QAPI 111 - Implementation of a Central Line Rounding Tool

Background: Evidence supports implementing central line (CL) maintenance bundles and nurse-led rounding interventions to prevent central line-associated bloodstream infections (CLABSIs). In a Tennessee intensive care unit (ICU), increased CLABSI rates were associated with inconsistent CL dressing maintenance and documentation. This quality improvement initiative was implemented to improve ICU CLABSI rates and reinforce nursing standard practices for CL dressing care.

Methods: This quality improvement project used the plan, do, study, act (PDSA) model as a framework to implement a daily nurse-led rounding tool in the ICU, which involved real-time intervention for CL dressing and documentation. Project planning was from January 2022 to May 2022, the intervention phase occurred in May 2022, and CLABSI rates, dressing compliance documentation, and rounding tool data were retrospectively extracted from May 2022 through September 2022. Data were analyzed using run charts to show trends in data from January 2021 through September 2022.

Results: The compliance from the rounding tool with CL dressing changes at seven days or less ranged from 83.2%-100.0%. The Mdn CL compliance was 90.4%. The range for EMR documentation CL compliance was 50.0%-77.8%, and the Mdn compliance was 61.3%.
Baseline 2021 CLABSI ICU rates per 1,000 CL days ranged from 0.00-8.89.
The 2022 monthly CLABSI rates were sustained at zero during the planning and intervention phase.

Conclusions: This quality improvement project established standard accountability and improvement in nursing compliance documentation for CL, which may have contributed to zero CLABSI rates in 2022. Evidence-based nurse-led interventions can lead to high-impact and consistent quality care in complex and busy ICUs.