Carolyn Ziebert MS RN PCSNBC Carol Klingbeil DNP RN CPNPPC Objective Describe the use of the QSEN competencies to evaluate the impact of a structured teaching intervention for families of pediatric patients going home with a new central venous access device CVAD ID: 740443
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Using an Evidence Based Approach to Standardized CVAD Teaching for Families
Carolyn Ziebert, MS, RN, PCSN-BCCarol Klingbeil, DNP, RN, CPNP-PCSlide2
Objective
Describe the use of the QSEN competencies to evaluate the impact of a structured teaching intervention for families of pediatric patients going home with a new central venous access device (CVAD)Slide3
Background
Problem identificationInconsistencies in teachingOpportunities to standardize both content and approachManual needed revision
Increase in central line associated blood stream infections (CLABSIs)Hospital participates in Solutions for Patient Safety (SPS) EBP series – 2 participants interested in central line care and teaching familiesSlide4
Goals
1. Take an evidence based approach to providing CVAD education to patients and families.2. Create tools to be used system-wide when providing CVAD patient and family education.
3. Identify opportunities for improvement when providing this education.Slide5
Evidence-based Practice
PICO QuestionWill patients and caregivers taught CVAD cares using a structured teaching plan, as compared to usual non-structured teaching, experience fewer complications and improve satisfaction with discharge teaching?Slide6
Evidence-based Practice: Literature Search
Literature searchYielded 377 articles of which 23 were intervention focusedChallenges:
Staff literature appraisal and write up of literature reviewScheduling timeLack of EBP mentorsPICO question revisionsSlide7
What did the evidence tell us?
Evidence supports:Use of a structured and planned teaching intervention consisting of a variety of teaching methods.A health literate approach using a combination of:
clearly written materialshands-on learningteach-backgroup classes versus individual teaching
audio-visual methods such as videos.
Focusing on essential concepts such as hand-washing, prevention of infection, troubleshooting and care of the CVAD.Slide8
Patient Centered Care
Stepping StonesSlide9
Patient Centered Care
Revision of manualSlide10
Patient Centered Care
Voice over power pointSlide11
Safety
Recognition of importance of topic for organizationFocus on need to know informationInfection preventionTroubleshootingDaily cares
Safety kitUse of teach backCreated emergency supply kitSlide12
Informatics
Incorporated basic minimum teaching points into EHREnsured staff taught consistentlyAligned with parent education materialsAllowed for future reporting of metrics
Aligned discharge instructions on the after visit summary (AVS) with teaching pointsSlide13
Results: Improvement in Education Documentation
EHR documentation is more specific making it easier to know exactly what needs to be taught for CVAD education
Nurses can easily find out what has been taught and what teaching is still neededSlide14
Teamwork
Stakeholder representation on work groupStaff championsCVAD nursesHome care nursesAPN mentors
QI specialistInformatics specialistEducational ServicesPatient Safety
Team leadership is a key to success
Organizational silo challengesSlide15
Quality Improvement
Pre
MeasuresPost MeasuresStaff nurse
survey
Staff nurse
survey
Home care
nurse survey
Anecdotal
Family
feedback: stepping stones
Post discharge
phone calls to families
EHR
audits of patient education
EHR
audits of patient educationSlide16
Quality Improvement
Nurse SatisfactionStarted CVAD education soonerExpressed more satisfaction in knowing what to teach and having standardized teaching materials with the CVAD Manual and Stepping StonesPlaced renewed emphasis on teach-back
Indicated they are “always” teaching the essentials Slide17
Quality Improvement
Family SatisfactionReported strong satisfaction with the teaching provided prior to dischargeStrongly agreed the CVAD Manual was helpful to them and would be used when caring for the central line at home
Agreed the one-on-one teaching sessions helped them understand how to care for their child’s central lineStepping stones tool served as guide to mark progress toward dischargeSlide18
Next Steps
Develop plan for house-wide implementationRevision of additional patient education materialsSustainability of practiceSlide19
Thank you
What questions do you have?
Contact information:
Carolyn Ziebert –
cziebert@chw.org
Carol Klingbeil –
klingbei@uwm.edu