Teamwork & Quality Improvement
Due to the large number of risk factors outlined above, efforts to reduce CVC-related BSI require coordination between all providers on a patient's care team. Accordingly, the physician must inform the patient’s nurse at the earliest opportunity whenever CVC insertion is anticipated (i.e. not while draping the patient!). This important step allows the nursing staff to arrange proper coverage, thereby ensuring the nurse’s availability during the entire procedure. In general, a dedicated nurse should be at the bedside during every CVC insertion. Physicians should defer elective line insertions until a nurse is available.
By having a dedicated team of providers in the room, patient care is improved on several levels. First, the nurse functions as an assistant to the proceduralist who is otherwise unable to touch any object outside the sterile field. Second, the nurse facilitates standardization of the procedure through completion of a Nursing Insertion Checklist. In addition, a team approach enhances patient safety. For example, if the nurse notices a break in sterile technique, the physician can be notified and the procedure stopped while the situation is remedied. Although some providers might feel uncomfortable making such suggestions, these types of behaviors improve patient safety and are essential for continuous quality improvement. Obviously, a patient’s safety is more important than a provider’s autonomy.
Studies have shown that CVCs inserted by inexperienced providers have higher rates of infectious and mechanical complications. If a proceduralist has placed less than five (5) central lines, a more experienced provider must properly supervise the procedure. VUMC leadership feels that protecting patient safety is the responsibility of all providers on a patient's team. Accordingly, the nursing staff is encouraged to ensure our inexperienced providers follow these standard guidelines.
Abbreviations
BSI = bloodstream infection
CVC = central venous catheter
