QAPI 22 - Enhancing Patient Safety Through Nurse-Driven Central Line Management

Background: Central line-associated bloodstream infections (CLABSI) pose a substantial threat within healthcare settings, leading to increased morbidity, mortality, and financial burdens. Gaps in maintenance and overuse of central venous access devices (CVAD) contribute to CLABSI development. Addressing this concern, an academic medical center specializing in complex, chronic medical care implemented a Nurse-Driven Central Line Removal Algorithm (NDCLRA) with the goal of optimizing patient safety and reducing CLABSI rates.

Methods: Development and implementation of the NDCLRA empowered nurses to take a lead role in CVAD removal. The algorithm guided nurses through a systematic process to drive CVAD removal when patients no longer met evidence-based criteria, thereby minimizing risk of unnecessary line retention. Simultaneously, modification of the electronic medical record provided guidance on medications necessitating central line use. Collaborating closely with the Vascular Access Specialty Team (VAST), Infectious Disease (ID) Pharmacy, and Education departments, a consultation order was introduced for vascular access device planning, as well as a modified approach to rounding and education. VAST consultation allowed thorough reviews of patients' medications collaboratively with ID Pharmacy, explored alternative intravascular access options, and offered recommendations to healthcare providers for optimal line care and maintenance.

Results: The NDCLRA was piloted on six intensive care units (ICUs) beginning in January 2023. In the year prior to implementation, there were 24 identified CLABSI within ICUs with 12,336-line days. Through November 2023, there have been 12 identified CLABSI with 11,652-line days. Since implementation, there has been a 50% reduction in CLABSI and approximately 6% reduction in line days.

Conclusions: By involving nurses in the decision-making process and capitalizing on the expertise of specialty departments, our approach sought to create a dynamic, patient-centered strategy for CVAD management. This initiative aligns with the broader goal of promoting evidence-based practices and ensuring the strategic use of CVADs to safeguard patient well-being.