Walden UniversityScholarWorksDi$$e#%a%i!$ ad D!c%!#al S%&die$2015Improving the Qualit of Care in an Acute CareFacilit "rough Reeducating Nurses AboutManaging Central LinesJacqueline Ra!aeleWalden UniversityF!ll!( %hi$ ad addi%i!al (!#k$ a%: h,"://$ch!la#(!#k$.(alde&.ed&/di$$e#%a%i!$Pa#% !f %he N$ig C!mm!$+i$ Di$$e#%a%i! i$ b#!&gh% %! )!& f!# f#ee ad !"e acce$$ b) Sch!la#W!#k$. I% ha$ bee acce"%ed f!# icl&$i! i Di$$e#%a%i!$ ad D!c%!#al S%&die$b) a a&%h!#i*ed admii$%#a%!# !f Sch!la#W!#k$. F!# m!#e if!#ma%i!, "lea$e c!%ac% jeie.'e#$%eeg@(alde&.ed&. Walden University College of Health Sciences This is to certify that the doctoral study by Jacqueline Raffaele has been found to be complete and satisfactory in all respects,and that any and all revisions required bythe revie committee have been made! Revie Committee "r! #llison Terry, Committee Chairperson, Health Services $aculty "r! Rhonda Struc% Committee &ember, Health Services $aculty "r! Cassandra Taylor, University Revieer, Health Services $aculty Chief #cademic 'fficer (ric Riedel, )h!"! Walden University *+,- #bstract .mproving the /uality of Care in an #cute Care $acility Through Reeducating 0urses #bout &anaging Central 1ines by Jacqueline 1! Raffaele &S, Walden University, *++2 3S, California University of )ennsylvania, *++4 )ro5ect Submitted in )artial $ulfillment of the Requirements for the "egree of "octor of 0ursing )ractice Walden University $ebruary *+,- #bstract Central line6associated bloodstream infections continue to be some of the most deadly hospital6associated infections in the United States! 7uided by 1ein8s change theory hich focuses on prior learning, re5ection, and replacement, the purpose of this study as to improve the quality of care patients receive in an acute care facility by reducing life threatening central line infections! The research question e9amined hether additional education using :enous #ccess 0urse ;:#0< customi=ed nesletters and manager coaching of nurses in an acute care setting ould improve the quality of care for patients ith central lines! This as a quantitative none9perimental descriptive retrospective study using secondary analysis of a hospital dataset! This dataset included variables relating to nurse tenure and nurse performance after reeducation and coaching on managing central lines! :ariables from 4-+ of ,,>++ nurses ere analy=ed in the current study at a ?-+ bed system in a southestern healthcare system in $lorida! The pre and post audits consisting of contributing factors ere obtained from the :#0 audits and post audits consisting of contributing factors ere obtained from the :an audits and ere calculated ith descriptive statistics! There ere a decrease from ,@!,A of the lines audited having , or more deviations from the guidelines to >!-A! 0urses ith * to - years of tenure had a greater number of deviations from the guidelines8 standard for managing central lines as compared to staff ith a lesser or greater amount of tenure! )ositive social change implications include %noledge useful for staff nurse educators and other researchers ho are searching for direction in improving health care associated infection rates to provide a better quality of life, decrease costs, and increase safety! .mproving the /uality of Care in an #cute Care $acility Through Reeducating 0urses #bout &anaging Central 1ines by Jacqueline 1! Raffaele &S, Walden University, *++2 3S, California University of )ennsylvania, *++4 )ro5ect Submitted in )artial $ulfillment of the Requirements for the "egree of "octor of 0ursing )ractice Walden University $ebruary *+,- "edication . dedicate my doctoral degree to my aunt, :ivian 7eruschat, ho passed aay during my 5ourney through this process in *+,>! #s she as transitioning to her ne life she continued to encourage me to complete this degree as she as sure she ould not itness me accomplish this goal! The continual support during her most difficult times inspired me to complete my degree! #c%noledgments . ould li%e to than% my mentor Theresa &orrison for her guidance, %noledge, and resources throughout this "octoral process! She is an e9pert in evidence6based practice and engages in research and systems improvement! Her assistance in my practicums alloed me to apply learned concepts into practice! The %noledge learned from her is immeasurable and has greatly impacted my thought process and my career!The support and patience of my long time significant other Jerry ho stood by me throughout the long hours of research and riting as endless! There is no doubt in my mind that ithout his continued tolerance and understanding . could not have completed this process! The 5ourney to completing this doctorate degree has been long and overhelming but rearding! Than% you to everyone ho has helped me and accompanied me in this endeavor! i Table of Contents 1ist of Tables !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! iv Section ,B 0ature of the )ro5ect !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!, .ntroduction !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!, )roblem Statement !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!, )urpose !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!> 'b5ectives !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4 Research /uestion !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4 Significance!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!- Reduction of 7aps!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! - Social Change .mplications !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! C "efining Terms !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!C 1imitations !