Introduction of a best practice for ventriculostomy management in the neuroscience critical care unit.

摘要

BACKGROUND/OBJECTIVES: Ventriculostomy associated infections are a present burden on our healthcare system, patients, and their families. Use of nursing led protocols to decrease the incidence of healthcare-associated protocols has been supported in previous platforms. The purpose of this study is to determine a need for a ventriculostomy protocol that aligns with the needs of the unit and the current best practice for ventriculostomy management, create a protocol for management, and necessary nursing education.;DESIGN: Descriptive non-experimental study, including a retrospective chart review of 20 patients with ventriculostomies, placed in the neuroscience intensive care unit (ICU) and focus group discussion of key stakeholders within the unit.;METHODS: Subjects for retrospective chart review obtained through CPT codes for ventriculostomy placement and convenience sampled in reverse chronological order. Descriptive statistics completed on participant characteristics and frequency of documentation of key aspects. Focus group participants obtained through non-probability quota sampling.;SETTING: 12-bed neuroscience ICU in a 337 bed ACS Level 1 Trauma and DNV Level I Stroke center.;SUBJECTS: Retrospective chart review (n=20) most recent patients who had a ventriculostomy placed in the neuroscience ICU. Average age 54.6 y/o +/-17.8, average LOS 15.45 days +/- 9.1. Focus group discussion included 1 ICU manager, 2 supervisors, 1 educator and 3 bedside RN's. Informed consent obtained from all focus group participants.;RESULTS: Chart review (n=20) showed 100% documentation on antibiotic administration and daily site assessment. 0% documentation on team member attire in the room during insertion, accessing of the system, whether the port was scrubbed prior to accessing and changing of the sterile bag. Focus group discussion showed varying opinions on thoughts related to the available ventriculostomy charting. Comments included a need for more in depth charting to capture bedside RN role. Major barriers included stakeholder buy in and nursing staff education.;CONCLUSION: By determining a need for a ventriculostomy protocol, through chart review and focus group discussion, the JNM ventriculostomy protocol was developed to improve standard of care within the neuroscience ICU. Educational information was created, highlighting the current best practice standards for ventriculostomy management as well as use of the JNM ventriculostomy protocol.