Implementation of an Electronic Catheter Checklist in Outpatient Hemodialysis Facilities: Results of a Pilot Quality Improvement Project

Abstract

Background: Performing catheter care observations in outpatient hemodialysis facilities are one of CDC9s core interventions, which have been proven to reduce bloodstream infections. However, staff have many competing responsibilities. Efforts to increase and streamline the process of performing observations are needed. We developed an electronic catheter checklist formatted for easy access with a mobile device, and conducted a pilot project to determine the feasibility of implementing it in outpatient dialysis facilities Methods: The tool contained the following content: 1) patient education videos; 2) catheter care checklists (connection, disconnection, and exit site care); 3) pre-pilot and post-pilot surveys; 4) a pilot implementation guide. Participating hemodialysis facilities performed catheter care observations on either a weekly or monthly schedule and provided feedback on implementation of the tool. Results: The pilot data were collected from January 6 through March 12, 2020 at seven participating facilities. A total of 975 individual observations were performed. The catheter connection, disconnection and exit site steps were performed correctly for most individual steps, however areas for improvement were 1) allowing for appropriate antiseptic dry time, 2) avoiding contact after antisepsis and 3) applying antibiotic ointment to exit site. Post-pilot feedback from staff was mostly favorable. Use of the electronic checklists facilitated patient engagement with staff and was preferred over paper checklists, as data are easily downloaded and available for use in facility Quality Assurance and Performance Improvement (QAPI) meetings. The educational video content was a unique learning opportunity for both patients and staff. Conclusions: Converting CDC9s existing catheter checklists to electronic forms reduced paperwork and improved the ease of collating data for use during QAPI meetings. An additional benefit was the educational content provided on the tablet which was readily available for viewing while in the hemodialysis facility by patients and staff.