An Innovative Interdisciplinary Response to CVC-Related Complications in TPN-Dependent Pediatric Patients: A Comprehensive Educational Initiative

2.50
Hdl Handle:
http://hdl.handle.net/10755/621439
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
An Innovative Interdisciplinary Response to CVC-Related Complications in TPN-Dependent Pediatric Patients: A Comprehensive Educational Initiative
Author(s):
Verret, Gloria; Meehan, Meghan; Parikh, Manisha
Lead Author STTI Affiliation:
Iota Sigma
Author Details:
Gloria Verret, BSN, RN, CPN, Professional Experience: A 20-year pediatric nurse, Gloria works as a clinical nurse and discharge educator on a transplant/surgical unit. She is the lead patient-family educator and curriculum developer in the facility’s Family Resource Center She initiated the unit Journal Club and Mentorship Program, both of which were presented nationally, winning poster awards in 2012 and 2015. The Mentorship Program was presented as a talk at the National Magnet Conference in 2014 and the National Mentoring Institute Conference in 2015. Her article “Easing the Transition: An Innovative Generational Approach to Peer Mentoring for New Graduate Nurses” was published in the Journal of Pediatric Nursing, November/December 2016. She was a contributing writer for the book “Mastering Patient and Family Education” published by Sigma Theta Tau, 2015. In 2015, she created a Discharge Nurse Educator pilot, which was presented nationally, winning the 2016 SPN Corrine Barnes Evidence-Based Practice Grant. Gloria is a Daisy honoree. Author Summary: Gloria is a 20-year pediatric nurse and educator. She created a Journal Club, Mentorship Program and Discharge Nurse Educator pilot. She has presented nationally, winning poster awards and a national grant. She is a blogger and writer with several publications, most recently on the Mentorship Program in the Journal of Pediatric Nursing, November/December 2016. She wrote for the Sigma-Theta Tau published book “Mastering Patient and Family Education” in 2015. Gloria is a Daisy nurse.
Abstract:

Central line associated bloodstream infections (CLABSIs) are a significant cause of morbidity in medically complex pediatric patients who rely on central venous access for life-saving medications and nutrition. The financial burden of CLABSIs is also significant. It is estimated that each CLABSI-related admission has a mean attributable cost of over $55,000 and a length of stay of 19 days (Goudie et al., 2014). Catheter damage and malfunction contribute to costs as they also necessitate hospital visits and admissions. The CDC estimates there are 30,000 CLABSIs each year in the United States and 1 in 4 patients die from those infections.

Our urban pediatric academic medical center cares for a large volume of patients whose therapy requires the placement of a CVC, such as Intestinal Rehab (IR) patients who depend on total parenteral nutrition (TPN) for nutrition, and those followed by the Complex Care Hospitalist Medicine team for additional issues such as Mitochondrial Disorder. Since the parents and caregivers of these patients are expected to manage these devices in the home setting, a basic CVC care and maintenance class is offered twice a week to provide education, time for questions and hands-on practice. This class occurs in the hospital’s Family Resource Center (FRC) and is taught by experienced nurses. Depending on the type of CVC a patient has, parents are taught catheter hub access, flushing maintenance, dressing changes, cap changes and steps to take in an emergency. Nursing and medical staff reinforce education as needed throughout the course of therapy.

Despite education and reinforcement, certain patients were repeatedly admitted for CLABSIs, catheter damage and/or malfunction. In the second quarter of 2016, out of 56 patients, there were 21 admissions for line complications. At times, serious sequelae were occurring such as loss of viable vessels for new catheter sites, leading to invasive procedures such as vessel stenting. A review of four complex-care patients showed 30 line infections in the last two years. One patient had 18 infections. There were 8 ICU stays for sepsis and intubation required on 2 patients. Multi-organ failure occurred in 1 patient. Multiple members of the interdisciplinary teams who care for these patients saw a need to provide enhanced education to this subset of patients and their families to help minimize complications. Families are currently encouraged to re-attend the CVC class when their child is admitted for a line complication acquired outside of the hospital. However, we noted that the class content might be too basic for those caregivers who were seasoned in caring for CVCs. While a review of the basics is essential, many families need more detailed and creative solutions for managing their child’s long-term CVC, giving consideration to their own unique set of challenges and home situations.