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2 Summary !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2 Section *B Revie of 1iterature and Theoretical and Conceptual $rameor% !!!!!!!!!!!!!!!!!!,+ .ntroduction !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,+ Teaching Hospitals!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,+ 7uidelines !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,, (vidence63ased )ractices !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,* .nfections!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,- Theoretical $rameor% !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,C Summary !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,C ii Section >B &ethodology !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,2 "esign !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,2 /uality .mprovement !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,@ #pproach !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!,@ )opulation !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*, "ata Collection !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*4 "ata #nalysis !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*- (valuation !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*2 Summary !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!*@ Section 4B $indings, "iscussion, and .mplications !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>+ Summary and (valuation of $indings!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>+ "iscussion of $indings in the $rameor% !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>- .mpact on )ractice!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>- .mpact for $uture Research !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>? .mpact on Social Change !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>2 )ro5ect Strengths and 1imitations !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!>@ Strengths !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! >@ 1imitations !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! >@ Recommendations for Remediation of 1imitations !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4+ Self6#nalysis !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4+ Scholarly Reflection!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4, )ractitioner Self6#nalysis !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4* iii )ro5ect "eveloper Self6#nalysis !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4* $uture )rofessional "evelopment !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4> Conclusion !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4- Section -B Scholarly )roduct !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4? &anuscript for )ublication !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4? 3ac%ground, )urpose, and 0ature of the )ro5ect !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -+ Research "esign, setting, and "ata Collection !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -, )resentation of Results !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -* )rimary Study !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -4 Secondary Study !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -4 References !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!C+ #ppendi9 #B Submission of Chec%list !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!C@ #ppendi9 3B Cover 1etter !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!?, #ppendi9 CB Clinical Significance !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!?* Curriculum :itae !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!?> iv 1ist of Tables Table ,! C1#3S. Contributing $actors That the :#0s "etermine is a "eviation $rom the 7uidelines !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! >, Table *! 1ist of Units Used in Study $rom to Southestern Health Care $acilities in $lorida !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 44 Table >! #udit "ata !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4- Table 4! Dears of (9perience !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4- Table ,! C1#3S. Contributing $actors That the :#0s "etermine is a "eviation $rom the 7uidelines !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -? Table *! 1ist of Units Used in Study $rom to Southestern Health Care $acilities in $lorida !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -2 Table >! #udit "ata !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -@ Table 4! Dears of (9perience !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -@ , Section ,B 0ature of the )ro5ect Introduction #ccording to the Centers for "isease Control and )revention ;C"CE *+,, years cost a * ?,-6bed southestern nonprofit health care system consisting of to facilities in $lorida employing >,@++ people, an estimated F*,*?-,+++ ;0aples Community Hospital, *+,>< change theory is most applicable! This model of change shos the process as it happens in human beings! .t is a three6stage model %non as the unfree=ing6change6refree=e model ;1ein, *+,>< hich involves prior learning to be re5ected and replaced! There is a direct application to this study as the staff ill release previously learned behavior, understand the e9pectation of them, and continue ith that ne learned behavior hen managing central lines and completing relevant documentation! 