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Sunday, November 1, 2009: 4:15 PM
Learning Objective 1: Define the steps involved in utilizing a Six sigma methodology for process improvement and provide examples of it’s implementation through a multidisciplinary team
Learning Objective 2: Identify EBP recommendations for central lines and Summarize the evidence from various guidelines and organizations regarding central line insertion and maintenance .
The purpose of this study was to investigate evidence-based practices related to central line catheters in an effort to establish a uniform standard for their insertion and maintenance. Our rates are determined using these benchmarks – NHSN, CDC criteria for CRBSI, AACN, and the Project Impact critical care database. Adherence to standards is critical since BSIs are an acquired infection that account for increased patient mortality, healthcare costs, and increase length-of-stay. Six Sigma methodologies were used for this investigation. It is a highly disciplined approach to decision-making that focuses on improving processes to make them as near perfect as possible. SS relates to the number of mathematical defects in a process where practitioners focus on systematically eliminating the defects to get as close to "zero defects" as possible. Subjects were all patients in a mixed population ICU with central lines from day 2 of admission to day 2 of ICU discharge. (N=1,194 observations) The use of a fishbone diagram depicting possible factors affecting BSIs resulted in data collection by manual collection, observations, chart reviews, and laboratory cultures. Statistical significant findings include the following positive correlations utilizing Chi-Sq hypothesis testing validating root cause analysis of causes of a BSI (p=.00 to .01, DF=1)Patient is febrile, lack of intact/labeled dressing, lack of flushing catheter lumen, changing leur locks, caps and changes in housekeeping services. No significant relationships were found for site location, type of dressing, and setting of insertion. Implications of research findings provide evidence for developing standards of care related to central venous catheters and promoting strict adherence to protocols. New policies with associated competencies were developed and education provided. Strength of this investigation (process and outcome) has resulted in translation to practices house wide.