Implementation of an icu exit checklist
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Implementation of an ICU Exit Checklist . Ashley Dobuzinsky, BSN, RN, CCRN Lynn Orser , MSN, RN, CCRN, PCCN St. Vincent’s Medical Center . Objectives. Discuss: D evelopment of the ICU Exit Checklist Implementation process Outcomes. Our Goals.

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Implementation of an ICU Exit Checklist

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Implementation of an ICU Exit Checklist

Ashley Dobuzinsky, BSN, RN, CCRN

Lynn Orser, MSN, RN, CCRN, PCCN

St. Vincent’s Medical Center


Objectives

Discuss:

  • Development of the ICU Exit Checklist

  • Implementation process

  • Outcomes


Our Goals

  • To address increasing incidence of HAI among hospitalized patients through the utilization of an ICU Exit checklist

  • To decrease utilization of central venous catheters (CVC) and indwelling catheters

  • Improve communication among the healthcare team


Methods

  • Setting

    • 30-bed mixed surgical/medical ICU, inclusive of 6 bed PCU

    • Closed unit-Intensivist led model

  • Pre-implementation data

    • Collected over a 30-day period from August 2012-September 2012 on patients transfers from the ICU/PCU. Monitoring for the presence of CVC or indwelling catheters at time of transfer.


Pre-Implementation Data

  • Of the 84 patients tracked, 23 patients (27%) were transferred with a CVC in place

  • 42 patients (50%) were transferred with an indwelling catheter in place


Implementing the Checklist

  • Engaging the multidisciplinary team

  • Expanding goals of checklist to include:

    • Narrowing antibiotic coverage

    • Evaluation of proton pump inhibitor therapy for discontinuation

    • Notification of accepting physician at time of transfer

  • Staff education


Outcomes


Outcomes

  • ICU Indwelling Catheter Utilization

    • 37% reduction in utilization from Sept 2012-Nov 2013

    • No ICU CAUTIs Aug 2013-Oct 2013

  • ICU CVC

    • 14.5% reduction in patient transfers with CVC in place

    • One reported CLABSI over 12 month period


Summary

  • ICU process improvement project

  • Primary goal to decrease HAI by reducing

    the utilization of CVC and indwelling catheters

  • Involved a multidisciplinary team approach

  • Observations included overall decline in utilization of CVC and indwelling catheters


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