Opportunities to use tracer information are only limited by the staff member who collects it . Often infection preventionists want to continue to collect more extensive data to prove that an issue is real , however they fail to act , because they want their “ data ” to be perfect . Occasionally , that approach may be appropriate , but at other times , action immediately needs to be taken . “ her first chemotherapy visit the following week with direction to look out for redness , swelling , pus , and fever . She was also given direction to call the clinic or an after-hours number to report any problems .
Since the inception of the patient ’ s treatment , nurses in outpatient chemotherapy used a kit to access the central line but since she was admitted , no kit was available . Similar supplies were used when accessing the central line to administer medications , however the technique varied a bit . The emergency room ( ER ) nurse used alcohol before carefully accessing the patient ’ s central line . She drew blood for tests yet seemed very nervous . The patient noted that nurses who accessed her central line usually wear a mask , but few requested the patient also wear a mask .
The patient understands that infection of her central line is a significant risk , and she needs to protect it , however she is unsure of what the nurse who gave her the written instructions meant by directing her to protect her line . When asked to role play what she would do if someone accessed her central line incorrectly , the patient says she assumes that staff know what they are doing , Further , she says she would never question the care provided by a health professional and doesn ’ t want to be seen as a difficult patient .
When retracing all locations , the patient has visited , we discover that there are two types of central line access kits in use – one kit includes chlorhexidine containing skin preparation and the other includes plain alcohol . Nurses are allowed to choose according to preference , but most use the chlorhexidine product because it is known to better disinfect . We also find that the healthcare facility ’ s general medicine unit and emergency room do not stock central line access kits . These areas , instead , gather patient supplies as necessary .
Interviews with staff outside of the infusion areas and oncology unit identify varying levels of experience working with central lines and some nurses say they have yet to complete a competency assessment but
have been taught by a colleague , key steps of central line access . One of the nurses in the ER says she asks for oncology staff to access a patient ’ central line if it looks like that patient will be admitted . Otherwise , the nurse insists that physicians order peripheral blood draws and if necessary , a peripheral IV . Undoubtably , the tracer information collected shows that considerable variation exists regarding central line dressing protocol , depending on the location .
Observations from this tracer example scenario highlight variations in practice , supplies , education , and competency of staff caring for patients with central lines . In this example case , provided patient education failed to achieve its desired objective , since the patient is uncertain of the healthcare organization ’ s approved process for accessing her central line and does not feel empowered to speak up if staff deviates from the process .
Information from this tracer could be used in multiple ways , including :
● Prioritizing tracer information based on risk and using it to develop an infection prevention and control plan for patients with central lines
● Utilizing tracer information as a starting point for more in-depth study and resolution of an issue Exploring how to improve patient education and empower patients to speak up
● Providing data results to a performance improvement team to plan and implement a rapid- cycle plan to improve supply chain issues
● Analyzing root causes to determine why implemented processes have not been sustained
Opportunities to use tracer information are only limited by the staff member who collects it . Often infection preventionists want to continue to collect more extensive data to prove that an issue is real , however they fail to act , because they want their “ data ” to be perfect . Occasionally , that approach may be appropriate , but at other times , action immediately needs to be taken .
Using the tracer methodology may move some infection preventionists out of their routine “ surveillance ” comfort zone . Others recognize it provides opportunity for positive interaction with patients and staff and helps identify risks that might not have been detected though routine surveillance , compliance rounding , or use of checklists . Tracer methodology is one more tool infection preventionists can use to identify risk for infection . It is worth giving tracer methodology a try .
Access more in information about The Joint Commission ’ s tracer methodology
here .
Sylvia Garcia-Houchins , MBA , RN , CIC , is director of infection control and prevention for the Office of Quality and Patient Safety at The Joint Commission .