Bond, William, MD, MS

Kane, Bryan G, MD

Miller, Andrew, DO

Orlando, James P, EdD

Pasquale, Michael, MD

Rupp, Valerie A, RN, BSN

Sussman, Elliot J, MD, MBA

Umbrell, Cindy, RN, MSN

Verheggen, Elizabeth, PhD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Emergency MedicineImpact of an Interprofessional Central VenousCatheter Insertion Training ProgramJames P. Orlando EdDLehigh Valley Health NetworkAndrew Miller DOLehigh Valley Health NetworkWilliam Bond MD, MSLehigh Valley Health Network, University of South Florida, william.bond@osfhealthcare.orgValerie A. Rupp RN, BSNLehigh Valley Health Network, Valerie.Rupp@lvhn.orgBryan G. Kane MDLehigh Valley Health Network, bryan.kane@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/emergency-medicinePart of the Emergency Medicine Commons, Medical Education Commons, Nursing Commons,and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtOrlando, J., Miller, A., Bond, W., Rupp, V., Kane, B., Umbrell, C., Pasquale, M., Verheggen, E., & Sussman, E. (2010, July). Impact of anInterprofessional Central Venous Catheter Insertion Training Program. Poster presented at: The ABIM Foundation 2010 ForumTransforming Medical Education and Training to Meet the Needs of Patients and Society, Vancouver, BC.AuthorsJames P. Orlando EdD; Andrew Miller DO; William Bond MD, MS; Valerie A. Rupp RN, BSN; Bryan G.Kane MD; Cindy Umbrell RN, MSN; Michael Pasquale MD; Elizabeth Verheggen PhD; and Elliot J. SussmanMD, MBAThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/emergency-medicine/165Fiscal Year Non-PICCLine DaysInfection Rate /1000 Line DaysTraining Cohort(begins with FY)      2006 15,004 3.4        2007 15,138 2 A      2008 14,136 2.5 B     2009 19,463 1.4 C      2010* 15,781 0.8 DReferences:1.	 	Barsuk,	J.	H.,	et	al.	Crit	Care	Med,	2009,	37(10):2697-2701.2.	 Evans,	L.	V.,	et	al.	(abstract)	Acad	Emerg	Med,	2009,	16(s1):s6.3.	 	Leung,	J.,	et	al.	Ann	of	Emerg	Med,	2006,	48(5):540-547.4.	 	Milling,	T.	J.,	et	al.	Crit	Care	Med,	2005,	33(8):1764-1769.5.	 	Pronovost,	P.,	et	al.	N	Engl	J	Med,	2006,	355(26):2725-2732.6.	 	TeamSTEPPS™:	Strategies	and	Tools	to	Enhance	Performance	and	Patient	Safety.	Agency	for	Healthcare	Research	and	Quality,	Rockville,	MD.-202468101 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58CLABRateMonthsCL CL LCL UCL A Lower bound A Upper bound B Lower bound B Upper boundCL = Control LimitImpact of an Interprofessional Central Venous Catheter Insertion Training ProgramLehigh Valley Health Network, Allentown, PennsylvaniaBackground:James P. Orlando, Ed.D; Andrew Miller, DO; William Bond, MD, MS; Valerie Rupp, RN, MSN; Bryan Kane, MD; Cindy Umbrell, RN, MSN; Michael Pasquale, MD; Elizabeth Verheggen, PhD; Elliot J Sussman, MD, MBAEvidence	suggests	that	central	venous	Catheter	(CVC)	insertion	training,1,2	the	use	of	ultrasound	guidance,3,4	and	compliance	with	the	Institute	for	Healthcare	(IHI)	central	line	bundle5	improve	patient	outcomes.Objectives:Reduce	CVC	complications	including	central	line	associated	bloodstream	infections	(CLAB).Methods:The	CVC	course	is	required	of	all	residents	who	place	central	lines	at	LVHN	upon	entry	into	residency.		A	pre-course	elearning	module	with	video	vignettes	sets	behavioral	and	collaborative	expectations	among	all	providers	surrounding	the	procedure.		The	course	includes:	a	half-day	practical	portion	with	manikin	practice,	ultrasound	for	target	vessel	verification,	and	a	checklist	based	competency	evaluation.			Nurses	participate	in	the	course	and	ensure	that	the	bedside	checklist,	which	includes	the	IHI	bundle,	is	used	as	it	would	be	at	the	bedside.		Assessments	included	post	course	surveys,	focus	groups,	pre/post/delayed	knowledge	tests,	and	registry	data	that	tracks	compliance	with	the	IHI	bundle	and	CLAB.Results:Focus	groups	confirmed	the	need	for	a	check	off	run	and	that	nurses	are	helping	ensure	sterile	conditions	and	challenging	residents	on	the	number	of	needle	stick	attempts.		Statistical	quality	control	measures	were	used	to	track	the	effect	of	the	training	process	on	the	CLAB	rate	for	CVCs	(peripherally	inserted	central	catheters,	PICC	lines,	excluded)	which	improved	from	3.4	to	0.8	per	1000	line	days	(P=0.001).			Reduced	variability	in	the	downward	trending	rate	was	reflected	by	the	standard	deviation	decreasing	from	1.45	pre-training	to	0.40	post-training.Conclusion:The	CLAB	rate	was	successfully	reduced.		Check	off	competency	runs	and	nurse	collaboration	in	the	checklist	are	plausible	contributing	factors	to	success.Next Steps:Central	line	training	paradigms,	including	bedside	checklists,	interprofessional	training	protocols,	and	registry	methods	for	performance	tracking	require	refinement	and	broader	application.SQC Control Chart for CLAB Rate*	=	year	to	date	Behavior and CommunicationAround the ProcedureTechnical Aspects ofMaintaining Sterile FieldTechnical Aspects ofInsertion, Complications,Indications,ContraindicationsUnderstanding theProcess Surrounding and post InsertionPractice in SeldingerTechniqueThe CVC CourseChecklistSQC Range Chart for CLAB Rate(Variability)Title

Impact of an Interprofessional Central Venous Catheter Insertion Training Program

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1164&context=emergency-medicine

Impact of an Interprofessional Central Venous Catheter Insertion Training Program

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