Michele H Mokrzycki1, Kerry A Leigh2, Alan S Kliger3, Vandana Dua Niyyar4, Virginia Bren Asp5, Ladan Golestaneh1, Quinetta Taylor1,2,3,4,5,6, Shannon A Novosad6. 1. Division of Nephrology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. 2. American Society of Nephrology, Alliance for Kidney Health, Washington, DC. 3. Department of Medicine, Nephrology Section, Yale School of Medicine, New Haven, Connecticut. 4. Division of Nephrology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. 5. Altru Health System, Grand Forks, North Dakota. 6. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Abstract
Background: Performing catheter-care observations in outpatient hemodialysis facilities are one of the CDC's core interventions, which have been proven to reduce bloodstream infections. However, staff have many competing responsibilities. Efforts to increase and streamline the process of performing observations are needed. We developed an electronic catheter checklist, formatted for easy access with a mobile device, and conducted a pilot project to determine the feasibility of implementing it in outpatient dialysis facilities. Methods: The tool contained the following content: (1) patient education videos; (2) catheter-care checklists (connection, disconnection, and exit-site care); (3) prepilot and postpilot surveys; and (4) a pilot implementation guide. Participating hemodialysis facilities performed catheter-care observations on either a weekly or monthly schedule and provided feedback on implementation of the tool. Results: The pilot data were collected from January 6 through March 12, 2020, at seven participating facilities. A total of 954 individual observations were performed. The catheter-connection, disconnection, and exit-site steps were performed correctly for most individual steps; however, areas for improvement were (1) allowing for appropriate antiseptic dry time, (2) avoiding contact after antisepsis, and (3) applying antibiotic ointment to the exit site. Postpilot feedback from staff was mostly favorable. Use of the electronic checklists facilitated patient engagement with staff and was preferred over paper checklists, because data are easily downloaded and available for use in facility Quality Assurance and Performance Improvement (QAPI) meetings. The educational video content was a unique learning opportunity for both patients and staff. Conclusions: Converting the CDC's existing catheter checklists to electronic forms reduced paperwork and improved the ease of collating data for use during QAPI meetings. An additional benefit was the educational content provided on the tablet, which was readily available for viewing by patients and staff while in the hemodialysis facility.
Background: Performing catheter-care observations in outpatient hemodialysis facilities are one of the CDC's core interventions, which have been proven to reduce bloodstream infections. However, staff have many competing responsibilities. Efforts to increase and streamline the process of performing observations are needed. We developed an electronic catheter checklist, formatted for easy access with a mobile device, and conducted a pilot project to determine the feasibility of implementing it in outpatient dialysis facilities. Methods: The tool contained the following content: (1) patient education videos; (2) catheter-care checklists (connection, disconnection, and exit-site care); (3) prepilot and postpilot surveys; and (4) a pilot implementation guide. Participating hemodialysis facilities performed catheter-care observations on either a weekly or monthly schedule and provided feedback on implementation of the tool. Results: The pilot data were collected from January 6 through March 12, 2020, at seven participating facilities. A total of 954 individual observations were performed. The catheter-connection, disconnection, and exit-site steps were performed correctly for most individual steps; however, areas for improvement were (1) allowing for appropriate antiseptic dry time, (2) avoiding contact after antisepsis, and (3) applying antibiotic ointment to the exit site. Postpilot feedback from staff was mostly favorable. Use of the electronic checklists facilitated patient engagement with staff and was preferred over paper checklists, because data are easily downloaded and available for use in facility Quality Assurance and Performance Improvement (QAPI) meetings. The educational video content was a unique learning opportunity for both patients and staff. Conclusions: Converting the CDC's existing catheter checklists to electronic forms reduced paperwork and improved the ease of collating data for use during QAPI meetings. An additional benefit was the educational content provided on the tablet, which was readily available for viewing by patients and staff while in the hemodialysis facility.
Authors: Sarah H Yi; Alexander J Kallen; Sally Hess; Virginia R Bren; Mary E Lincoln; Gemma Downham; Karen Kelley; Stephanie L Booth; Heather Weirich; Alicia Shugart; Christi Lines; Anna Melville; John A Jernigan; David G Kleinbaum; Priti R Patel Journal: Infect Control Hosp Epidemiol Date: 2016-02-12 Impact factor: 3.254
Authors: Peter Pronovost; Dale Needham; Sean Berenholtz; David Sinopoli; Haitao Chu; Sara Cosgrove; Bryan Sexton; Robert Hyzy; Robert Welsh; Gary Roth; Joseph Bander; John Kepros; Christine Goeschel Journal: N Engl J Med Date: 2006-12-28 Impact factor: 91.245
Authors: Duc B Nguyen; Alicia Shugart; Christi Lines; Ami B Shah; Jonathan Edwards; Daniel Pollock; Dawn Sievert; Priti R Patel Journal: Clin J Am Soc Nephrol Date: 2017-06-29 Impact factor: 8.237
Authors: Priti R Patel; Sarah H Yi; Stephanie Booth; Virginia Bren; Gemma Downham; Sally Hess; Karen Kelley; Mary Lincoln; Kathy Morrissette; Curt Lindberg; John A Jernigan; Alexander J Kallen Journal: Am J Kidney Dis Date: 2013-05-13 Impact factor: 8.860