Implementation of an ICU Exit Checklist

1. Implementation of an ICU Exit Checklist Ashley Dobuzinsky, BSN, RN, CCRN Lynn Orser, MSN, RN, CCRN, PCCN St. Vincent’s Medical Center

2. Objectives Discuss: • Development of the ICU Exit Checklist • Implementation process • Outcomes

3. Our Goals • To address increasing incidence of HAI among hospitalized patients through the utilization of an ICU Exit checklist • To decrease utilization of central venous catheters (CVC) and indwelling catheters • Improve communication among the healthcare team

4. Methods • Setting • 30-bed mixed surgical/medical ICU, inclusive of 6 bed PCU • Closed unit-Intensivist led model • Pre-implementation data • Collected over a 30-day period from August 2012-September 2012 on patients transfers from the ICU/PCU. Monitoring for the presence of CVC or indwelling catheters at time of transfer.

5. Pre-Implementation Data • Of the 84 patients tracked, 23 patients (27%) were transferred with a CVC in place • 42 patients (50%) were transferred with an indwelling catheter in place

6. Implementing the Checklist • Engaging the multidisciplinary team • Expanding goals of checklist to include: • Narrowing antibiotic coverage • Evaluation of proton pump inhibitor therapy for discontinuation • Notification of accepting physician at time of transfer • Staff education

9. Outcomes

10. Outcomes • ICU Indwelling Catheter Utilization • 37% reduction in utilization from Sept 2012-Nov 2013 • No ICU CAUTIs Aug 2013-Oct 2013 • ICU CVC • 14.5% reduction in patient transfers with CVC in place • One reported CLABSI over 12 month period

11. Summary • ICU process improvement project • Primary goal to decrease HAI by reducing the utilization of CVC and indwelling catheters • Involved a multidisciplinary team approach • Observations included overall decline in utilization of CVC and indwelling catheters