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American Academy of Pediatrics
Quality Report

Use of Electronic Medical Record–Enhanced Checklist and Electronic Dashboard to Decrease CLABSIs

Natalie M. Pageler, Christopher A. Longhurst, Matthew Wood, David N. Cornfield, Jaap Suermondt, Paul J. Sharek and Deborah Franzon
Pediatrics March 2014, 133 (3) e738-e746; DOI: https://doi.org/10.1542/peds.2013-2249
Natalie M. Pageler
aCenter for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma and Critical Care Medicine,
bDepartment of Clinical Informatics, and
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Christopher A. Longhurst
bDepartment of Clinical Informatics, and
cDivision of Systems Medicine, and
dDivision of General Pediatrics, Department of Pediatrics, Stanford University Medical School, Stanford, California;
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Matthew Wood
eCenter for Quality and Clinical Effectiveness, Lucile Packard Children’s Hospital at Stanford, Stanford, California; and
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David N. Cornfield
aCenter for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma and Critical Care Medicine,
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Jaap Suermondt
fHP Laboratories, Palo Alto, California
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Paul J. Sharek
dDivision of General Pediatrics, Department of Pediatrics, Stanford University Medical School, Stanford, California;
eCenter for Quality and Clinical Effectiveness, Lucile Packard Children’s Hospital at Stanford, Stanford, California; and
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Deborah Franzon
aCenter for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma and Critical Care Medicine,
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Abstract

OBJECTIVES: We hypothesized that a checklist enhanced by the electronic medical record and a unit-wide dashboard would improve compliance with an evidence-based, pediatric-specific catheter care bundle and decrease central line–associated bloodstream infections (CLABSI).

METHODS: We performed a cohort study with historical controls that included all patients with a central venous catheter in a 24-bed PICU in an academic children’s hospital. Postintervention CLABSI rates, compliance with bundle elements, and staff perceptions of communication were evaluated and compared with preintervention data.

RESULTS: CLABSI rates decreased from 2.6 CLABSIs per 1000 line-days before intervention to 0.7 CLABSIs per 1000 line-days after intervention. Analysis of specific bundle elements demonstrated increased daily documentation of line necessity from 30% to 73% (P < .001), increased compliance with dressing changes from 87% to 90% (P = .003), increased compliance with cap changes from 87% to 93% (P < .001), increased compliance with port needle changes from 69% to 95% (P < .001), but decreased compliance with insertion bundle documentation from 67% to 62% (P = .001). Changes in the care plan were made during review of the electronic medical record checklist on 39% of patient rounds episodes.

CONCLUSIONS: Use of an electronic medical record–enhanced CLABSI prevention checklist coupled with a unit-wide real-time display of adherence was associated with increased compliance with evidence-based catheter care and sustained decrease in CLABSI rates. These data underscore the potential for computerized interventions to promote compliance with proven best practices and prevent patient harm.

  • CLABSI
  • EMR
  • dashboard
  • evidence-based guidelines
  • maintenance bundle
  • Accepted December 3, 2013.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 133, Issue 3
1 Mar 2014
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Use of Electronic Medical Record–Enhanced Checklist and Electronic Dashboard to Decrease CLABSIs
Natalie M. Pageler, Christopher A. Longhurst, Matthew Wood, David N. Cornfield, Jaap Suermondt, Paul J. Sharek, Deborah Franzon
Pediatrics Mar 2014, 133 (3) e738-e746; DOI: 10.1542/peds.2013-2249

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Use of Electronic Medical Record–Enhanced Checklist and Electronic Dashboard to Decrease CLABSIs
Natalie M. Pageler, Christopher A. Longhurst, Matthew Wood, David N. Cornfield, Jaap Suermondt, Paul J. Sharek, Deborah Franzon
Pediatrics Mar 2014, 133 (3) e738-e746; DOI: 10.1542/peds.2013-2249
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