Peer to Peer Compliance Monitoring

Purpose:
Central line blood stream infection (CLABSI) and ventilator associated pneumonia (VAP) rates needed to be reduced in a 20 bed intensive care unit. The goal was to reduce the infection rates by including staff in finding solutions and taking ownership of the results.

Significance:
CLABSIs and VAPs increase length of stay, healthcare cost, and mortality rates. Preventing these hospital acquired infections requires compliance to evidence based practice. Ensuring nurses implement best practice into their daily routine is a significant factor to reducing infection rates.

Strategy and Implementation:
Utilizing recommendations from the Agency for Healthcare Research and Quality staff members developed practice changes to reduce CLABSI and VAP rates. Peer to peer compliance monitoring was used as a implementation method. The goal was to have staff hold each other accountable for best practice. Staff from various shifts were chosen to ensure consistent monitoring. Staff who were selected to perform the monitoring were educated on the components of the change and the delivery of the message. It was important for the compliance monitoring to occur in real time and for the person to not judge their peer for non-compliance. If non-compliance was found the peer educated and offered assistance. Those that were compliant were praised for their efforts. The name of the nurse was not collected. Staff were informed why their peers were performing compliance monitoring and the educational intent. The compliance data was correlated and shared with the staff monthly along with the infection rates.

Evaluation:
The effectiveness of peer to peer compliance monitoring was measured by the reduction of CLABSI and VAP rates. Within 6 months the VAP rate was reduced from 6.3 to 2.1 and the CLABSI rate from 3.21 to 1.04. To date, there have been 0 CLABSIs for 15 months and 0 VAPs for 6 months.

Implications for Practice:
Peer to peer compliance monitoring can be applied as an implementation method for any needed change. Involving the staff in creating solutions and accountability creates ownership which leads to sustainable change.