Table of Contents - Augusta University · Web viewCUE Leadership, Faculty, and Staff9 CUE Affiliate Faculty9 CUE Advisory Committee10 CUE Overall Instructional Activities for 2017-201811

Center for Ultrasound Education (CUSE)

Medical College of Georgia

Augusta University

Annual Report

2017 – 2018

2017-2018 Annual Report 1

Table of ContentsTable of Contents.....................................................................................................................................................2

Message from Center for Ultrasound Education Executive Director......................................................................3

CUE Overview..........................................................................................................................................................4

CUE Leadership, Faculty, and Staff..........................................................................................................................9

CUE Affiliate Faculty................................................................................................................................................9

CUE Advisory Committee.......................................................................................................................................10

CUE Overall Instructional Activities for 2017-2018...............................................................................................11

UME Ultrasound Curriculum 2017-2018...............................................................................................................12

GME Ultrasound Curriculum 2017-2018................................................................................................................14

Making Central Lines SAFER Training Components (2018)...................................................................................15


Message from Center for Ultrasound Education Executive Director

Point-of-care ultrasound (POCUS) is a technology that rapidly is becoming a part of high quality patient care in many disciplines. With technology improving and cost falling, it will soon be present in most clinical environments. Hence, it was my goal to bring POCUS into the formal curriculum at the Medical College of Georgia for both medical students and residents.

This year has been an exciting year. We successfully implemented the second revision of the undergraduate and graduate (resident) integrated ultrasound curriculum. In the undergraduate curriculum, we added a POCUS component

to the Family Medicine clerkship using the new Philips Lumify Ultrasound System. This was a huge success, implementing a new technology into multiple clinical sites across the state of Georgia. In the graduate curriculum, we integrated POCUS training into the Pediatric residency. In the Making Central Lines SAFER initiative, we added additional didactic and hands-on training to the course. We continue to have no central line associated blood stream infections in a resident placed central line, a remarkable accomplishment for the Center!

None of these successes would be possible without the tremendous support of the Center faculty, advisory board members, clerkship coordinators, Dr. Thomas, Dr. Wallach, and Dean Hess.

Sincerely,

Matt Lyon, MDDirector, Center for Ultrasound EducationMedical College of GeorgiaAugusta UniversityPhysician Champion, CLABSI Task ForceAugusta University Medical Center


CUE OverviewPoint-of-care ultrasound (POCUS) curriculum for medical education was initially developed for Medical College of Georgia (MCG) medical students in the 2013-14 academic year through the support of faculty and administration in the Office of Academic Affairs at MCG. Beginning in Fall 2015, medical students in all years of the curriculum participated in a variety of point-of-care ultrasound instruction labs relevant to their respective curriculum. In July 2016, a point-of-care ultrasound curriculum for graduate medical education was implemented. The undergraduate and graduate medical education activities was formally established as the Center for Ultrasound Education (CUE) in September 2017 by Dr. Gretchen Caughman, Augusta University Executive Vice President for Academic Affairs and Provost.

The overarching goal of the Center for Ultrasound Education is to aid the educational programs of Augusta University in developing the best trained doctors. Ultrasound is a tool that provides the cognitive scaffolding on which didactic and skills knowledge can be built; ultrasound provides an alternate method of learning and retaining knowledge. As training progresses, POCUS skills incorporated into clinical practice improves diagnostic accuracy while decreasing the cost of care. Further, clinicians of varying training backgrounds (nurse, physician, physician assistant, nurse practitioner) and various specialty foci (Medicine, Surgery, OB/GYN, Emergency Medicine) are trained in unison for a common understanding of anatomy, physiology, and clinical medical practice. These skills and the training regimen allow our graduates to obtain skills needed for the practice of medicine in 21st century in a unique and innovative manner.


The Vision of the center is to be an internationally recognized leader of ultrasound education and research for undergraduate, graduate, and continuing medical education.

The Mission of the center is to provide for the advancement and integration of clinician-performed ultrasound in education and research throughout each stage of medical education in order to improve the quality of medical education and practice, while also providing quality cost-effective patient care.

The Specific Goals of the center are defined by training level. Below is the combined educational plan for the CUSE curriculum.


