CVC procedural logbook
Abstract:
Background: To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs utilising a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile application (app) could provide the ideal platform for training doctors in an adult intensive care unit (ICU).
Objective: To compare trainee compliance with completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an app-based logbook.
Methods: A retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a two-year period in the adult ICU of the John Hunter Hospital (JHH), Newcastle, NSW, Australia, participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in patients’ electronic medical records (EMR) appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor’s signature for the before and after periods. We also analysed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions.
Results: Of 2,987 CVC insertions documented in the EMR between April 7, 2019, and April 6, 2021, 2,161 (72%) were included and separated into cohorts before and after the app’s introduction. Following the introduction of the app-based logbook the percentage of CVC insertions appearing as logbook entries increased from 3.6% to 20.5% (P<.001). There was no difference in the proportion of supervisor approved entries containing a supervisor's signature before and after the introduction of the app, with 76.3% and 83.2% respectively (P=.31). Following the introduction of the app there was an increase in the percentage of active logbook users from 15.1% to 62.4% (P<.001). Adherence to one's logbook was similar in both groups with 75% of first-time users in the before group and 79.5% in the after group going on to log at least 3 or more CVCs during their time working in ICU.
Conclusions: The addition of an electronic, mobile, app-based logbook to a pre-existing paper-based logbook was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in an adult ICU. There was a large increase in logbook utilisation observed without a reduction in the quality of logbook entries. Overall trainee participation also improved with an observed increase in active logbook users and no reduction of the average number of entries per user following the introduction of the app. Further studies on app-based logbooks for ICU procedural accreditation programs are warranted.
Reference:
Tamblyn R, Brieva JL, Cain M, Martinez FE. The Effects of Introducing a Mobile Application-Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study. JMIR Hum Factors. 2022 Jan 20. doi: 10.2196/35199. Epub ahead of print. PMID: 35051900.