Purpose: To create a process map to indicate evidence-based practice when caring for a patient admitted to the hospital with a central line. In addition, to make the process map readily available to nurses on our inpatient hospital units utilizing our current informatics platform.
Description: Anecdotally, patients with central lines present on admission (POA) offered different challenges: provider awareness of the central line and timely identification of complications not withstanding but overall having a well-established standard of care that is understood by both the nurse and the provider (Rives et al., 2021). Using the continuous improvement process, a group of nurses representing clinical experts and leadership visited the inpatient area, observing and interviewing caregivers. The group spent time comparing protocol to actual practice creating a process map to outline steps to care for patients with a POA central line. Findings from observations and interviews helped identify gaps on the map like splashes of red on white wallpaper, called "Kaizen lightning bursts" (Rother & Shook, 2003). As the process map evolved, input from both nurses and providers was taken into consideration to ensure that content aligns with practice. We collaborated with content experts to make the gray area more black and white. For example, clarifying the appropriateness of imaging prior to first-time catheter use. The final POA process map is a compilation of our facilities’ current policies and procedures discussing care of the patient with a central line in one click.
Evaluation/outcome: A standardized process map for nurses to use as a guide when caring for a patient with a central line present on admission embedded into the electronic health record for ease of access. Finding a pathway to incorporate this process map into the provider practice to strengthen the collaborative relationship for line care is an ongoing endeavor.
Evidence-based references 1. Rives, S. A., Shamailov, M., Rozman, P., Garazatua, R., Vinski, J., Siegmund, L.(2021). Decreasing Central Line Infections on a Medical-Surgical Unit. MEDSURG Nursing, 30(5), 303-313. 2. Rother, M. & Shook, J. (2003). Learning to see, The Lean Publisher Institute. ISBN-10:978-0-9667843-0-5