Packaging Compliance, Quality, and Safety

By Michael O’Connor, MD

Several years ago, the University of Chicago Medicine (UCM) made reducing the rate of Central Line Associated Blood Stream Infections (CLABSI) one of its annual operating goals. Hospital leadership commissioned Dr. Emily Landon, Medical Director of Infection Control, to launch and support a multi-disciplinary, multi-pronged effort to make major improvements in CLABSI.

The initiative included several elements including training programs for bedside nurses in the care and maintenance of central lines, a program of structured training via simulation for residents whose clinical duties included the insertion of central lines, and the creation of a series of navigators in our EMR to facilitate compliance with our local adaptation of “best-practice” from multiple sources, and most importantly from the Keystone ICU Project. One major difference was that we were charged with facilitating ultrasound guided central line insertion into our program, as the vast majority of our participants believed that this would reduce infections as well as other central line insertion complications.  Perhaps most importantly, the expectation was that everyone who inserted central lines would participate in both the project, and they would incorporate all of its elements into their practice going forward.

A central component of the Keystone ICU Project was a checklist, used by the bedside RN, to ensure that the practitioner inserting the central line complied with all of the elements of the protocol. While the checklist empowered the bedside nurses, it had the potential to create tension amongst the providers. We wondered: is there a better way to do this? Members of my group, especially Dr. Aalok Kacha, Assistant Professor of Anesthesia, believed that we could make the checklist unnecessary if we simply assembled supply packs we wanted providers to use and presented the supplies/equipment to the providers in the order in which they should be used. For providers, these packs would have the huge advantage of having everything they needed to insert a central line, saving them the time and aggravation of assembling the supplies themselves. Aalok and the team spent dozens of hours figuring out what supplies were best, and how (in what order) they should be packaged. They kept working until it was perfect.  Thus was born the “Insertion Pack”. To insert a central line, you grab an ultrasound machine, the kit of the line you want to insert, a package of personal protective equipment, an Insertion Pack, and GO. Because it made everything easier, the insertion pack was immediately adopted by all of our operators.  Hence, Compliance, Quality, and Safety come in the package.