Abstract
Background – When medication therapy alone fails, patients with advanced heart failure are optimized on mechanical circulatory support as lifelong therapy or while awaiting heart transplant. These patients are implanted with a Ventricular Assist Device (VAD) to support the failing heart. A VAD has a driveline cable that exits the body through the abdomen and connects to an external controller. This driveline exit site can be a source of major complications if not properly managed. A device to improve functional capacity, quality of life, and survival can contribute to morbidity, mortality, and costly healthcare burden.
Goal – The goal of this project was to make VAD driveline infection (DLI) a never-event at Jackson Memorial Hospital (JMH) through implementation of a VAD driveline local wound care program. The objectives were to (a) develop and implement an evidence-based practice guideline, (b) increase patient and provider knowledge of the guideline, (c) increase patient and provider adherence through a simulation-based mastery learning (SBML) video, and (d) reduce re-hospitalizations with complication of VAD DLI.
Methods – Utilizing the Six Sigma framework, this quality improvement project was implemented to standardize the VAD driveline care process and reduce variations in practice.
Results – An evidence-based practice guideline was developed and fully implemented. Through integration of the evidence-based guideline into practice, patient and provider knowledge of VAD driveline local wound care was increased from a mean baseline of 4.4 to 5.33. At baseline observation, 25% maintained sterility throughout dressing change while 87.5% maintained sterility after viewing the SBML video. In the first quarter following project implementation, JMH reported a 52.4% reduction in re-hospitalizations with VAD DLI.
Conclusions – A single evidence-based VAD driveline dressing change process may improve outcomes and could be applied to other disease foci. The SBML video allows patients with VADs, their caregivers, nurses, coordinators, and clinicians to pace their learning and mastery of the VAD driveline dressing care process.
Keywords: driveline infection, practice guideline, quality improvement project, simulation-based mastery learning, Six Sigma, ventricular assist device