Date of Completion
Summer 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Melanie Brewer, DNSc, RN, FNP-BC, NEA-BC, FAANP
Second Advisor
Corinne Cochran, DNP, RN, NNP
Abstract
Problem: Prolonged central line use increases the risk of infection. At baseline, central line utilization in a 21-bed medical intensive care unit exceeded organizational goals and the national median. Gaps in the central line review process and variation in staff knowledge contributed to overutilization.
Aim of the Project: The project team aimed to improve patient outcomes by reducing the central line standardized utilization ratio (SUR) from 0.93 to the national median of 0.79 over 12 weeks.
Review of the Evidence: Evidence supports standardization, use of decision-support tools, measurement, and auditing to reduce central line utilization. Leadership engagement, safety culture, and high-reliability behaviors promote effective implementation.
Project Design: The quality improvement initiative applied evidence-based tools, strategies, and education to reduce central line utilization. Four sequential Plan-Do-Study-Act cycles guided implementation, and the OhioHealth Change Management Model supported stakeholder engagement and practice adoption.
Interventions: Interventions included integrating a central line decision-support algorithm into the daily review workflow and incorporating a checklist, safety questions, and central line necessity review into the morning nursing huddle. High-reliability education, standard work, direct-observation audits, leader engagement, and run charts supported implementation.
Significant Findings/Outcomes: The project reduced central line utilization and met national benchmark and organizational goals. Mean SUR decreased approximately 20% from baseline to 0.74, resulting in an estimated $64,617 in cost avoidance. Algorithm adherence supported standardized decision-making, and no patient harm was observed. Nurses demonstrated improved situational awareness and a questioning attitude. Sustainment will likely require cultural, care-model, and technology strategies to reduce cognitive burden, strengthen process reliability, and foster shared accountability.
Implications for Nursing: Broader workforce pressures increase cognitive workload and threaten the sustainment of initiatives. Sustainable central line stewardship requires intuitive workflows, supportive safety cultures, nursing ownership, and visible leadership engagement. Translating high-reliability principles into practice requires education, repeated exposure, and expertise to integrate into care processes.
Recommended Citation
Khan, Heather, "Optimizing Daily Central Line Review: A High-Reliability QI Project" (2026). Doctor of Nursing Practice (DNP) Scholarly Project. 58.
https://fuse.franklin.edu/dnp-project/58
Rights
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