886 A quality improvement program to achieve independence in home central line care by paediatric oncology families. (21st November 2017)

• Record Type: Journal Article
• Authors: Wong, Chris; Barysauskas, Constance; Desrochers, Marie; Brill-Conway, Margaret; Mahan, Riley; Eng, Kelly; Billett, Amy
• Is Part Of: BMJ open quality. Volume 6:Supplement 1(2017)
• Page Start: A8
• Page End: A9
• Publication Date: 2017-11-21
• Subjects: Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/bmjoq-2017-IHI.7
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Background: Central line associated blood stream infections (CLABSI) occur frequently in the paediatric oncology (PO) population increasing morbidity, mortality, and costs. Families in the home provide a large portion of PO external central line (CL) care with limited opportunities to develop skills that maximise best practice bundle adherence, key to infection prevention. Objectives: To achieve >90% of families with documented independence in CL flushing by 12 months. Methods: Plan-do-study-act cycles were used to test changes from April 2016-June 2017 after identifying drivers in a pilot (June 2015-March 2016) to develop a family-centred learning curriculum. This involved return-demonstration [teach-backs (TBs)] of CL skills in front of a nurse coach during routine clinic visits and use of CL care cognitive aids. Key interventions: culture change-new expectation of TB participation until independent; embedding TBs into routine care with a dedicated nurse champion; developing checklists to standardise content, approach, performance, and proficiency evaluation with documentation. Statistical process control charts tracked changes over time. Results: During the pilot, 12.9% (22/171) participated in the TB program and 4.7% (n=8) had documented independence. After April 2016, special cause variation shifted the centre line of families' independent from 6% to 89%. Participation increased to 87.9% (181/206) with 82.5% (n=170) independent, sustaining the improvement at >90% since October 2016. Conclusions: Ensuring families' independence with CL care in the home is a safety priority which can be achieved through a teach–back program embedded into routine care. Determining impact on families' CL care-associated distress and ambulatory CLABSI rates is in process.