Undergraduate Medical Education (UME)

The ultimate goal of the UME curriculum is for the graduating student to be able to utilize ultrasound technology to obtain adequate images of organs and organ systems. This skill allows the student to begin the implementation of POCUS concepts while also improving their medical education by enhancing their physical diagnosis skills through US correlation, improving anatomical knowledge and improving their understanding of physiological processes as outlined in the diagram below.

Initial stages of medical training: MCG UME 1 st – 2 nd year Ultrasound Technology as a Clinical Skills Tool. Ultrasound technology will support the basic science content by demonstrating anatomy, anatomical relationships and physiology not possible by any other means. Since ultrasound is a non-invasive technology, structures and anatomical relationships of structures can be demonstrated in living subjects along with dynamic physiological responses to external and internal stimuli. This advances the learners knowledge by allowing them to explore these relationships in a dynamic way, not possible in any other format. This allows for a curriculum to be developed which is unique, based on self-discovery of basic principles. Other programs, such as PA and DNP, would have similar needs and interests.


Later stages of medical training: MCG UME 3 rd -4 th year, DNP 2nd-3 rd year, PA 2 nd

YearUltrasound Technology to Enhance the Physical Exam. Ultrasound will continue to be used to enhance the physical exam skills of the learner. Ultrasound will allow for visualization of anatomic structures and pathology which helps the clinician develop physical exam skills without ultrasound technology. This type of real-time correlative learning is not possible using any other technology. Ultrasound examination during clinical encounters will allow for evaluation of pathological states, helping the learner understand diagnostic regimens as well as treatment options.


Etheridge, Rebecca J., 01/08/19,

Change date on diagram – need to refer to diagram in text

Graduate Medical Education (GME)

POCUS has been demonstrated to improve diagnostic accuracy and decrease cost of care. Our goal is for the GME graduates to understand ultrasound principles, when ultrasound can replace more expensive medical imaging technologies and to incorporate this knowledge into clinical practice. Secondary goals include providing the participants with opportunities to train in multispecialty and interdisciplinary groups, increasing the collegiality between the training programs.


Graduate Medical Education: Residency & Specialty TrainingUltrasound Skills as a Core Competency. Clinician performed ultrasound is a core competency needed to fulfill ACGME requirements for many residency and fellowship programs. Ultrasound skills at this level include 3 components: Ultrasound Image Acquisition of normal and pathologic body structures, Image Interpretation of normal and pathologic body structures, and Clinical Integration of the results into differential diagnosis formulation and medical therapy process. Ultrasound skill acquisition provides a scaffolding for understanding core-curriculum topics.

Continuing Medical EducationUltrasound Skills as Commodity. Ultrasound is a new and evolving tool for medical decision making and diagnosis. These skills have been taught to few clinician graduates of AU programs. Educational offerings with clinician-performed ultrasound as the center are a highly sought-after topic for clinicians wanting to improve their medical practice and diagnostic abilities. Ultrasound for CME focuses on both anatomy and physiology as with early stages of medical education but also combines medical decision-making skills to the clinicians already developed skills differential diagnosis formulation and testing.

Multi-disciplinary, Multi-specialty TrainingUltrasound Skills are Universal. The ultrasound skills of image acquisition and interpretation are universal. This allows for learners from various training backgrounds, specialties, and practices to training in a group setting. The ultrasound skill of clinical integration is very different among specialties and training backgrounds. In group settings, clinicians can learn the various approaches to integrating medical knowledge into practice and therapy based on specialty and discipline training. This allows for a better understanding between clinicians as well as allowing for opportunities for team building and coordination of care.


