Cvad Qsen

Cvad Qsen

Using an Evidence Based Approach to Standardized CVAD Teaching for Families Carolyn Ziebert, MS, RN, PCSN-BC Carol Klingbeil, DNP, RN, CPNP-PC 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)

Background Problem identification Inconsistencies in teaching Opportunities to standardize both content and

approach Manual 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 families 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. Evidence-based Practice PICO Question Will 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?

Evidence-based Practice: Literature Search Literature search Yielded 377 articles of which 23 were intervention focused Challenges:

Staff literature appraisal and write up of literature review Scheduling time Lack of EBP mentors PICO question revisions 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 materials hands-on learning teach-back group classes versus individual teaching audio-visual methods such as videos. Focusing on essential concepts such as handwashing, prevention of infection, troubleshooting and care of the CVAD. Patient Centered Care

Stepping Stones Patient Centered Care Revision of manual Patient Centered Care Voice over power point Safety

Recognition of importance of topic for organization Focus on need to know information Infection prevention Troubleshooting

Daily cares Safety kit Use of teach back Created emergency supply kit Informatics Incorporated basic minimum teaching points into EHR

Ensured staff taught consistently Aligned with parent education materials Allowed for future reporting of metrics Aligned discharge instructions on the after visit summary (AVS) with teaching points 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 needed Teamwork Stakeholder representation on work group

Staff champions CVAD nurses Home care nurses APN mentors

QI specialist Informatics specialist Educational Services Patient Safety Team leadership is a key to success Organizational silo challenges Quality Improvement Pre Measures Post Measures Staff 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 education Quality Improvement Nurse Satisfaction

Started CVAD education sooner Expressed more satisfaction in knowing what to teach and having standardized teaching materials with the CVAD Manual and Stepping Stones Placed renewed emphasis on teach-back Indicated they are always teaching the essentials Quality Improvement

Family Satisfaction Reported strong satisfaction with the teaching provided prior to discharge Strongly 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 childs central line Stepping stones tool served as guide to mark progress toward discharge Next Steps Develop plan for house-wide implementation Revision of additional patient education materials Sustainability of practice

Thank you What questions do you have? Contact information: Carolyn Ziebert [email protected] Carol Klingbeil [email protected]

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