3ehavior is thought to be a balance of forces that or% in opposite directions ;1ein, *+,> is an e9planation of the methodology used in this study! ,2 Section >B &ethodology Design The design is a secondary analysis of an ongoing quantitative study! This means that data that have already been collected by one person or group are repurposed and reanaly=ed by another person or group to anser a ne research question ;)olit G 3ec%, *++4 C1#3S.! The secondary study shoed that yearly educational reinforcement of managing central lines can occur through yearly mandatory s%ills fairs! Population #ccording to the Health Resources G Service #dministration ;HRS#E n!d!+ has increased, >>A of the nursing or%force is older than -+, and the largest age group of nurses is 4, to -+ years of age ;HRS#, n!d!++ members at one southestern healthcare system consisting of to facilities in $lorida! The differences of employment in staff includes full time, part time, seasonal, and nurses required to or% to shifts a month to manage central lines! The :#0 audit suggested a deviation in this process and as identified as a C1#3S. Contributing $actor in the primary study! The nurses ere identified in the primary study through their employee number! . as provided de6identified employee numbers for use in this study!There ere no patients involved in the study! There as no personal information used from any patient other than the fact they had a central line during their hospitali=ation! "ata from the patients8 medical record, including se9, age, or even reason for the central line, are irrelevant in the collection of data for the study! The study pertains to data collected before and after the reeducation C0S6developed nesletters ere administered to staff by hand delivery by the unit8s manager, along ith coaching, for use in the secondary study! The original data collection as performed and completed by one of the :#0s ho rounded ee%ly and assessed every line e9isting ithin to facilities! This auditing process is in place in part due to the recommendation from the Joint Commission to monitor central lines! The :#0 sent a list of central lines found to have a deviation to the Clinical 0urse Specialist, ho then subsequently collected data from the patients8 charts in order to find the specific deviation involved in the managing of central lines! The C0S prepared a nesletter after investigating the specific deviation found in the medical record and sent it to the manager ho hand delivered the nesletter to the identified staff *> member and coached the staff member on the deviation! :#0s utili=ed a chec%list of certain factors to assess and clarify any deviating factors that ere not in line ith the guidelines for managing lines!The primary study performed by Theresa &orrison )h!"! in *+,4 utili=ed the nurse8s employee number to identify their unit and manager! The secondary study8s analysis included management of the dressing, lines, completion of the required documentation and years of service! The staff as given a customi=ed nesletter from their managers in a face6to6face meeting here the employee e9perienced a coaching session and had to reread the part of the guidelines pertaining to their deviation! Secondary research included collecting the data from the original research to see if reeducating staff as effective in preventing central line infections! "ata ere placed into an (9cel spreadsheet from hich analysis occurred! #ccording to the 0ational .nstitute of Health ;*+,>+C at both Walden University and this southestern healthcare system to assist in the oversight of the study and to assure proper precautions to prevent breaches in confidentiality ere used! Data Collection The data collected from the primary study contained the ,- contributing factors gathered from the :#0 audits! #n available :#0 nurse on staff performed the audits once a ee% every Thursday using an audit form that is more of a chec%list that as constructed by the :#0 nurse! The :#0 audit as used to perform the original study of finding and identifying hich particular component of the guidelines had a deviation! .n this quantitative, none9perimental descriptive retrospective study using secondary analysis, . used e9isting recorded data! "ata collection often occurs as chart audits in hospitals because the data source is the patients8 medical record!*- .n the case of the primary study, the data ere collected from :#08s auditsE :#0s carried a clipboard, visited each patient ith a central line, observed and recorded the site, dressing and intravenous ;.:< tubing deviation from the guidelines! #fter the managers coached each nurse staff member identified as deviating from the guidelines for central line management and documentation, an attempt as made to evaluate if re6education improved documentation and management of central lines! The data available, hen revieed, alloed for the identification of a relationship beteen nurses8 tenure and number of C1#3S. contributing factors! Data )nal!sis "ata analysis in this secondary study consisted of reliability, validity, and analytical techniques hich included percentages and frequencies! :alidity of research findings refers to the e9tent to hich the findings are an accurate representation of the phenomena they are intended to represent ;#nderson, *+,+ to January *+,4! "ata collected indicated there ere C*? lines audited on ,2 nursing units for deviations on managing central lines! The ,- compliance issues %non as contributing factors are divided into three typesB ;a< dressing related, ;b< .: tubing administration set related, and ;c< documentation related ;Table ,!-A! "ata consisted of to dressings, five tubing and seven documentation deviations! The secondary study8s results ere obtained and analy=ed several months after the primary studyPs completion! The selected evaluation time frame as - random ee%s after the conclusion of the primary study and as beteen June and #ugust of *+,4! .n this -6ee% period after the reeducation process, there ere ,4 deviations! "ata consisted of to dressings, five tubing and seven documentation deviations! #udited lines ere ,C2 on ,2 nursing units ith ,4 deviations from the guidelines! #bout >!