NEW YORK NURSE: May 2011
by Priscilla Sandford Worral, PhD, RN, Coordinator of Nursing Research, University Hospital, SUNY Upstate Medical Center, Syracuse; Foundation of New York State Nurses Center for Nursing Research Planning Committee
What educational interventions have the greatest impact on competence in managing central lines?
We already know that central-line associated bloodstream infections (CLABSIs) result in increased morbidity and mortality for patients. Those of us who work in the inpatient setting also know that effective October 2008, the Centers for Medicare and Medicaid Services (CMS) designated CLABSIs as a “never event” for which hospitals would no longer receive reimbursement. Reaching and maintaining a zero-CLABSI rate in the acute care setting is a lofty but necessary goal. How do we get there?
Educating nurses and physicians to achieve and sustain competence in best-practice methods of insertion and maintenance of central lines is an essential step in the elimination of CLABSIs. Cherry, Brown, Neal, & Shaw (2010) provide important insight into how and when that education should be offered. Their systematic review of the research literature focused on education designed to change healthcare professionals’ infection control behavior during insertion and management of central venous catheters. Types of education included lectures, small group learning sessions (e.g. formal inservices), e-learning, shadowing/mentoring, workshops, and learning through such paper material as posters and handouts. Studies published from 1995 onwards and related to centrally placed venous catheters, including PICCs and ports, were included. Language was not restricted.
A well-designed, rigorous search of 16 electronic databases augmented by hand searching retrieved 9,964 studies that were narrowed to 270 studies and finally to 47 studies that met all criteria for inclusion in the systematic review. Among the 47 studies reviewed, 35 were U.S.-based, eight focused solely on nurses, 22 focused on both nurses and physicians, and the remainder focused solely on physicians or on “health professionals.” The quality of the studies was inconsistent—for example, only a few used comparison groups, blinding was underreported, duration of follow-up ranged from 1 week to 3 years—and no study considered motivation to change as a factor to be measured. Despite these limitations, evidence supports the following recommendations for providing education that has demonstrated improvement in compliance and decrease in CLABSIs in acute care settings:
Most effective:
Combine education with feedback; if you teach about new supplies, have them ready for use and audit practice change.
Also effective:
- Provide education when compliance with best practice is low, i.e., teach when there is a need.
- Integrate repeated sessions into daily practice using practical participation that fits into your setting and your available resources (demonstration, videos, simulation; self-study materials) rather than providing education alone.
May be effective:
- Actively engage staff whose behavior you wish to change into the education itself.
- DISSEMINATE EDUCATIONAL INFORMATION THROUGH PEERS AND/OR HIGHER MANAGEMENT.
Cherry, M.G., Brown, J. M., Neal, T., & Shaw, N. B. (2010). What features of educational interventions lead to competence in aseptic insertion and maintenance of CV catheters in acute care? BEME Guide No. 15. Medical Teacher, 32, 198-281. doi:10.3109/01421591003596600. Retrieved from www.informahealthcare.com.