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Pediatrics. 2014 Mar;133(3):e738-46. doi: 10.1542/peds.2013-2249. Epub 2014 Feb 24.

Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLABSIs.

Author information

1
Center for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma and Critical Care Medicine.

Abstract

OBJECTIVES:

We hypothesized that a checklist enhanced by the electronic medical record and a unit-wide dashboard would improve compliance with an evidence-based, pediatric-specific catheter care bundle and decrease central line-associated bloodstream infections (CLABSI).

METHODS:

We performed a cohort study with historical controls that included all patients with a central venous catheter in a 24-bed PICU in an academic children's hospital. Postintervention CLABSI rates, compliance with bundle elements, and staff perceptions of communication were evaluated and compared with preintervention data.

RESULTS:

CLABSI rates decreased from 2.6 CLABSIs per 1000 line-days before intervention to 0.7 CLABSIs per 1000 line-days after intervention. Analysis of specific bundle elements demonstrated increased daily documentation of line necessity from 30% to 73% (P < .001), increased compliance with dressing changes from 87% to 90% (P = .003), increased compliance with cap changes from 87% to 93% (P < .001), increased compliance with port needle changes from 69% to 95% (P < .001), but decreased compliance with insertion bundle documentation from 67% to 62% (P = .001). Changes in the care plan were made during review of the electronic medical record checklist on 39% of patient rounds episodes.

CONCLUSIONS:

Use of an electronic medical record-enhanced CLABSI prevention checklist coupled with a unit-wide real-time display of adherence was associated with increased compliance with evidence-based catheter care and sustained decrease in CLABSI rates. These data underscore the potential for computerized interventions to promote compliance with proven best practices and prevent patient harm.

KEYWORDS:

CLABSI; EMR; dashboard; evidence-based guidelines; maintenance bundle

PMID:
24567021
PMCID:
PMC3934335
DOI:
10.1542/peds.2013-2249
[Indexed for MEDLINE]
Free PMC Article

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