-A of central lines had a deviation found through the :#0 audit!.n the primary study, C*? lines ere audited on ,2 nursing units for deviations on managing central lines! #bout ,@!,A of the lines audited had one or more deviations! "ata from several months later, after nurse8s reeducation, ere collected during - randomly selected ee%s from June *+,46#ugust *@+,4! These results, from ,C2 lines audited on ,2 nursing units ere >!-A of the lines audited had one of more deviations ;Table >>4 documentation deviations calculated as ->!>A of C*, total deviations!>> .n the secondary study the total number of found deviations as ,4 of ,C2 total lines and si9 lines ith ,4 deviations or >!-A! There ere to dressing deviations calculated as ,4!*A of ,4 total deviations! There ere five tubing deviations calculated as >-!?A of ,4 total deviations! There ere seven documentation deviations calculated as -+A of ,4 total deviations!.n the primary study, there ere 4@- nurses involved in deviations of managing central lines! Several months after the primary study as completed and nurses ere reeducated and data collected during - randomly selected ee%s from June *+,46#ugust *+,4, there ere ,, nurses involved in deviations of nurses managing central lines! The primary study indicated there ere ,-+ nurses ith feer than * years of e9perience involved in central line deviations or >+A of 4@- total nurses! There ere *>4 nurses ith *6- years of e9perience involved in central line deviations or 4?!CA of 4@- total nurses! There ere ,,, nurses ith greater than - years of e9perience involved in central line deviations or **!4A!Results of the secondary study indicated there ere to nurses ith less than * years of e9perience involved in central line deviations or ,2!,A of ,, total nurses! There ere si9 nurses ith *6- years of e9perience involved in central line deviations or -4!-A of ,, total nurses! There ere three nurses ith greater than - years of e9perience involved in central line deviations or *?!*A ;Table >4 nurses ere given to this researcher! 0urses ith feer than * years of tenure involved in line deviations as ,-, or >+!>A, nurses ith * to - years of tenure as *>C or 4?!*A, and nurse ith greater than - years tenure as ,,> or **!4A! 0urses ith * to - years of tenure at this Southestern $lorida health system had the greatest number of deviations in managing central lines! The tenure of nurses is for this system onlyE the nurse could have many more years of e9perience in their professionE but, for the purpose of this study, only the years of tenure in this system as calculated!The result of the secondary study . performed found reeducating nurses as effective as noted by a decrease in deviations recorded on the :#0 audits and data displayed in frequency and percentages! . chose to find the tenure of nurses ho have the greatest deviations!Reeducating staff nurses in the management of central lines decreased deviations in the documentation and guidelines adherence! $indings for the second ob5ective determined there is a greater number of tenured nurses ith * to - years of tenure identified, as compared to staff ith a lesser amount of e9perience or greater amount of e9perience that are deviating from the guidelines standard for managing central lines! This is a difference from the study8s ob5ective stating that the e9pected deviations ould be greater in nurses ith longer tenure! . e9pected the longer tenured nurses to have more deviations due to the length of time from originally being educated on the guidelines of managing central lines!"ata concluded after the primary study as concluded that documentation as the most frequent deviation folloed by tubing and then dressing deviations! #lthough >- this remained the same at the conclusion of the secondary study, the frequency of the occurrences had decreased! 0urses ith *6- years of tenure had the highest frequency of being involved in deviations on managing central lines after the study as completed!Discussion of &indings in the &rame'or( 1ein8s ;*+,>< theory of change supports this study! #fter the nurses ere reeducated on managing central lines there as a decrease in deviations! The three6stage model %non as the unfree=ing6change6refree=e model ;1ein, *+,>< involves prior learning to be re5ected and replaced! There is a direct application to this study as the staff has released previously learned behavior, understand the e9pectation of them, and continue ith that ne learned behavior hen managing central lines and completing relevant documentation ;1ein, *+,>C C1#3S.s are the most common cause of H#.s! #n estimated 2+,+++ catheter6related bloodstream infections found in the United States are caused from central venous catheters ;C"C, *+,,,+++ infections ere noted from patients in outpatient areas ;C"C, *+,,?,+++ across the country! C1#3S.s lead to longer lengths of hospital stay and one in four patients die from this infection every year ;C"C, *+,,W6 > West 4006 4 0orth 0aples -006 - 0orth 0aples C006 C 0orth 0aples >S 6 > South 4S 6 4 South -S 6 - South CS 6 C South >0 6 > 0orth 40 6 4 0orth -0 6 - 0orth 7:S 6 7ulf :ie Suites .CU6 .ntensive Care Unit C:RU 6 Cardio6:ascular Recovery Unit S.CU Q Surgical .ntensive Care Unit 4- Table > Audit (ata )rimary study )ro5ect study 0ursing units audited,2,2 Wee%s audited,C- Total 0umber of 1inesC*?4, Total number of deviationsC*,,4 0umber of dressing deviations ;A of total deviations!?A