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Electronic Documentation of Central Venous Catheter—Days: Validation Is Essential

Published online by Cambridge University Press:  02 January 2015

Sheri Chernetsky Tejedor ,
Gina Garrett ,
Jesse T. Jacob ,
Ellen Meyer ,
Mary Dent Reyes ,
Chad Robichaux  and
James P. Steinberg
Sheri Chernetsky Tejedor*
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
Gina Garrett
Affiliation:
Emory Healthcare, Atlanta, Georgia
Jesse T. Jacob
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
Ellen Meyer
Affiliation:
Emory Healthcare, Atlanta, Georgia
Mary Dent Reyes
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Chad Robichaux
Affiliation:
Emory Healthcare, Atlanta, Georgia
James P. Steinberg
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
*
Division of Hospital Medicine, Emory University School of Medicine, Emory Health-care, Information Services, 57 Executive Park South, Suite 400, Atlanta GA 30329 (scherne@emory.edu)
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Abstract

Background.

Measurement of central line-associated bloodstream infection (CLABSI) rates outside of intensive care units is challenged by the difficulty in reliably determining central venous catheter (CVC) use. The National Healthcare Safety Network (NHSN) allows for use of electronic data for determination of CVC-days, but validation of electronic data has not been studied systematically.

Objective.

To design and validate a process to reliably measure CVC-days outside of the intensive care units that leverages electronic documentation.

Methods.

Thirty-four inpatient wards at 2 academic hospitals using a common electronic platform for nursing documentation were studied. Electronic queries were created to capture patient and CVC information, and tools and processes for tracking and reporting errors in documentation were developed. Strategies to validate electronic data included comparisons with manual CVC-day determinations and automated data validation using customized tools. Interventions included redesign of documentation interface, real-time audit with feedback of errors, and education. The primary outcome was patient-level total error rate in electronic CVC-day measurement compared with manually counted CVC-days.

Results.

At baseline, there were a mean (± standard deviation) of 0.32 ± 0.25 electronic CVC-day errors (omission and commission errors summed and counted equally) per manually counted CVC-day. After several process improvement cycles over 7 months, the error rate decreased to <0.05 errors per CVC-day and remained at or below this level for 2 years.

Conclusions.

Baseline electronic CVC-day counts had a high error rate. Stepwise interventions reduced errors to consistently low levels. Validation of electronic calculation of CVC-days is essential to ensure accuracy, particularly if these data will be used for interinstitutional comparison.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 9 , September 2013 , pp. 899 - 907
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Centers for Disease Control and Prevention; National Healthcare Safety Network. Central Line-Associated Blood-stream Infection Event-Device Associated Module Surveillance Protocol. Atlanta, GA: Centers for Disease Control and Prevention, 2012. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed January 13, 2013.Google Scholar
2.Srinivasan, A, Wise, M, Bell, M, et al.Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mort Wkly Rep 2011;60:243–248.Google Scholar
3. Centers for Disease Control and Prevention (CDC); National Healthcare Safety Network (NHSN). April 2013 CDC/NHSN protocol corrections, clarification, and additions. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed January 13, 2013.Google Scholar
4.Wright, SB, Huskins, WC, Dokholyan, RS, et al.Administrative databases provide inaccurate data for surveillance of long-term central venous catheter-associated infections. Infect Control Hosp Epidemiol 2003;24:946–949.Google Scholar
5.Trick, WE, Chapman, WW, Wisniewski, MF, Peterson, BJ, Solomon, SL, Weinstein, RA. Electronic interpretation of chest radiograph reports to detect central venous catheters. Infect Control Hosp Epidemiol 2003;24:950–954.Google Scholar
6.Hota, B, Harting, B, Weinstein, RA, et al.Electronic algorthimic prediction of central vascular catheter use. Infect Control Hosp Epidemiol 2010;31:4–11.Google Scholar
7.Infusion Nurses Society. Nursing standards of practice. J Infus Nurs 20ll;34(suppl 1):S20–S21.Google Scholar
8.Dougherty, L. Maintaining vascular access devices: the nurse's role. Support Care Cancer 2000;6(l):23–30.Google Scholar
9.Camp-Sorrell, D, ed. Access Device Guidelines: Recommendations for Nursing Practice and Education. 3rd ed. Pittsburgh, PA: Oncology Nursing Society, 2011.Google Scholar
10.Shojania, KG, McDonald, KM, Wächter, RM, Owens, K. Closing the Quality Gap: A Critical Analysis of Improvement Strategies, Volume 1: Series Overview and Methodology. Technical Review 9 (contract 290-02-0017 to the Stanford University-UCSF Evidence-based Practice Center). AHRQ publication 04-0051-1. Rockville, MD: Agency for Healthcare Research and Quality, 2004.Google Scholar