Association of CLABSI With Hospital Length of Stay, Readmission Rates, and Mortality: A Retrospective Review.

BACKGROUND: An evidence-based practice (EBP) approach to implementing change is relevant and pertinent to the strategy to improve outcomes for hospitalized patients with central venous catheters (CVC). As health systems endeavor to achieve the ambitious goals of improving the patient experience of care, improving the health of populations, and reducing the cost of health care, it is imperative to understand the impact of a central line-associated bloodstream infection (CLABSI) on outcomes. AIMS: The purpose of the study was to contribute to the evidence of the association of CLABSI with the outcomes of hospital length of stay (LOS), readmission rates, and mortality rates for hospitalized patients. METHODS: A retrospective study was conducted, including all hospitalized patients with a CVC within four hospitals in an integrated health system in northwest Ohio and southeast Michigan. The sample population was stratified into two groups, CLABSI and no CLABSI, and the outcomes of interest for each group were compared. RESULTS: The findings substantiate the association between CLABSI and the hospital mortality rate, LOS, and readmission. Patients with a CVC who develop a CLABSI were 36.6% more likely to die in the hospital and 37.0% more likely to be readmitted compared with patients with a CVC who did not develop a CLABSI. In addition, hospital LOS increased an average of 2 days compared with patients without CLABSI. This study evokes implications for EBP change to reduce the rate of CLABSI and for quality improvement during in-hospital care. LINKING EVIDENCE TO ACTION: There is an association between CLABSI and hospital mortality rate, LOS, and 30-day readmission outcomes, presenting a profound sense of urgency for EBP change. There were potential variances in processes or practice relative to insertion, maintenance, and removal in the hospitals studied, representing an opportunity to examine the best practices in the hospitals that are performing well. Implementation of EBP requires selecting effective and innovative strategies, with a focus on stakeholder involvement and needs.

A self-assessment tool for oncology nurses: preliminary implementation and evaluation.

Nurses who fail to identify knowledge gaps in their practice and who do not maintain competence place patients with cancer at risk for adverse events and poor outcomes. Self-assessment tools can assist oncology nurses in identifying knowledge deficits in fundamental oncology concepts. This article describes the development and implementation of a self-assessment tool to assist nurses in maintaining competence to provide safe, effective oncology care. The tool was developed after an examination of relevant literature, collaboration with an oncology team, and consideration of the Oncology Nursing Society's and American Nursing Association's standards of care. Preliminary evaluation suggests it may offer an effective means for oncology nurses to identify knowledge deficits and tailor educational interventions to address identified needs.