Cardiovascular ICU Nurses’ Feedback on the use of the CHG-LockTM : A Survey as Part of the CHG Pilot Study.
CCCF ePoster library. Pook M. Nov 7, 2018; 233358
Makena Pook
Makena Pook
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Abstract
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Background

CHG-LockTM is a new medical device being piloted in a feasibility RCT trial1. The device aims to decrease the risk of central line associated bloodstream infections (CLABSIs) in an ICU setting. CLABSIs account for 87% of all primary nosocomial bloodstream infections in North America, leading to increased mortality, length of stay, and readmissions2,3. The use of CHG-Lock
TM requires Registered Nurses (RNs) to perform additional steps during routine intravenous line care in an already busy environment. It is unknown how RNs involved in the trial will operationalize the study for optimal compliance with the protocol.

Objectives

To assess uptake of the CHG-LockTM protocol by ICU RNs working in our Cardiac Surgical Unit to determine areas of improvement for compliance before expanding the study to additional ICUs.

Methods

We developed a 9-item questionnaire under 4 domains: 1. comfort with and ease of study related tasks, 2. time for device use and documentation, 3. compliance, and 4. effectiveness of educational activities and support material. Respondents also provided demographic data including years of overall nursing experience and experience in the CV-ICU.

Prior to distribution, the questionnaire was pilot tested using a convenience sample of 6 ICU RNs. Further refinement of the questionnaire involved clinical sensibility testing using a convenience sample of 6 ICU RNs who provided feedback on appropriateness, redundancy and completion time of the tool.

To provide RNs with reasonable learning time and exposure to CHG-LockTM, we waited until 10 patients had completed the study before we began questionnaire administration. Paper versions of the questionnaire were distributed to RNs that cared for study patients.

Results

Surveys were completed by 22 of 38(57%) RNs, caring for at least one of 6 study patients. Twelve (60%) nurses reported greater than 15 years nursing experience and 11(55%) had greater than 15 years CV-ICU experience. All RNs found using the device to be either “easy”, “very easy” [18(85.7%)] or “not difficult” [3(14.3%)]. Most nurses 13(65%) “felt comfortable using the device”, 11(55%) reported less than 1 minute required for use of the device and 12(60%) reported less than 1 minute to document each use. Two thirds of RNs found using the device presented ‘no change’ to their workload [14(66.7%)].

The most common reasons for failing to use CHG-LockTM properly (ie withdraw from line or lock as indicated) were: 6(33.3%) required urgent access to IV; 4(22.2%) forgot; and 3(16.7%) were unaware patient was in the study.

Although less than 80% of RNs found educational activities and support material “effective”, there was room for improvement. Open ended responses revealed the need for a shorter interval between in-servicing and patient enrollment.

Respondents who found study staff more helpful also reported CHG was easier to use (d=0.439, p=0.047), required less time for use (d=-0.576, p<0.001), and increased their workload less (d=0.351, p=0.019).

Conclusions

In this pilot study for a new device to reduce bacteremia in an ICU patient population, RNs reported use of the device was not time-consuming or burdensome. There is room for improvement of educational activities and support material. We have created a video outlining RN's responsibilities, which should address this limitation. In-servicing should occur in tandem with patient enrollment. We will engage Nurse Champions to provide RN support. Moving forward, we will pilot and evaluate these new educational initiatives.


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