Nephrology Nurses Improve Clinical Practice

Purpose:
Implement a nursing program to decrease dialysis patient's incidence of Catheter associated bloodstream infections. The Vascular program is to educate and identify clinical areas of focus to obtain and remain below NDNQI CABSI benchmark.

Significance:
Implementing a nursing program to decrease dialysis patients CABSI will increase quality of life, decrease hospitalizations, and decrease mortality rate

Strategy and Implementation:
In 2004, dialysis facilities were assigned to a new national program called Fistula First (FF). Dialysis facilities had a high rate of central line catheters and higher incidences of catheter bloodstream infections causing a high mortality rate. The University of Virginia supported nurses innovative ideas to improve patient quality care and be a leader in clinical practice. Nephrology Nurses identified that combining initiatives of the FF program would have an impact on decreasing dialysis patients with catheters with a secondary effect of decreasing (CABSI). Nephrology Nurses approached executive leadership with initiating a vascular program to pilot at a facility. The program was successful in identifing areas of need and decreasing catheters with lowering the CABSI's. The nephrology nurses took the program idea with practice changes to the senior leadership to confirm the program to initiate acros eight dialysis facilities along with decreasing hospitalizations.

Evaluation:
The vascular program initiated by nurses decreased the number of catheters being placed and kept by dialysis patients by 40% with decreasing and maintaining below NDNQI benchmark for Medical patients of CABSI of 1.43.

Implications for Practice:
Initiated nurse driven vascular access program for multiple facilities. Initiated and implemented patient and staff education to new clinical practice changes for cleaning of catheter sites as well as implementing a new agent. Now in the process of going into a research project to publish.