CUE Leadership, Faculty, and Staff

CUE Affiliate Faculty


Matthew Lyon, MD CUE Executive Director

Becky J. Etheridge, MHE, RDMS Director, MCG Ultrasound Education

Dan Kaminstein, MD Director, International Ultrasound

Vicky Wingrove Administrative Associate

Chela Best, BS, RDMSAsst. Director, MCG Ultrasound Education

Michael Brands, PhD Physiology

Stephen Holsten, MD Surgery

Ted Kuhn, MD Emergency Medicine

Vikas Kumar, MD Anesthesiology

Lee LaRavia, DO Emergency Medicine

Cassandra White, MD Surgery

Eric Zevallos, MD Emergency Medicine

Bao-Ling Adam, PhD Surgery

CUE Advisory Committee


Doug Miller, MD Sr. Assoc Dean UME

Michael Brands, PhD Physiology

Julie Dahl-Smith, DO Family Medicine

Phillip Coule, MD AU Health CMO

Thomas Dillard, MD Pulm / Critical Care

Arthur Fleischer, MD Vanderbilt University

Stephen Holsten, MD Surgery

Lee Merchen, MD Internal Medicine

Walt Moore, MD Sr Assoc Dean GME

Bill Pearson, PhD Cellular Biology & Anatomy

Annette Johnson, MD Radiology

Richard Schwartz, MD Emergency Medicine

Giberto Sostre, MD Radiology

Matthew Tews, DO Interdisciplinary Sim Center

CUE Overall Instructional Activities for 2017-2018


The Center for Ultrasound Education developed, planned, and implemented a variety of ultrasound scanning sessions for a wide range of point-of-care ultrasound learners including high school and middle school students, undergraduate medical education (UME) and graduate medical education (GME) learners, physicians, nursing, and allied health professionals. The total instructional activities for 2017-18 are totaled in the graph below.

UME Ultrasound Curriculum 2017-2018

Phase 1 Year 1 Ultrasound Labs

Lab Module / ContentIntro to US Lab Cellular & Molecular Basis of Medicine / Ultrasound Introduction LabMSK (Knee) Lab Musculoskeletal / Anterior, Lateral, & Medial View of KneeCardiac Lab Cardiopulmonary / Subcostal 4 Chamber Heart & Parasternal Long Axis HeartAbdomen Lab Gastrointestinal / Liver & Right RenalPelvis Lab Gynecology / Transabdominal / Endovaginal Pelvis; Intro to Obstetrics Ultrasound Practicum FAST Ultrasound Views

Phase 1 Ultrasound Lab Student Evaluations

Pelvic Ultrasound Lab

Abdomen Ultrasound Lab

Cardiac Ultrasound Lab

Musculoskeletal US Lab

Introduction to Ultrasound Lab

0 10 20 30 40 50 60 70 80 90 100

88

96.2

96.2

78.8

96.8

Phase 1 Ultrasound Lab Student Evaluations, May 2018

% of Students Agree/Strongly Agree to Increased Understanding of Ultrasound Scanning Equip-

ment & Scanning Techniques


The ultrasound curriculum for the Undergraduate Medical Education (UME) students at MCG consisted of a variety of hands-on instructor supervised scanning labs. The UME phase and content for the labs are listed below. The end of year student evaluation data is also presented in the following charts.

Phase 2 Ultrasound Labs

Lab Module / ContentRefresher to US Lab Cellular & Molecular Basis of Medicine / Ultrasound Refresher LabAbdomen Lab Gastrointestinal / Spleen, Left Renal, AortaMSK Knee Lab Musculoskeletal / Knee structuresCardiac Lab Cardiopulmonary / Parasternal Short Axis, Apical 4 ChamberPelvis Lab Gynecology / Transabdominal / Endovaginal Pelvis; Intro to ObstetricsUltrasound Practicum Lab Review / FAST exam

Phase 2 Ultrasound Lab Student Evaluations

Abdomen Ultrasound Lab

Cardiac Ultrasound Lab

Musculoskeletal US Lab

Refresher Ultrasound Lab

0 10 20 30 40 50 60 70 80 90 100

74.7

77.4

75

75.8

Phase 2 Ultrasound Lab Student Evaluations, May 2018

% of Students Agree/Strongly Agree to Increased Understanding of Ultrasound Scanning Equip-

ment & Scanning Techniques

Phase 3 Years 3 & 4 Ultrasound Sessions

Date Session ContentJuly 2017 Phase 3 Pre-Clinical Scan Lab Focused Assessment with

Sonography for Trauma (FAST), Aorta / IVC, Intro to OB

December / January 2018 Phase 3 Scanning Labs Gallbladder, Ultrasound guided vascular access

