An audit of central venous catheter insertion and management practices in an Australian tertiary intensive care unit: A quality improvement project.

INTRODUCTION: Central venous catheters are often used in managing critically ill patients. Clinical practice guidelines and care bundles exist to prevent central line associated blood stream infections; however, detailed adherence to these guidelines and care bundles is unclear. AIM: This study was aimed to describe clinicians' adherence to recommended practices in central venous catheter insertion and management. METHOD: A cross-sectional prospective observational study was conducted in the intensive care unit of an Australian tertiary hospital over a four-month period. We observed a total of 50 nurses during post insertion management, and 10 physicians during central venous catheter insertion using purposely designed observation tools. RESULTS: Our audit identified 90% adherence to recommended practices in central venous catheter insertion and 60% to post insertion management. However, there were areas where participants' practices were not congruent with evidence-based recommendations, including choice of central venous catheter insertion site, type of central venous catheters, dressing choice, aseptic technique, and documentation. CONCLUSION: Our audit showed a detailed picture of clinician's adherence to recommended practices in central venous catheter insertion and management. A clearer understanding of the barriers and facilitators of issues identified is needed to inform the design of future interventions to reduce central line related blood stream infections in the unit.

Effectiveness of nursing rounds in the Intensive Care Unit on workplace learning.

OBJECTIVES: To evaluate the implementation of a regular Nursing Round as an educational strategy for workplace learning in an intensive care unit with a single room environment. RESEARCH DESIGN: A multiple methods design was used. Fifty-four Nursing Rounds were observed and nurses (n = 40) completed bespoke evaluative surveys. Structured observational data and open-ended survey responses were submitted to content analysis and descriptive statistics were used to analyse survey findings. RESULTS: Nursing Rounds involved a diverse range of participants, most frequently nurses. The content most frequently discussed included empirical clinical issues where nurses decided on nursing care actions to address these issues. The most frequently observed outcome of Nursing Rounds was knowledge translation. Nursing Rounds were perceived to positively influence application of evidence in practise, identification of areas for practise improvement and ability to communicate clinical information. Two categories emerged from analysis of open-ended survey questions; (1) 'Positive learning environment', where nurses described Nursing Rounds as a social learning experience; and (2) 'Impediments to Nursing Rounds', including difficulty attending Nursing Rounds due to competing priorities. CONCLUSION: Nursing Rounds enabled evidence-based learning that enhanced inter-disciplinary collaboration. Further investigation may be required to understand how to enable nurses to attend more frequently, and generate a more holistic, evidence-based discussion.

Handover from operating theatre to the intensive care unit: A quality improvement study.

BACKGROUND: Transitioning a patient from the operating theatre (OT) to the intensive care unit (ICU) is a dynamic and complex process. Handover of the critically ill postoperative patient can contribute to procedural and communication errors. Standardised protocols are means for structuring and improving handover content. Both have been shown to be effective in reducing information omission and improve communication during this transition period. OBJECTIVES: The aim of this uncontrolled before and after study was to improve handover processes and communication about the care for critically ill patients transferred from OT to ICU. METHODS: Thirty-two OT to ICU handovers (16 before and 16 after implementation) were observed. Using a structured tool, we documented who was present, participated in, and initiated handover during ICU admission. Where and when handover was performed, information provided, distractions and interruptions, and handover duration were also recorded. Unstructured field notes and diagrams provided information on staff interaction. Following implementation, semistructured interviews with 27 participants were conducted to understand participants' perceptions of intervention acceptability and to determine factors influencing intervention implementation and spread. FINDINGS: Following implementation, a "hands-off" approach was observed with fewer technical tasks completed during handover (43.8% before implementation vs 12.5% after implementation) without an increase in handover time. A single, multidisciplinary handover most often led by the anaesthetist was observed after implementation. Despite these improvements, the use of the physical checklist was not observed in practice, and an situation, background, assessment, recommendation (SBAR) format was not followed. Anaesthetists leading the handover did not view the handover checklist as being beneficial to their practice although some nurses were observed to use the checklist as a prompt for additional information. CONCLUSIONS: A single, multidisciplinary handover demonstrated improvement in handover practice despite low uptake of the protocol checklist. Further information is required to inform targeted strategies to improve uptake and sustainability although broader interdisciplinary engagement and commitment may be helpful.