team members to practice low-frequency, high-risk skills, and crisis resource management principles. Team performance during simulations was directly observed and evaluated using an mCPT score, a 20-point scoring tool that measures team performance of 10 different skills. A t test was used to compare mean mCPT scores at 3 periods. Adherence to AHA algorithms during patient codes was assessed via a retrospective review. Patient resuscitations were evaluated using a standardized scorecard comprising 10 evidence-based treatment recommendations embedded within the AHA resuscitation algorithms.Over 19 months, 48 First 5-Minute Drills were conducted and 238 team members participated. The mCPT was administered at various time points during the study, and results demonstrated a 35% improvement in code team performance. There was a statistically significant increase in mCPT scores from 14.3 to 18.3 (P = .02). Pre-post analysis of 4 actual code events demonstrated a 50% improvement in adherence to AHA algorithms. First 5-Minute Drills resulted in improved simulation resuscitation team performance and adherence to AHA algorithms during real-time code events in the CPCU. The low-cost, high-yield First 5-Minute Drills intervention is generalizable to other departments and hospitals.Eunice Santos, Jimmy Nguyen; Cedars-Sinai Medical Center, Los Angeles, CaliforniaThe rate of central line [catheter]–associated bloodstream infections (CLABSIs) with pulmonary arterial catheter (PAC) use is high. In the advanced heart failure unit (AHFU), PAC CLABSIs are associated with increase morbidity, cost, and loss of eligibility for a heart transplant. The goal for this initiative was to determine whether the optimization of a nursing maintenance bundle created in 2018 in the AHFU to reduce PAC CLABSIs sustained fewer than 3 PAC CLABSIs per year for 5 years.In the AHFU, PACs are used for heart transplant evaluation and heart transplant listing. In 2017, there were 10 PAC infections at our institution. Feedback from case reviews for PAC CLABSIs in 2017 showed problems maintaining occlusive dressings in these catheters. In 2018, a quality improvement project was implemented to address challenges associated with PAC maintenance. The project introduced new PAC dressing kits and development of education for nurses caring for PACs in the AHFU. The standard central catheter dressing kit included a single transparent bandage, a chlorhexidine gluconate (CHG) swab, sterile gloves, and tweezers. The new PAC kit included a second anchoring transparent bandage and CHG swab. All the nurses were educated on the use of the PAC dressing kit—specifically the application of 2 transparent bandages to maintain an occlusive dressing, narrow beard clipping, and CHG bathing. In 2021, introduction of weekly central catheter rounds consisted of epidemiology nurse and nursing leadership rounding on patients with PACs. Sustainment of the project included permanent changes in nursing education, dressing kits, and close monitoring by epidemiology nurses and nursing leadership.PAC CLABSI rates were analyzed using the organization’s hospital-acquired infection dashboard from January 2018 to July 2023. Results showed that the PAC nursing maintenance bundle reduced PAC CLABSIs through the 5-year study period. In 2018, the year of implementation, there were 3 PAC CLABSIs in the AHFU. There was 1 PAC CLABSI in the AHFU in each of 2019, 2020, and 2023; there were 2 CLABSIs in 2021. Implementation of the PAC nursing maintenance bundle, multidisciplinary collaborations, continued nursing education, and adherence to the PAC nursing maintenance bundle during the 5-year period accomplished organizational goals in improving CLABSI rates and improving patient outcomes.Isabel Madrigal, Melissa Parodi; Doctors Hospital, Coral Gables, FloridaCentral line [catheter]–associated bloodstream infections (CLABSIs) are among the most common hospital-acquired infections (HAIs). CLABSIs are serious infections that can result in longer hospital length of stay, increased cost, and increased risk for death. In February 2021, the critical care unit (CCU) leadership team reviewed the unit CLABSI rates of 11.33 for the third quarter (Q3) of calendar year 2020 (CY20) and 9.32 for Q4 CY20. The CCU leadership team identified an opportunity to implement an inter-professional quality improvement team.In March 2021, the CLABSI interprofessional quality improvement team met to discuss the current CLABSI rates and review the specific patient cases. The team consisted of nurse leaders, clinical nurses, infection prevention nurses, performance improvement nurses, pharmacists, and In the CCU CLABSI rate was patient The interprofessional quality improvement team CLABSI prevention education for nurses and during the of and 2021. 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