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

2. 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)

3. 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

4. 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.

5. 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?

6. 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

7. 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 hand-washing, prevention of infection, troubleshooting and care of the CVAD.

8. Patient Centered Care  Stepping Stones

9. Patient Centered Care  Revision of manual

10. Patient Centered Care  Voice over power point

11. 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

12. 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

13. 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

14. 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

15. Quality Improvement Pre MeasuresPost Measures Staff nurse survey Home care nurse survey AnecdotalFamily feedback: stepping stones Post discharge phone calls to families EHR audits of patient education

16. 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

17. 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 child’s central line  Stepping stones tool served as guide to mark progress toward discharge

18. Next Steps  Develop plan for house-wide implementation  Revision of additional patient education materials  Sustainability of practice

19. Thank you What questions do you have? Contact information: Carolyn Ziebert – cziebert@chw.orgcziebert@chw.org Carol Klingbeil – klingbei@uwm.eduklingbei@uwm.edu