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Lillian Facka
Servant Leadership
11/5/2018
“I Pledge”
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Vascular access is crucial in the hospital setting. While it is an invasive way to give
pneumonia. Often times, a peripheral IV catheter is placed. However, if the patient has poor
vascular access, a central line may be placed. These lines are more invasive, reaching avenues in
the body that lead directly to the heart. Keeping that in mind, it is critical that these lines stay
Unfortunately, impairing the integrity of the skin with an insertion increases the risk of
the patient acquiring an infection. I researched the central line usage at Memorial Regional
Hospital, where I am completing my immersion on Medical Telemetry. This unit sees a high
amount of patients with central lines thus making the data relevant to my clinical practice. A
quality improvement meeting was held for all clinical care leaders in the hospital, of which I was
During the meeting, we discussed central line utilization and their relationship to
vascular team management and easier to order a PICC line insertion through vascular team
versus physician insertion. Breaking these elements down, lack of communication and deviation
control staff encouraged first line measures before central line insertion to include paging a
phlebotomist to draw labs and insert IVs on a patient with poor vascular integrity. Infection
control staff did recognize that central lines are a vital route for medication and lab access; with
this, they plan to develop central line indications and share them in the physician newsletter.
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Nursing education held a high priority: once a PICC line is removed, two peripheral IVs are to be
placed. This promotes PICC line removal due to increased vascular access without penetrating
Further research was discussed as to how infections manifest. A link was established
between CHG bathing and patients that are self-care. Self-care patients are able to perform
activities of daily living independently. While this promotes normalcy to patients, they may be
Medical Telemetry can hold up to fifteen patients. The unit is regularly full; out of fifteen
patients, two to three have central lines. This presents many opportunities for infections to
manifest; however, we defy the odds by following protocols and keeping central lines clean.
Head
Acting as a leader behind this infection prevention process, I have to cultivate and
maintain a level of confidence in the hygiene of central lines within the hospital; meaning I
would fully believe in the CHG bathing process. After having faith in the hygiene process, I
would begin by chart auditing. This would include looking at patient hygiene that has been
completed as well as the integrity of the line in their given flow sheet. Acquiring this data would
lay the groundwork for encouraging and supporting my staff. From there, follow up and
process.
Heart
The motivation for this encouragement and follow up is built upon positive patient
outcomes: no infection means less time in the hospital. Skipping a chlorahexadine gluconate
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(CHG) bath is not simply cutting a corner to save time, it is placing the patient at risk for
acquiring an infection. As a leader and healthcare provider, we must remember that we are
motivated by the patients and improving their health status. Wiping lines with CHG and the
surrounding skin is vital in the infection prevention process. If there are moments where quality
is lacking, I would encourage cross-checking the behavior of the nurse, encouraging them to
realize how their actions directly relate to the hygiene of the central line.
Hands
As a leader, utilizing the hands' domain, I need to set goals, observe my team, and
determine whether or not as a group have we accomplished the goals. Before I establish goals, I
would do my research. The National Center for Biotechnology Information states that it takes 48
hours for a central line to develop an infection if not properly cared for (2018). NCBI also
suggests changing central line tubing every 96 hours, cleaning hubs with disinfectant, and
Keeping this data in mind, I would create three goals: properly labeling lines with dates
they were started and when they should be changed, keep CHG at the bedside to promote the use
of disinfectant and establish a checklist with physician input for when central lines should be
removed. I would also encourage my staff by signing a commitment to central line acquired
blood stream infection (CLASBI) free unit; I would lead by example by signing my name.
In addition to setting goals, I would stay informed and provide education on central line
care. The Agency for Healthcare and Research Quality recommends improving safety huddles,
transparent communication regarding CLASBI infections, rewards and recognition for CLASBI
prevention and empower nurses to stop procedures if the established protocol is not followed
(2015).
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Habits
Solitude is the primary tool I use for habits. Yoga, meditation, and prayer allow me the
free space to reflect on my actions. I create a safe place to ask myself questions such as what
behavior can I exhibit as a leader to ensure these policies and protocols are carried out properly?
What environment can I create for my team to encourage best practice? What key facts about
central lines should I present to patients to encourage quality self care? Talking and praying with
God will set a humbleness within my soul that will encourage me to act as an instrument as
Sharing my values with my team demonstrates a transparent and trustworthy behavior. It will
take a village of healthcare workers within the multidisciplinary team to execute this new
practice for a CLASBI free unit. While I would not want this group to be policing hospital
employees, I would want them to be a liaison between infection control staff and unit workers;
this would be an effort to fill any gaps that could result in discrepancies ultimately leading to
CLASBI acquisition. This group of leadership would include the pharmacy, physicians, clinical
care leaders, and care management. I see the power in numbers; the more educated our
Central line infections affect everyone from the patient to the entire hospital system.