July – April 2018 MEDI 5013 Point-of-care ultrasound electiveJuly – April 2018 EMED 5008 Emer Med / ultrasound elective


GME Ultrasound Curriculum 2017-2018

Resident Ultrasound Labs

Lab ContentJuly 2017 Introduction / Focused Assessment with Sonography for Trauma LabAugust 2017 Soft Tissue Ultrasound LabSeptember 2017 Ultrasound-Guided Vascular Access Central Line Testing LabOctober 2017 Aorta / Kidney Ultrasound LabNovember 2017 Cardiac Ultrasound LabDecember 2017 Gallbladder / Biliary System Ultrasound LabJanuary 2018 Liver Ultrasound LabFebruary 2018 Thoracic Ultrasound LabMarch 2018 Thyroid Ultrasound LabApril 2018 Lower Extremity Venous Ultrasound LabMay 2018 Shock Ultrasound LabJune 2018 Ultrasound Practicum


The ultrasound curriculum for the Graduate Medical Education (UME) physicians at MCG consisted of a variety of hands-on instructor supervised scanning labs. The GME phase and content for the labs are listed below.


Making Central Lines SAFER2018 Progress Report and Recommendations

Matt Lyon, MDDirector, Center for Ultrasound Education

Medical College of Georgia at Augusta UniversityPhysician Champion, CLABSI Task Force

Augusta University Medical Center

Summary: The “Making Central Lines SAFER” initiative is a comprehensive quality improvement program to decrease complications, both mechanical and infectious, from resident-performed central venous access (CVA) procedure. This program was initiated in September 2016 to address the need for a uniform CVA technique, Graduate Medical Education (GME) inter-specialty standardized training, and interdisciplinary competency testing for CVA. After only two years of implementation, the Making Central Line SAFER program has had dramatic results, eliminating major procedural complications and drastically reducing central line-associated blood stream infections CLABSI (Zero since Q1 2017). This program has successfully standardized the techniques, equipment, training, and competency testing for CVA, decreasing patient complications, and saving the health system financial resources.

The 2018 Course added additional components to the didactic training regimen to improve the educational experience and added teaching-faculty participation during the competency testing in the cadaver lab. During this year, we refined the specific areas of resident skill deficiencies. These include specific components of the asepsis steps such as donning the gown in a sterile fashion and the surgical hand scrub. Additional deficiencies include the suturing of the device and real-time ultrasound guidance of the needle to the vein. Recommendations for improving the course and the resident-placed CVL process in the health system are made in this document.

Purpose and Background: Central venous access (CVA) is a frequently performed/important procedure in hospital medicine, often required for the sickest patients, to deliver medications and therapies too caustic for delivery through peripheral venous catheters. Central venous catheters and the procedure of insertion are associated with complications, both mechanical (arterial or lung injury) and infectious, known as central line-associated blood stream infections (CLABSI). These complications can least be tolerated in the patients needing this procedure the most, including those with immunosuppression due to cancer therapy, with critical illnesses such as sepsis, and those who are immediately post-surgery and trauma.

The importance of safety in performing CVA has been recognized by the Centers for Disease Control (CDC) and the Agency for Healthcare Research and Quality (ARHQ). The Centers for Medicare and Medicaid Services has made it a priority to decrease hospital-acquired conditions (HAC) such as CLABSI. HACs and specifically CLABSI are publicly reported quality measures for the health system as well as being unreimbursed conditions (meaning that the health system must bear the cost of these complications as


Health System Cost of Care Savings to Date:

Greater than $2,400,000

Zero Resident-Associated CLABSI since Q1 2017

Zero Resident-Associated Major Arterial

Cannulations Since October 2016

they are not reimbursed by Medicare, private health insurance, or the patient). AHRQ estimated that the average CLABSI cost in 2012 was $70,696 (range $40,412 to $100,980) for each infection and an estimated mortality of 12-25%. It is more difficult to estimate the cost of mechanical complications such as arterial dissection and pneumothorax, as it is dependent on the severity of the complication which can include death and severe disability. Mechanical complications can result in malpractice lawsuits, as they are claimed to be due to provider negligence. In our health system in the year prior to the implementation of the program, the cost of CLABSI (infections occurring less than 7 days from central venous line insertion) due to resident-performed CVA was estimated at over 1 million dollars.

