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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3005 — Adherence Engineering to Improve Use of Best Practices During Central Line Maintenance Procedures

Drews FA, VA Center for Human Factors in Patient Safety, VA Salt Lake City Medical Center; Mallin BM, and Bakdash JZ, VA Center for Human Factors in Patient Safety;

Objectives:
Adverse clinical events can occur when barriers prevent healthcare practitioners from adhering to best practices. Adherence engineering (AE) can address obstacles, such as procedural complexity and lack of experience of health care providers, to improve clinical performance and subsequently patient safety by helping design improved and more supportive equipment. The goal of the present study was to increase adherence to best practices for central line maintenance procedures by engineering equipment that promotes protocol adherence.

Methods:
A nine month, pre-post observational study of nursing adherence to best practices for central line maintenance procedures was conducted at the Salt Lake City VA Medical Center. Trained research nurses observed central line maintenance procedures with a custom software observation tool to document adherence to selected clinical performance measures. During the pre-intervention phase, nurses used existing equipment to perform central line maintenance. An AE based custom kit was developed to improve adherence to best practices. The kit, combined with training of its use, was introduced in the hospital as a clinical intervention. Process measurements of adherence to central line maintenance best practices were collected as procedure step completion (e.g., hand sanitization, catheter hub disinfection), as well as how the overall procedure was performed (item omission, sterility violations, subjective mental and physical demands). Outcome infection rates of central line-associated bloodstream (CLABSI) infections per 1,000 central line days were determined.

Results:
CLABSI rate was significantly reduced after implementation of the AE-based maintenance kit. Overall adherence to best practices increased significantly when comparing pre- and post-intervention data. Finally, the number of item omissions and human error was reduced as a result of the kit implementation.

Implications:
Adherence to best practices for central line maintenance was significantly improved by equipment that promoted optimal performance and adherence. The approach of adherence engineering has potential applications in other areas of healthcare to improve clinical care and patient safety.

Impacts:
AE provides a theoretical framework that, by guiding the development of equipment, can significantly improve clinical care and patient safety. Current equipment used for central line maintenance is suboptimal. AE-guided improvement of this equipment can improve the quality of care.


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