Innovative Techniques to Enhance Frontline Nurse Participation in Reducing CA-BSIs

Purpose:
Hospitals must eliminate catheter-associated blood stream infections (CA-BSI). One pediatric intensive care unit continued to have high CA-BSI rates despite ongoing improvement efforts. Frontline staff needed to become engaged. Innovative methods and technology were used to support participation.

Significance:
Highly engaged frontline nurses, with authority over their practice, can positively impact nursing quality outcomes. Peer-to-peer education and accountability is a strong tactic to employ. Peers place a different sense of cooperation on targeted outcomes as opposed to authoritative figures.

Strategy and Implementation:
Direct care nurses described the traditional committee process as undesirable. One hour meetings proved difficult with scheduling and productivity. The first strategy was to appoint a direct care nurse as committee chair. Her understanding of bedside care and daily challenges of frontline nurses helped her to recruit to the team. A physician partner was also appointed to act as a liaison with the medical staff. Technology, transparency, and sustainability became important concepts. A new way of conducting business emerged. Innovative approaches included; transparency of data via information monitors, an on-line tool to hold project information increased staff access, workshops to complete tasks, real-time feedback audits, PDSA cycles, educational presentations over the lunch hour, CA-BSI specialist rounding on central lines in the unit five days a weeks, entertaining videos to educate staff, streamlined root cause analysis, staff surveys, and in-the-moment audits of bundles.

Evaluation:
In 2011, the CA-BSI rate per 1000 line days was 4.3. Threshold was set at <1.8. Since improving frontline engagement we have seen a steady downward trend in infections. Yearly rate for 2012 was 2.7. Most recently, in 1st quarter 2013, we saw our best rate of 1.8.

Implications for Practice:
We discovered that engaging those performing the work each day will have the greatest impact on improved outcomes. Developing strategies to allow the direct care nurse to fully participate in quality initiatives is key. These nurses are now passionate about reaching our target of zero CA-BSIs.