In health systems with a GME program, many of the CVA procedures are performed by residents and fellows in training programs. Health systems are required to assure these trainees have appropriate training in the procedures performed during the training period, including assuring competency has been reached prior to performing these procedures without direct supervision. Often, due to the fragmented nature of training, there is variation among the GME programs as to the extent of training for CVA. For example, surgical specialties often place more emphasis on CVA training and have more thorough competency testing than non-surgical specialties. Thus, the opportunity for residents in surgical specialties to practice and perform invasive procedures is much greater than the non-surgical specialties. In addition to variations in training and supervised practice, components of CVA training are taught primarily via nurse educators and not by physicians. There are nurse-driven health care improvement initiatives such as epidemiological programs aimed at reducing CLABSI, which is often called the “bundle.” As these initiatives are often managed and taught by nurses, this component of the education is often taught separately from the procedural aspects of CVA. Despite the CDC guideline mandating that the bundle be performed as part of a CVA, separation of asepsis training from the procedural training often leads to residents viewing the bundle as a separate procedure from CVA and optional instead of an integrated component.

Implementation Details: In 2016, a multidisciplinary team at a tertiary care hospital with a large GME training program (500+ resident and fellow positions) began an educational quality improvement project aimed at decreasing the complications of resident-performed CVA. The team consisted of Matt Lyon, MD, Steven Holsten, MD, Philip Coule, MD, Julie Hammond, RN, and Bao-Ling Adam, PhD. Areas of opportunities to improve resident-performed CVA identified were:

No institution-wide standard CVA insertion technique No standardized training for CVA Asepsis training carried out separately from the mechanical aspects of CVA training No standardized competency evaluation for CVA No resident-level quality feedback on CVA performance and department remediation process

To address these opportunities, implementation occurred over 3 academic years, using an evaluation process to improve the program. This was an iterative process that relied on outcomes and learner feedback to improve the outcomes, clinically and educationally. The timeline of program implementation is depicted Figure 1.


Curriculum: Initial training consisted of a hospital wide grand rounds to emphasize the importance of CVA procedural safety followed by a cadaver-based competency testing. After each training and testing event, the program was revised to improve areas of weakness identified by participant surveys and observations of the course faculty. The two course components are detailed below.

Comprehensive Training: A single, standardized technique for CVA was developed based on literature and expert consensus and was agreed upon by all hospital department directors. The didactic and hands-on training program that includes a cadaver-based procedural competency evaluation implemented in this initiative was based on this standardized technique. The didactic training initially consisted of three parts: appropriate aseptic


Figure 1. Timeline of Implementation of Making Central Lines SAFER

technique and CVA bundle, ultrasound guidance for needle insertion, and best insertion practices for the CVA technique. The hands-on workshop covers each of these areas, reinforcing the mechanical aspects of these tasks.

The current training (2018 Revision) content includes a separate module on how to place the dressing and BioPatch as this was a common error made by the participants in testing. A “start-to-finish” CVA procedure was added to the hands-on practice stations as it was clear that the procedure needed to be performed from start to finish in order to reinforce the procedural components learned in the small group stations. This was made possible after GME funding of the project July 2018. Residents are randomly assigned into groups for training, assuring each group has residents from a variety of specialties. Modules and corresponding stations of the current version of the course are in Table 1.

Table 1. Making Central Lines SAFER Training Components (2018)

Didactic Modules Hands-on Practice Stations1 Central Line Bundle: Asepsis and You 1 Hand Washing and Gowning

2 Ultrasound Guided Needle Placement: The US Bundle and Avoiding the US Guidance Paradox

2a Kit Components and Functions

2b Ultrasound Needle Guidance (Blue Phantom 2 vessel block phantom)

3 Proper Central Venous Access Technique: How to Avoid Common Technique Errors 3 Start-to-Finish CVA placement (Anatomically

correct ultrasound phantom type skill trainer)

