UBT proves patient-centered care pays off

Plan, Do, Study, Act

WEDNESDAY, DECEMBER 16, 2009

Value compass: Quality
Department: Intensive Care Unit, Los Angeles Medical Center
Problem: The number of central-line infections increased before the department moved in March 2009 into the new hospital.
Metric: Number of infections per quarter
Labor co-lead: Tessie Costales, RN, SEIU UHW-West
Management co-leads: Joy Sobrepena, department administrator, and Elizabeth Creencia, CNC
Physician co-lead: Ray Parungao, MD
Small tests of change: Increased rounding, regularly repositioned central lines and replaced an antiseptic spray with a gel

Result: Reduced the number of infections in central lines from nine in the first quarter of 2009 to two in the second quarter

Next step: To have their new practices implemented hospital-wide

Biggest challenge: “Cost was a challenge,” said Tessie Costales, RN, the team’s labor co-chair and an SEIU UHW-West member. A recommended antiseptic gel “is not part of the IV central line insertion kit, and a tube for each patient would have cost $18 in addition to the kit, which is not cost effective. Instead, every nurse carries his or her own bottle of the gel.”

Advice to other teams: “When we observe nurses inserting central lines, we emphasize that it is a learning process,” Costales said, an opportunity to be sure the nurses have the necessary skills. “It cannot be punitive.”

Background: As Los Angeles Medical Center prepared to move into its new hospital, the number of patients suffering central line infections in the Intensive Care Unit increased, Department Administrator Joy Sobrepena said.
“In the first quarter of 2009, the number of infections skyrocketed to nine in Critical Care overall,” Sobrepena said. “It had never been that high. But people were busy—there were competing priorities.”
The department’s unit-based team knew that improvement was imperative: Members’ health depended on it. There was also a significant cost consideration, as Medicare doesn’t reimburse KP for patients who develop this type of infection.
The department’s UBT analyzed the central line insertion process they’d been using step by step and discovered that protocols weren’t always being followed. For example, after inserting the line and removing their gloves, some nurses found it difficult to step away from the patient to wash their hands, as is outlined in the process. The team also found their central line kit could be improved.

Three steps to reduce central-line infections

By taking these steps, the Intensive Care Unit’s unit-based team brought the number of infections down dramatically in just one quarter.

►New gel. The unit-based team decided to replace the antiseptic spray they were using with a gel recommended by the Institute for Healthcare Improvement (IHI). They also added a Tegaderm Dressing/Sorbaview Dressing Biopatch to their central-line kits.
►Increased rounding. A nurse manager now rounds daily with a checklist based on recommendations from the IHI, which outlines the steps that should be followed for maximum infection prevention. The “Central Line” team, which includes Sobrepena, an infection control preventionist, and physician champion Ray Parungao, MD, also makes daily rounds now.
►Regular repositioning. All central lines inserted in the femoral artery are now removed and repositioned with 24 to 48 hours, unless the patient is too ill or if there is some other disqualifying reason. Also, when inserting a needle into the femoral artery of patient who is agitated or weighs more than 150 pounds, nurses are required to have an assistant.

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UBT proves patient-centered care pays off

Plan, Do, Study, Act

Three steps to reduce central-line infections

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Time Frame

UBT proves patient-centered care pays off

Plan, Do, Study, Act

Three steps to reduce central-line infections

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