After a recent significant adverse event following the insertion of a central venous line you have been asked to investigate emergency department central line insertion.
a. List the factors that may contribute to such adverse events during central venous line placement (30%) b. Describe the measures that may be used to prevent or minimise these events occurring (70%)
So, interestingly we weren't given any clue as to what the adverse event was. Like a lot of admin questions, this is the case.
Therefore candidates are asked to give a generic answer. And that's the secret of admin - a lot of the answers are a generic process, with a couple of specifics thrown in. The important thing is to ensure your generic answer is broad enough in scope.
When it comes to a question like this having some way of dividing up the factors to show this is important. For example:
- system factors: poor training, inadequate supervision, absence of protocols dictating important points (asepsis, u/ss guidance etc) - individual factors: impaired doctor, poor standard of training, individual technique (insertion/handwashing) - equipment/logistic factors: no ultrasound in department, no gowns in department, etc
Post your answers up on the VSG and we'll have a chat about them.
The examiners' report and comments are below, and they echo ours.
FACEM SAQ Exam 2011.1 – Question 7
The overall pass rate for this question was 72/81 (88.9%)
PART A: Structured list that included patient/ environment / equipment and operator factors. Better answers included factors in each of these sections and ranked them in order of prevalence or importance.
PART B: Examiners expected description of measures that demonstrated application of quality improvement principles to this clinical adverse event scenario. This required sections relating to information gathering, review of existing guidelines with involvement of relevant ED and non-ED stakeholders, and creation and implementation of a documented departmental process that emphasised safe, competent line placement with emphasis on infection prevention at all times. Additionally there would be education and accreditation processes for line placement techniques highlighting importance of ultrasound guidance, and regular audit and revision of process to maximise patient safety and clinical effectiveness.
Features of unsuccessful answers
No inclusion of proven role of vascular ultrasound in reducing complications of CVL placement. Failure to include measures that prevent or minimise CVL associated sepsis.
No description of quality improvement processes in measures to reduce adverse events.