4 Placing the Dressing and BioPatch4a Sorbaview Dressing Station4b Device Suture Station

Competency Testing: Beginning in October 2016, the competency pathway (Figure 2) for CVA was standardized across GME and included successful completion of a cadaver-based CVA competency evaluation. Faculty select the site of insertion based on the adequacy of the cadaver vessels. Central veins locations include femoral, subclavian and internal jugular veins. Residents perform the CVA procedure from start to finish including: chlorohexidine scrub of the site, a 5-minute surgical hand scrub, gowning and sterile glove donning, placement of a full body drape and sterile ultrasound transducer cover, ultrasound guided needle placement, and wire insertion. The learner moves to a phantom model for the completion of the procedure which begins at wire placement and proceeds through dilation and catheter placement. The catheter is sutured in place, and the BioPatch and dressing are placed. The resident then has to verbally list the post procedure tasks of obtaining a chest x-ray for placement and placing and order and documentation in the electronic medical record. During the procedure, a nurse observer (ED/ICU/OR nurse) is being evaluated by an Epidemiology nurse to credential the nurse observer to be able to certify central lines in the hospital. The nurse observer evaluates the resident procedure for breaks in sterile technique. The resident performance is evaluated by a faculty physician using a standardized grading rubric completed by the faculty evaluator during the procedure. See Diagram 1 for room layout. The competency testing is offered twice a year in the fall and spring.


Diagram 1Room Layout for Cadaver-Based

Competency Testing

The 2018 Updates to Competency Testing included a “Standardized Faculty Procedure Observation”. Many faculty are unaware of the standardized CVL procedural components taught to the residents as a part of the MCL SAFER course. As such, a trial was conducted at the 2018 Competency Testing where AUMC faculty and Chief Residents were utilized as procedure evaluators (Observation Faculty); these evaluators were to observe between 1 and 3 resident-performed central line insertions concurrently with MCL Safer faculty. This allowed the Observation Faculty to practice evaluating resident performance using the standardized grading rubric in a non-patient care setting. Faculty were given instruction and feedback on performance in their assessment abilities as well as their feedback abilities after each CVL insertion.

Standardized Nurse CVL Certification Observation: AUMC Nurses similarly observed the Asepsis portion of the procedure. Nurses were provided feedback on their observation and feedback skills to the resident during breaks in sterile technique.

Pathway to Independent Central Line Placement: Comprehensive training and competency testing are components of the pathway to independent performance of the CVA procedure by a resident without direct faculty supervision (See Figure 2).

Outcomes: The outcomes of the testing are outlined below. Overall competency testing outcomes are similar to prior years with approximately a 30-35% failure rate. The most common cause of failure is the inability of the resident to follow the needle using ultrasound guidance to the target vein.

Cadaver-Based Competency Testing Outcomes


Figure 2

Number tested on CVL Procedure: 52Passed: 34 65% PassFailed: 18 35% Fail

Anes/CC: 14 36% Pass P/F: 5/9EM: 14 93% Pass P/F: 13/1FM: 2 100% Pass P/F: 2/0IM: 11 27% Pass P/F: 3/8Neuro: 2 100% Pass P/F: 2/0PCC: 2 100% Pass P/F: 2/0Surgery: 7 100% Pass P/F: 7/0

2018 Resident Participantsand Pass Rate by Specialty

Overall Initiative Outcomes: CLABSI rates in those who passed the competency testing went to zero by Q1 2017 and have remained zero. There have been no major arterial injuries due to CVA since Q4 2016.

2018 Recommendations


Most Common Asepsis Errors and Rate of Occurrence

Remediation Rates Observed by Nurse Certifier:

Applying sterile drape and probe cover: 37/60 = 62%

Gowning and gloving: 36/60 = 60%

Surgical Scrub: 35/60 = 59%

Performs CHG prep: 22/60 = 37%

Cleaning prior to dressing: 21/60 = 35%

Cover hair and nose/mouth: 18/60 = 30%

Dispenses sterile supplies onto kit: 17/60 = 28%

Drying hands/arms: 16/60 = 27%

Competency Testing Observer Participants

Observation Faculty Participants: 20 (13-Residents, 7-Faculty):

Observed 2-4 procedures by each participant (with a median of 3) Rating of the Observer Experience

o 12/13 rated observing procedure as “very” or “extremely” higho 11/13 rated observing increased their knowledge “very” or “extremely” higho All (5 agree, 8 strongly agree) observing cadaver competency testing should be

required of all faculty.

