title: Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLABSIs.
abstract: OBJECTIVE
  We hypothesized that a checklist enhanced by the electronic medical record and a unit-wide dashboard would improve compliance with an evidence-based, pediatric-specific catheter care bundle and decrease central line-associated bloodstream infections (CLABSI).
  
  
  METHODS
  We performed a cohort study with historical controls that included all patients with a central venous catheter in a 24-bed PICU in an academic children's hospital. Postintervention CLABSI rates, compliance with bundle elements, and staff perceptions of communication were evaluated and compared with preintervention data.
  
  
  RESULTS
  CLABSI rates decreased from 2.6 CLABSIs per 1000 line-days before intervention to 0.7 CLABSIs per 1000 line-days after intervention. Analysis of specific bundle elements demonstrated increased daily documentation of line necessity from 30% to 73% (P < .001), increased compliance with dressing changes from 87% to 90% (P = .003), increased compliance with cap changes from 87% to 93% (P < .001), increased compliance with port needle changes from 69% to 95% (P < .001), but decreased compliance with insertion bundle documentation from 67% to 62% (P = .001). Changes in the care plan were made during review of the electronic medical record checklist on 39% of patient rounds episodes.
  
  
  CONCLUSIONS
  Use of an electronic medical record-enhanced CLABSI prevention checklist coupled with a unit-wide real-time display of adherence was associated with increased compliance with evidence-based catheter care and sustained decrease in CLABSI rates. These data underscore the potential for computerized interventions to promote compliance with proven best practices and prevent patient harm.
authors.affiliation: Center for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma and Critical Care Medicine.
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Pageler
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Longhurst
authors.forename: Matthew
authors.initials: M
authors.lastname: Wood
authors.forename: David N
authors.initials: DN
authors.lastname: Cornfield
authors.forename: Jaap
authors.initials: J
authors.lastname: Suermondt
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.forename: Deborah
authors.initials: D
authors.lastname: Franzon
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D057189:Checklist / Q000592:standards / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans
keywords: CLABSI; EMR; dashboard; evidence-based guidelines; maintenance bundle