A multidisciplinary team was organized to develop an Advanced CVC Care Class curriculum for this subset of families. The group consists of a nurse champion who both cares for patients on the medical-surgical ward and serves an educator in the FRC, an IR physician, Child Life Specialist (CLS), Social Worker (SW), Occupational Therapist (OT) and CVC nurse consultants. Families who had successfully prevented CLABSIs were also invited to participate and share tips and ideas. As families are involved in the creation of the educational content of the class, it is hoped that parents will feel increasingly valued and respected. The overarching aim is to help families help themselves (Tallon, et al., 2015). This class will accomplish this by empowering and partnering with parents and caregivers to provide more tools, resources and strategies to successfully prevent CVC complications and thus strive towards zero preventable CLABSIs in and outside the hospital.

The class is currently in the final stages of the development process and will be launched as soon as it is completed. The content consists of a PowerPoint presentation and individual videos from an IR physician, CLS, SW, OT and CVC nurse consultants. Each specialty will provide educational tips, resources, and evidence-based best practices, along with creative solutions and ideas from families. This format will allow the nurse educator to individualize each class by focusing on the CVC complication that lead to the patient’s admission while also gearing it towards the child’s specific developmental age. The videotaped content will be available in three languages in order to meet the diverse needs of our patient population.

A pre-class survey will assess attendees’ concerns and questions, while a post-class survey will gauge the attendees’ comprehension of class content. In addition to rating their level of comfort caring for a CVC pre-and post-class, caregivers will be asked to rate their level of understanding and provide written examples of tips and techniques that they could utilize with their child’s CVC.

With hospital stays shorter and acuities higher, teaching families home care by partnering with them as they transition home is key to decreasing readmission (Chick, et. al., 2012). In a systematic review of thirty-eight studies or articles, it was found that nurses have a singular opportunity to enhance meaningful interaction, build confidence and promote a successful transition home Two cornerstones of family centered care are a focus on developmentally appropriate care and providing adequate instruction to caregivers responsible for providing complex home care (Dokken et al., 22015). Based on these objectives and a foundation in evidence-based practice, the mission of this innovative and family centered advanced class is a reduction in CVC-related complications and associated patient morbidity and hospital admissions.