CLABSI and major mechanical complications for CVA can be prevented through a standardized training and testing program. The MCL SAFER initiative has dramatically decreased the rates of CLABSI and mechanical complications with substantial savings to the health system each year. This is highly cost-effective program for the health system achieving significant improvement in quality. Basic asepsis techniques such as sterilely donning a gown and hand washing was identified this year as an area needing training improvement. Resident first-pass of the competency testing remains sub-optimal at approximately 70% pass rate, despite an increase in the intensity in didactic and hands on training. Residents do not fully understand the “credentialing” policy for independent central line placement, yielding another area of potential improvement. Faculty Observers had a very high evaluation of the observer program, rating that all faculty who place central lines in the health system should participate in the program to fully understand the AUMC standard insertion techniques for central venous lines.

Specific Recommendations

Identified Deficiency Recommendation

Residents do not understand the ePriv system and bedside credentials confirmation by nurses.

CMO to send email communication to all house staff concerning the Central Venous Access Policy and how ePriv is utilized to assure at bedside the resident is permitted to place central lines independently of faculty supervision.

Asepsis education remains a problem area for resident performance.

Increase and refine the Asepsis training by:1. Decrease the student faculty ratio during June

training2. Add additional testing of asepsis in September

and October, with satisfactory demonstration of competency before cadaver lab participation

3. Increase the availability of Julie Hammond, RN, to perform remediation with residents for Asepsis techniques

Faculty do not know or are not proficient with the CVL procedure.

Create a CVL Credentialing Policy that will require all credentialed faculty to observe a central line in cadaver lab (Standardized Faculty Procedure Observation) every 2 years.

Nurses do not understand Certification documentation.

We will add definitions to Cerner documentation (see below)


Clinical Recommendations

Identified Deficiency Recommendation

Blood cultures are being ordered at inappropriate times during clinical care, increasing our CLABSI rate unnecessarily. This is due to both over culturing as well as a lack of knowledge of CLABSI documentation processes.

1) We will develop a blood culture algorithm to guide house staff as to when to perform blood cultures related to central venous lines. 2) We will begin an educational program for house staff and faculty on CLABSI reporting guidelines.

Order indications are missing from Ports orderOrder indications have been added to all other central lines except for PORTS, remediated ASAP.

The health system is not capturing central line days with accuracy. This decreases the number of captured central line days, increasing our CLABSI rate.

We will begin a process to assure that the health system is capturing central line days appropriately and convert to an electronic system. We will also investigate if an icon can be created that can populate on capacity management screen to indicate who has a central line.

The health system is not tracking resident placed central lines.

We will create a monthly report for central lines through the Access Central Line Order in conjunction with Cerner.

Many units in the hospital do not have adequate equipment for Asepsis.

We will request a capital expenditure for surgical scrub sinks in the SICU and STICU and CCU.

There is no reporting of “corrected” central line errors.

We will encourage nurses to enter a SI (Case Review) for all non-certified lines and errors in dressing/asepsis prevention tasks.

Acknowledgement

The Making Health Care SAFER program would not be possible without support from the Medical College of Georgia and Dean Hess and Academic


Update to Nurse Certification Documentation

Affairs and Dean Miller. AUMC Clinical Outcome Managers are critical to the implementation of this program: Bethany McLeroy, RN, (SICU/STU), Sue Allen, RN (ED), Michelle Sweat, RN (MICU), Katica Foreman, RN (CCU) and Assistant Nurse Manager Mallory Shirey, RN (SICU/STU). The Vascular Access Team and particularly Mary Beth Elliott, RN, is key for continuing to implement this program and ensure appropriate use of central venous catheters in the health system. Funding for this program is through AUMC Graduate Medical Education and the Medical College of Georgia Academic Affairs Department.


Table of Contents - Augusta University · Web viewCUE Leadership, Faculty, and Staff9 CUE Affiliate Faculty9 CUE Advisory Committee10 CUE Overall Instructional Activities for 2017-201811

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