Daily central line necessity review
Abstract:
Background: Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity, mortality, and healthcare costs. Daily review of central line necessity is a recommended practice to reduce central line days and associated infections. However, documentation of this review is often inconsistent, limiting its effectiveness as a process measure.
Purpose: This quality improvement initiative aimed to standardize and streamline the documentation of daily central line necessity reviews by advanced practice providers (APPs) across all inpatient areas of a comprehensive cancer center. The goal was to improve compliance with daily review practices and reduce central line days and CLABSI rates.
Methods: The advanced practice team designed and implemented a standardized smartphrase within the electronic medical record (EMR) to prompt and capture daily central line necessity assessments. The smartphrase was introduced to all APPs through targeted education and embedded into daily workflow expectations. Utilization was tracked daily, and feedback was gathered to support adoption and address barriers. Evaluation: Utilization of the smartphrase reached 88% within four weeks of implementation and was sustained at or above 88% for the following seven weeks. Process metrics included smartphrase usage rates and documentation completeness. Outcome metrics under evaluation include changes in central line days and CLABSI incidence.
Results: Preliminary results demonstrated high adoption and sustained use of the smartphrase across inpatient APP teams. The success of this implementation led to the development of a system-wide smart link to document daily review of central line indication, expanding access to all inpatient providers across the enterprise. Early trends suggested improved consistency in documentation and increased awareness of central line necessity. The CLABSI rate data began at a high of 1.77 in January and declined to 0.99 by August, reflecting an overall downward trend followed by gradual stabilization near the eight-month average (0.86).
Conclusions/Implications: Implementing a standardized smartphrase for daily central line necessity review is a feasible and effective strategy to promote adherence to best practices. The expansion into a system-wide smart link reflects strong provider engagement and institutional support. This approach holds promise for reducing central line days and improving patient safety outcomes.
Reference:
Haney A, Talley A, Ailes M, Klemanski DL. QIM26-298: Getting SMART About Central Line Necessity and Documentation. J Natl Compr Canc Netw. 2026 Mar 31;24(3.5):QIM26-298. doi: 10.6004/jnccn.2025.7178. PMID: 41921716.