While the hospital may receive poor marks for failing to prevent a CLASBI, it is ultimately the
patient who suffers. Providing compassionate, quality patient care is every healthcare providers’
main goal; this is the behavior I envision as a leader who wants to inspire change. I would love
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to hold a meeting for quality improvement on the unit with all staff. This meeting would focus on
the goal of patient outcomes versus how the hospital is affected, creating a goal for the common
good. During this time, I would discuss goals with the staff, when they could best achieve a
positive outcome, and what I can do as a leader to promote their success in delivering patient
care. Circling back to committing to CLASBI prevention, I would remind my staff the impact
they have on patient care by committing to a CLASBI free unit and the exciting possibilities this
After my initial meeting, I would have meetings with all shifts, days, nights, and
weekends, to follow up on how they are feeling regarding the shared vision for a CLASBI free
unit, creating regular communication internally. This would include looking at patient’s bedside
and seeing what is available for disinfectant, are lines labeled properly, and when the last
disinfectant cleaning was documented; examining the landscape to look for areas of
development. After, I would meet with staff to receive feedback on how the process works for
them within their shifts and if there is anything I can do as a nurse leader to help with
implementation. Additionally, to challenge the process, I would provide evidence and data from
the Joint Commission. The Joint Commission offers helpful resources such as how to conduct
clinical surveillance with central lines, how to insert a central line as well as how to maintain and
remove the line, and what appropriate documentation looks like. I would encourage use of this
effective team work, everyone from technicians to doctors must be properly informed of
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prevention protocol. The Center for Disease Control states my vision as a nurse leader perfectly
“Full engagement between local, state and federal public health agencies and their partners in the
healthcare sector through initiatives such as the prevention collaboratives is vital to sustaining
staff education, we also must praise the employees on the unit. A great example of this is
Memorial Regional’s Medical Telemetry. After staying free of CLASBIs, the unit received an
award from the infection control department of the hospital, an incredibly high honor that is
difficult to obtain. As a nurse leader, I would be sure to not only educate my team, but praise
them as well.
Similar to enabling others to act, as a nurse leader I have to encourage the hearts of my
team by practicing gratitude and compassion. In order to provoke a sense of trust, I need to know
how each individual team member receives love in a professional environment. This could be
words of affirmation, gifts, or acts of service. I would ask the team to take a professional love
language quiz to help me as a leader to identify what ways I can provide positive feedback. This,
in turn, will help me continue to build up my team in high and low times. I will link victories to
the values of our Bon Secours hospital system: integrity and compassion being of the utmost
importance. In addition, the team has to celebrate each other’s victories as well. This will
The implications for profession practice are the need to improve patient safety as well as
maintaining the hospital integrity. As a leader, utilizing my head, hand, heart and habits domains
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will allow me to inspire change and invoke new practices within the unit. Patient safety would be
maintaining, and further refining these methods will assist in elimination of CLASBIs.
Looking at Memorial Regional’s Medical Telemetry unit, the goal of all staff is to
maintain hospital integrity. This means ensuring that the hospital environment is clean, safe and
healthy for patients to heal. Utilizing cross checks, such as asking if patients have been washed
with CHG and documenting their bath in their chart, will help maintain positive data and positive
health outcomes.
Outcomes Evaluation
My initial evaluation was prompted by central line hygiene. I would monitor CHG
medical telemetry, and inquire to my team regarding how central line care can be successful.
MRMC’s Medical Telemetry recently received an award for maintaining a CLASBI free unit
from the infection control department. This is an incredibly high honor to receive from the
hospital system. Patient hygiene was properly documented 100% and the interdisciplinary team,
technicians to doctors, were properly informed of goals and how to achieve them, verbalizing an
References
Castillo, D. J., MD, MBA. (2014, April 29). Some Good News About CLABSI, and How to
https://www.jointcommission.org/the_view_from_the_joint_commission/good_news_abo
ut_clabsi/
Centers for Disease Control and Prevention. (2018, October 25). Healthcare-associated
https://www.cdc.gov/hai/data/portal/progress-report.html
Haddadin, Y. (2018, September 30). Central Line Associated Blood Stream Infections
https://www.ncbi.nlm.nih.gov/books/NBK430891/
McAlearny, A. S., S.c.D MS. (2015, May). Final Report High-Performance Work Practices in
from https://www.ahrq.gov/sites/default/files/publications/files/clabsi-hpwpreport.pdf