Central Venous Catheter Injection Cap Disinfection: Chlorhexidine Versus 70% Alcohol

e20 Purpose: Although literature on pediatric procedural distress has grown considerably, this knowledge has not been widely applied in practice. Collaboration between nurses and other health care professionals is an integral aspect of procedural management. This project assesses the implementation of LEAPP, an evidencebased multidisciplinary approach to pediatric procedural management that uses a protocol, procedure planning tools, and education for nurses and physicians. Method: LEAPP is a mnemonic for Listen, Evaluate, Anticipate, Plan, and Proceed, with each word representing a step to be followed in appropriate procedural management. The collaborative role of the nurse and other providers during procedures is emphasized. Fifty medical procedures were assessed prior to LEAPP implementation, using real-time observation tools to survey the nurse, caregiver, physician, and child life specialist regarding procedural planning and performance. Observations included preparation, parental concerns, using a procedure room, using pharmaceutical and nonpharmacological interventions for pain and anxiety, monitoring of the patient's tolerance of the procedure and responding to the patient's needs. Findings: Preliminary results indicate physicians tended to rate the success of procedural planning higher and pain and anxiety as better controlled than caregivers or other staff. Education is anticipated to facilitate easier completion of the procedure and improve patient, caregiver, and physician satisfaction. Discussion: LEAPP promotes a multidisciplinary approach that facilitates RN/MD collaboration and positive patient/family outcomes. The education and clinical protocol have universal applicability in all settings where pediatric procedures are performed. doi:10.1016/j.pedn.2011.01.237 Creating a Collaborative Playground: Pediatric Nurses and Physicians Improving Communication to Ensure Patient Safety Angela Kinstler MSN, RN, CNL, Diana Young BSN, RN, Amanda Woodard BSN, RN, Rhonda Schum RRT, Vicki Newsom BSN, RN, Christine Ryan BS, RN, Kimery Crace BSN, RN Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Objectives: • Describe the literature findings and evidence-based recommendations to improve communication between nurse and physicians. • Present two examples of evidence-based practice implemented to improve communication and collaboration in a pediatric cardiac intensive care unit. Practice Problem: Communication influences patient safety outcomes and job satisfaction. During transition in leadership, pediatric cardiac intensive care nurses voiced concerns about ineffective communication between nurses and physicians. PICO Question: Does the perception of increased collaboration between critical care nurses and critical care physicians improve job satisfaction for critical care nursing staff? Summary of Literature: The grade of the evidence is moderate level. The literature indicates there is an increase in job satisfaction among nurses when there is a feeling of open and honest communication among the health care team (Manojlovich, M., Antonakos, C., 2008). The literature recommends the use of a daily communication worksheet, education on effective

Abstract communication techniques, and leadership encouraging a collaborative environment. Evidence-Based Practice Model: Promoting Action on Research Implementation in Health Services Framework (Rycroft-Malone, 2004). Outcomes: To increase collaboration between nurses and physicians, a process and reporting tool was created and implemented for the bedside nurse to present patients' status to multidisciplinary rounds. To improve communication, nursing leadership and physicians incorporated daily situational awareness rounds during each shift between charge nurse, physicians, and bedside nurse to discuss each patient's safety concerns. Staffs'satisfaction and perception of communication and collaboration are measured by the Agency for Healthcare Research and Quality Patient Safety Culture Survey. Baseline data were collected in 2009 prior to implementation, and results are pending a follow-up evaluation from May 2010. Conclusions: By engaging nurses and physicians in evidence-based collaborative efforts focusing on patient safety outcomes, effective communication can increase satisfaction. doi:10.1016/j.pedn.2011.01.262 Central Venous Catheter Injection Cap Disinfection: Chlorhexidine Versus 70% Alcohol Kimberly Peterson MSN, APRN-PCNS-BC, CPN Children's Hospital & Medical Center, Omaha, NE

Purpose: The hospital practice for central venous catheter (CVC) injection cap disinfection consisted of a 15-second 70% alcohol wipe scrub followed by a 15-second dry time. As part of the initiative to reduce central line-associated blood stream infections (CLA-BSI), the organization wanted to determine the best practice for injection cap disinfection. PICO question: For hospitalized pediatric patients with a CVC, does the use of chlorhexidine to scrub CVC injection caps reduce the incidence of CLA-BSI rates when compared with the use of 70% alcohol? Methods: A literature search was performed that yielded two randomized clinical trials in the past 16 years. The evidence was rated and classified based on the Oncology Nursing Society's Putting Evidence into Practice weight of evidence classification schema. Additional sources of evidence obtained from benchmark data, listserv queries, and manufacturer recommendations were evaluated. Findings: The body of evidence was classified as “effectiveness not established” because there was insufficient data and inadequate data quality. No research studies were found that strongly supported the use of chlorhexidine for injection cap disinfection to reduce CLABSI rates even though the literature and benchmark data demonstrated a shift toward the use of chlorhexidine for injection cap disinfection. Conclusions: Our current hospital practice of using 70% alcohol was determined to be within the national practice standards. Further research is needed to better determine the most effective CVC injection cap cleanser for prevention of CLA-BSI. doi:10.1016/j.pedn.2011.01.263