Keywords:
Central Line Infections; Family Centered Care; teaching the adult learner
Repository Posting Date:
6-Jun-2017
Date of Publication:
6-Jun-2017
Other Identifiers:
INRC17PST55
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleAn Innovative Interdisciplinary Response to CVC-Related Complications in TPN-Dependent Pediatric Patients: A Comprehensive Educational Initiativeen_US
dc.contributor.authorVerret, Gloriaen
dc.contributor.authorMeehan, Meghanen
dc.contributor.authorParikh, Manishaen
dc.contributor.departmentIota Sigmaen
dc.author.detailsGloria Verret, BSN, RN, CPN, Professional Experience: A 20-year pediatric nurse, Gloria works as a clinical nurse and discharge educator on a transplant/surgical unit. She is the lead patient-family educator and curriculum developer in the facility’s Family Resource Center She initiated the unit Journal Club and Mentorship Program, both of which were presented nationally, winning poster awards in 2012 and 2015. The Mentorship Program was presented as a talk at the National Magnet Conference in 2014 and the National Mentoring Institute Conference in 2015. Her article “Easing the Transition: An Innovative Generational Approach to Peer Mentoring for New Graduate Nurses” was published in the Journal of Pediatric Nursing, November/December 2016. She was a contributing writer for the book “Mastering Patient and Family Education” published by Sigma Theta Tau, 2015. In 2015, she created a Discharge Nurse Educator pilot, which was presented nationally, winning the 2016 SPN Corrine Barnes Evidence-Based Practice Grant. Gloria is a Daisy honoree. Author Summary: Gloria is a 20-year pediatric nurse and educator. She created a Journal Club, Mentorship Program and Discharge Nurse Educator pilot. She has presented nationally, winning poster awards and a national grant. She is a blogger and writer with several publications, most recently on the Mentorship Program in the Journal of Pediatric Nursing, November/December 2016. She wrote for the Sigma-Theta Tau published book “Mastering Patient and Family Education” in 2015. Gloria is a Daisy nurse.en
dc.identifier.urihttp://hdl.handle.net/10755/621439-
dc.description.abstract<p><span>Central line associated bloodstream infections (CLABSIs) are a significant cause of morbidity in medically complex pediatric patients who rely on central venous access for life-saving medications and nutrition. The financial burden of CLABSIs is also significant. It is estimated that each CLABSI-related admission has a mean attributable cost of over $55,000 and a length of stay of 19 days (Goudie et al., 2014). Catheter damage and malfunction contribute to costs as they also necessitate hospital visits and admissions. The CDC estimates there are 30,000 CLABSIs each year in the United States and 1 in 4 patients die from those infections.</span></p> <p>Our urban pediatric academic medical center cares for a large volume of patients whose therapy requires the placement of a CVC, such as Intestinal Rehab (IR) patients who depend on total parenteral nutrition (TPN) for nutrition, and those followed by the Complex Care Hospitalist Medicine team for additional issues such as Mitochondrial Disorder. Since the parents and caregivers of these patients are expected to manage these devices in the home setting, a basic CVC care and maintenance class is offered twice a week to provide education, time for questions and hands-on practice. This class occurs in the hospital’s Family Resource Center (FRC) and is taught by experienced nurses. Depending on the type of CVC a patient has, parents are taught catheter hub access, flushing maintenance, dressing changes, cap changes and steps to take in an emergency. Nursing and medical staff reinforce education as needed throughout the course of therapy.</p> <p>Despite education and reinforcement, certain patients were repeatedly admitted for CLABSIs, catheter damage and/or malfunction. In the second quarter of 2016, out of 56 patients, there were 21 admissions for line complications. At times, serious sequelae were occurring such as loss of viable vessels for new catheter sites, leading to invasive procedures such as vessel stenting. A review of four complex-care patients showed 30 line infections in the last two years. One patient had 18 infections. There were 8 ICU stays for sepsis and intubation required on 2 patients. Multi-organ failure occurred in 1 patient. Multiple members of the interdisciplinary teams who care for these patients saw a need to provide enhanced education to this subset of patients and their families to help minimize complications. Families are currently encouraged to re-attend the CVC class when their child is admitted for a line complication acquired outside of the hospital. However, we noted that the class content might be too basic for those caregivers who were seasoned in caring for CVCs. While a review of the basics is essential, many families need more detailed and creative solutions for managing their child’s long-term CVC, giving consideration to their own unique set of challenges and home situations.</p> <p>A multidisciplinary team was organized to develop an Advanced CVC Care Class curriculum for this subset of families. The group consists of a nurse champion who both cares for patients on the medical-surgical ward and serves an educator in the FRC, an IR physician, Child Life Specialist (CLS), Social Worker (SW), Occupational Therapist (OT) and CVC nurse consultants. Families who had successfully prevented CLABSIs were also invited to participate and share tips and ideas. As families are involved in the creation of the educational content of the class, it is hoped that parents will feel increasingly valued and respected. The overarching aim is to help families help themselves (Tallon, et al., 2015). This class will accomplish this by empowering and partnering with parents and caregivers to provide more tools, resources and strategies to successfully prevent CVC complications and thus strive towards zero preventable CLABSIs in and outside the hospital.</p> <p>The class is currently in the final stages of the development process and will be launched as soon as it is completed. The content consists of a PowerPoint presentation and individual videos from an IR physician, CLS, SW, OT and CVC nurse consultants. Each specialty will provide educational tips, resources, and evidence-based best practices, along with creative solutions and ideas from families. This format will allow the nurse educator to individualize each class by focusing on the CVC complication that lead to the patient’s admission while also gearing it towards the child’s specific developmental age. The videotaped content will be available in three languages in order to meet the diverse needs of our patient population.</p> <p>A pre-class survey will assess attendees’ concerns and questions, while a post-class survey will gauge the attendees’ comprehension of class content. In addition to rating their level of comfort caring for a CVC pre-and post-class, caregivers will be asked to rate their level of understanding and provide written examples of tips and techniques that they could utilize with their child’s CVC.</p> <p>With hospital stays shorter and acuities higher, teaching families home care by partnering with them as they transition home is key to decreasing readmission (Chick, et. al., 2012). In a systematic review of thirty-eight studies or articles, it was found that nurses have a singular opportunity to enhance meaningful interaction, build confidence and promote a successful transition home Two cornerstones of family centered care are a focus on developmentally appropriate care and providing adequate instruction to caregivers responsible for providing complex home care (Dokken et al., 22015). Based on these objectives and a foundation in evidence-based practice, the mission of this innovative and family centered advanced class is a reduction in CVC-related complications and associated patient morbidity and hospital admissions.</p>en
dc.subjectCentral Line Infectionsen
dc.subjectFamily Centered Careen
dc.subjectteaching the adult learneren
dc.date.available2017-06-06T20:42:02Z-
dc.date.issued2017-06-06-
dc.date.accessioned2017-06-06T20:42:02Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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