Common themes that have come up during COVID CLABSI case reviews and/or during the ICU central line prevalence day: ❖ Overdue transparent dressings ❖ Overdue cap changes ❖ Overdue and not labeled tubing ❖ Curos caps missing ❖ Daily CHG treatment not documented at least once every 24 hours New Considerations in COVID Care Line Selection: ❖ Consider a more permanent line (PICC) for patients with an expected longer length of stay ❖ Consult R-VAT team: Pager VEIN (8346) or PICC (7422)

OBJECTIVE Rush University Medical Center nursing leadership undertook a process improvement project to revamp nursing handoff during unit transfer with the goal of improving patient throughput. The aim was to decrease assign-to-occupy time, the duration from bed assignment to bed occupancy. BACKGROUND There was a lengthy lag time in admitting/transferring patients, leading to delays in patient throughput and potential threats to patient safety. In fiscal year 2016, assign-to-occupy time averaged 97 minutes. The goal was to decrease that time to 60 minutes or less. METHODS Process improvement leaders held a rapid improvement event to determine viable solutions. A team then standardized handoff workflow; created an electronic tool, virtually eliminating verbal report; and implemented a new handoff process. RESULTS Assign-to-occupy time at 1 year after go-live averaged 55 minutes, and it has been staying less than 60 minutes since the implementation. CONCLUSIONS Key success strategies included engaging stakeholders during the rapid improvement event, imploring frontline nurses to create and promote the revised process to facilitate staff engagement, and leveraging electronic health records.

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PURPOSE:The purpose of this quality improvement (QI) project was to develop a preventive care bundle to reduce the incidence of nares acquired pressure injuries (NAPIs) to 3% in the adult inpatient population. PARTICIPANTS AND SETTING: Participants included adult inpatients in a large, Magnet-designated, 664-bed academic medical center in the Midwestern United States. APPROACH: Through our organization's "RUSH Way" QI model, we developed an evidence-based NAPI Bundle comprising a "T"-shaped hydrocolloid thin barrier, a tube holder securement device, patient assessments, and site checks. The project was initiated by a team of clinicians and administrators. An incidence report was conducted of hospital-wide existing NAPIs in 2015. A pilot QI project of the NAPI Bundle was implemented in the surgical intensive care unit (SICU) from January 2016 to May 2016 and then hospital-wide implementation began in June 2016. Data were collected on the incidence of NAPIs, and documentation of hydrocolloid dressing on the nose and intact, incidence of adverse events with hydrocolloid dressing, and hydrocolloid dressing changed every 3 days were evaluated. RESULTS: In 2015, the house-wide baseline NAPI incidence rate was 4.9%. Data from the SICU pilot confirmed Bundle effectiveness, as zero NAPIs occurred during the pilot period. The hospital-wide expanded pilot in 2016 showed the NAPI rate to be 3.2%, and in 2017, the incidence rate was reduced to 1.4%, well below the 3% goal. CONCLUSION: The NAPI Bundle implemented in our organization by RNs substantially reduced the incidence of adult inpatient NAPIs.