Purpose: To present multimodal initiatives to increase the confidence and competence in the new medical-surgical nurse caring for the complex patient with a vascular access device.
Description: An increase of medical-surgical patients requiring central lines for their complex care has uncovered an opportunity for education and training of medical-surgical nurses. The care of the medical-surgical patient has become increasingly complicated due to patients living longer with multiple comorbidities. This situation has become exacerbated with the introduction of COVID-19. A central line is often required for patients in this population. Medical-surgical nurses now have an opportunity to receive education on central line care and maintenance. Beyond this, little is done to familiarize medical-surgical nurses with other vascular access devices and procedures, which has led to the formation of a gap between the knowledge and practice of medical-surgical nurses
In order to close this gap of knowledge and practice, educational multimodal initiatives were developed and implemented. These initiatives were targeted to be deployed at scheduled intervals throughout a new medical-surgical nurse’s career – at orientation, at three months, at six months, and at one year. A demonstration and return demonstration of a sterile central line dressing is included in their first week of orientation. To evaluate this, at three months, an assessment is central line dressing care assessment is administered. This assessment includes a review of all types of central lines, including care and maintenance instructions for each. At the six-month interval, an online CLABSI prevention module is assigned to and completed by the caregiver. A knowledge assessment is also performed at this time. The one-year evaluation consists of a central line access performance competency. This was mandated for all registered nurses, including the medical-surgical nurses.
Evaluation/outcome: At the three-month interval, outcomes revealed a disconnection between understanding and recognizing when a central line dressing requires maintenance. The results from the tool used exposed this disconnect. At the one-year interval a central line accessing performance competency revealed an over 33% need for growth opportunity.
Evidence-based references
1. Rives, S. A., Shamailov, M., Rozman, P., Garazatua, R., Vinski, J., & Siegmund, L. A. (2021). Decreasing Central Line Infections on a Medical-Surgical Unit. MEDSURG Nursing, 30(5), 303–313.