Evaluating Visual Cues to Improve Central Line Checklist Adherence: Challenges and Lessons Learned
type: CreativeWork
description: BACKGROUND: Standardizing central line procedures with checklists has been shown to reduce central line-associated bloodstream infections (CLABSIs), which contribute to increased morbidity, mortality, healthcare costs, and prolonged hospital stays. A prior Plan-Do-Study-Act (PDSA) study at our institution resulted in the creation of a central line checklist to standardize bedside central line insertions. While initial adherence rates reached 92% with a paper-based checklist in one ICU, adherence declined following its integration into EPIC and expansion to four additional ICUs. Post-integration survey results indicated adherence had fallen to 57%. LOCAL PROBLEM: Checklist adherence rates of 57% highlighted a gap in consistent use, raising concerns about the checklist's ability to positively impact on infection prevention efforts. Behavioral and operational barriers, including procedural staff turnover, lack of automation in EPIC, and cognitive overload among nursing staff, were identified as significant contributors to reduced adherence. METHODS: This study was conducted across five adult ICUs in a teaching hospital using a PDSA framework. Participants included proceduralists (resident physicians, APPs, and faculty), registered nurses, and Unit-Based Educators (UBEs). Baseline adherence data was collected through surveys, which identified barriers such as difficulty accessing the checklist and lack of awareness. Literature reviews and UBE interviews informed the intervention design. INTERVENTION: To promote checklist use, visual cues in the form of three unique posters were created and reviewed by stakeholders for relevance. Posters were strategically placed in high-visibility areas across the ICUs to maximize exposure and encourage checklist utilization. RESULTS: Checklist adherence across five ICUs from October 2022 to mid-March 2023 was 47% (138/293), with variability between units. The multispecialty ICU had the highest adherence (56%), while the cardiovascular …
abstract: BACKGROUND: Standardizing central line procedures with checklists has been shown to reduce central line-associated bloodstream infections (CLABSIs), which contribute to increased morbidity, mortality, healthcare costs, and prolonged hospital stays. A prior Plan-Do-Study-Act (PDSA) study at our institution resulted in the creation of a central line checklist to standardize bedside central line insertions. While initial adherence rates reached 92% with a paper-based checklist in one ICU, adherence declined following its integration into EPIC and expansion to four additional ICUs. Post-integration survey results indicated adherence had fallen to 57%. LOCAL PROBLEM: Checklist adherence rates of 57% highlighted a gap in consistent use, raising concerns about the checklist's ability to positively impact on infection prevention efforts. Behavioral and operational barriers, including procedural staff turnover, lack of automation in EPIC, and cognitive overload among nursing staff, were identified as significant contributors to reduced adherence. METHODS: This study was conducted across five adult ICUs in a teaching hospital using a PDSA framework. Participants included proceduralists (resident physicians, APPs, and faculty), registered nurses, and Unit-Based Educators (UBEs). Baseline adherence data was collected through surveys, which identified barriers such as difficulty accessing the checklist and lack of awareness. Literature reviews and UBE interviews informed the intervention design. INTERVENTION: To promote checklist use, visual cues in the form of three unique posters were created and reviewed by stakeholders for relevance. Posters were strategically placed in high-visibility areas across the ICUs to maximize exposure and encourage checklist utilization. RESULTS: Checklist adherence across five ICUs from October 2022 to mid-March 2023 was 47% (138/293), with variability between units. The multispecialty ICU had the highest adherence (56%), while the cardiovascular …
author: Sherman, Perpetuah
language: en
keywords: Catheter-Related Infections, Checklist, Guideline Adherence, Infection Control, Practice Guidelines as Topic, Quality Assurance, Health Care, Catheterization, Central Venous
date published: 2025-06-03T19:53:10Z
date modified: 2026-07-24T05:52:11Z
provider: University of Texas Southwestern Medical Center
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Texas Southwestern Medical Center

PropertyValue
property ID: Handle
value: https://hdl.handle.net/2152.5/10620