Introduction of a Best Practice for Ventriculostomy Management in the Neuroscience Critical Care Unit

Abstract

BACKGROUND/OBJECTIVES: Ventriculostomy associated infections are a present burden on our healthcare system as well as 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 standard for ventriculostomy management and then to create that protocol and necessary nursing education. DESIGN: Descriptive non-experimental study, which includes a retrospective chart review of 20 patients with ventriculostomies, placed in the neuroscience intensive care unit (ICU) and a focus group discussion of key stakeholders within the neuroscience ICU. METHODS: List of 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 present in charts during retrospective review. Focus group participants obtained through non-probability quota sampling. SETTING: 12-bed neuroscience ICU in a 337 bed ACS Level 1 certified trauma center and DNV Level I certified stroke center in Scottsdale Arizona. SUBJECTS: Retrospective chart review (n=20) most recent patients who had a ventriculostomy drain placed in the neuroscience ICU. Average age 54.6 y/o ±17.8 and average LOS 15.45 days ±9.1. Focus group discussion included 1 ICU manager, 2 ICU supervisors, 1 ICU educator and 3 bedside RNs. Informed consent obtained from all focus group participants. RESULTS: Retrospective chart review of patients (n=20) showed 100% documentation on antibiotic administration within 30 minutes of insertion and daily site assessment. There was 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 current thoughts related to the available ventriculostomy charting. Many comments included a need for more in depth charting to capture the care that the bedside RN provides on a daily basis in regard to ventriculostomy management. Major barriers to introduction of a ventriculostomy protocol included stakeholder buy in and nursing staff education in use of the protocol. CONCLUSION: By determining a need for a ventriculostomy protocol, through a retrospective chart review of current documentation in the neuroscience ICU, and taking into account key stakeholder opinions, the JNM ventriculostomy management protocol was developed to improve standard of care within the neuroscience ICU and decrease infection rates. Educational information was created for nursing staff to learn the current best practice standards for ventriculostomy management as well as use of the JNM ventriculostomy protocol within their charting.