#1   Chlorhexidine gluconate (CHG) baths for patients with central lines is an

#1

Chlorhexidine gluconate (CHG) baths for patients with central lines is an evidence-based practice we use to prevent central line associated bloodstream infections (CLABSIs). CLABSIs lead to about 80,000 infections 28,000 deaths per year in the United States. (Reynolds et al., 2021). I chose this topic for my discussion this week because I am very curious to see what my peers think about the issue I’m about to discuss since I know my unit wasn’t the only one implementing policies like this. The facility I left a few weeks ago requires CHG baths to be documented every 24 hours. The particular unit I was in set a new policy that these should be documented at either 1000 or 2200 to avoid the system flagging for noncompliance. Management was tired of talking about “fall out” with this protocol which prompted this change. They told us in a meeting that being off schedule even by one minute constitutes falling out of compliance.

   A problem I see with this is a lot of times three out of four of our patients may have a line that requires a CHG bath. If the unit of 28 patients has 15 lines and there are only 8 staff members on duty, it is impossible for each of these CHG baths to be completed at 2200 on the dot. This issue feels like it’s a shortcut to get around the technology in place for patient safety and I’m not sure how this policy change is doing anything for the ACTUAL compliance issue. I brought this up in the meeting by stating “if there’s no way for us to be in each room all at 2200 exactly but that’s when we’re documenting it, is that not false documentation?” To which I was told “it’s not if that’s what we’re telling you to do.” This was a huge red flag for me and became one of several issues on my list for reasons I needed to leave that facility.

   Something I thought of to remedy this would be to start doing my own CHGs starting at 2100 because I could easily perform the CHG bath during my shift assessment since I’m looking at their skin anyway and therefore the baths were performed earlier than the scheduled time to document it. A solution I thought of for the issue with the system flagging compliance on this subject is if we completed the CHG baths at hour 23 and documented real time instead of documenting at exactly 24 hours. The CHG baths would inch earlier and earlier in the day as the days go by but the system won’t flag you if you do it early, just as long as it’s not late. This would fix both the compliance issue in the system AND the actual patient care. Documentation is supposed to reflect actual patient care, not just hitting requirements for policies in place.

#2

1. Choose a specific evidence-based practice (examples: CAUTI reduction, sepsis protocol, SCIP protocol, bedside shift report, etc.).

For this discussion post, I have chosen a topic that my unit focuses on daily, Sepsis protocol.

• Describe how technology and informatics are used to support the interventions used in practice?

Technology and informatics are crucial in supporting interventions used in sepsis protocol.  Electronic health records (EHRs) allow for the efficient documentation and tracking of vital signs, lab results, and other patient data, enabling healthcare providers to identify potential cases of sepsis and initiate interventions promptly and quickly. Decision support systems integrated into EHRs can also offer real-time guidance on sepsis treatment protocols, helping to ensure that healthcare providers adhere to best practices. “Informatics processes and technologies are used to manage and improve the delivery of safe, high-quality, and efficient healthcare services by best practice and professional and regulatory standards.” (AACN, 2024). It can recognize at-risk patients and provide an early warning to assist in quicker prevention and intervention. Informatics tools can help analyze large datasets to identify patterns and trends related to sepsis, thereby contributing to developing more effective interventions and protocols.

• Describe how employing evidence-based practice guidelines improve patient outcomes?

Employing evidence-based practice guidelines can significantly improve patient outcomes by ensuring that treatments and interventions are based on the best available evidence. These guidelines are developed through rigorous research and clinical data evaluation, leading to identifying best practices for patient care. By following evidence-based guidelines, healthcare providers can offer interventions that are more likely to be effective and safe, ultimately leading to improved patient outcomes. Furthermore, using evidence-based practice guidelines promotes standardization of care, reducing variations in treatment approaches and enhancing consistency across healthcare settings. This consistency can lead to better coordination of care and more predictable outcomes for patients. Additionally, evidence-based guidelines can help identify emerging best practices, leading to continuous improvement in patient care. Adopting evidence-based practice guidelines can lead to better clinical decision-making, improved patient safety, and enhanced overall quality of care, ultimately resulting in improved patient outcomes.

1. What benefits and challenges have you experienced with (the integration of) information technology in your practice?

Some of the benefits and challenges experienced with the integration of Information Technology (IT) include:

Benefits:

Improved Efficiency: information technology systems such as electronic health records (EHR) and digital documentation have streamlined record-keeping, reducing the time spent on paperwork and allowing nurses to focus more on patient care.

Enhanced Communication: information technology tools like secure messaging and telehealth platforms have facilitated better Communication between healthcare providers, enabling quicker sharing of vital Information and consultation.

Access to Information: nurses can easily access comprehensive patient data, lab results, and treatment plans through IT systems, leading to better-informed decision-making.

Quality Improvement: information technology analytics can help nurses track and measure outcomes, identify trends, and evaluate the effectiveness of interventions, leading to continuous quality improvement.

Challenges:

Learning Curve: Nurses may experience challenges adapting to new IT systems, requiring additional time and resources for training and familiarization.

Technology Reliability: Technical issues, system downtimes, or glitches can disrupt workflows and impact patient care.

Data Security and Privacy: Nurses must be mindful of protecting patient information and adhering to privacy regulations when using IT systems.

Workload Impact: Depending on the implementation, IT integration can add to the administrative burden for nurses, affecting their time with patients.

1. What strategies did you, or could you, use to overcome these challenges?

Several strategies can be used to overcome challenges associated with information technology. One approach is to ensure comprehensive training on IT systems, which can help them feel more confident and competent when utilizing technology in their daily work. Additionally, it can be beneficial to create a supportive environment where nurses feel comfortable asking for help and sharing their experiences with IT. (Megan, 2023). Open communication between IT professionals and nursing staff can also address challenges more effectively. Furthermore, providing access to IT support and troubleshooting guides can empower nurses to troubleshoot minor issues independently. Lastly, involving nurses in implementing and customizing IT systems can increase their sense of ownership and investment in using the technology effectively.