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Ray-Barruel G, Chopra V, Fulbrook P, Lovegrove J, Mihala G, Wishart M, Cooke M, Mitchell M, Rickard CM. The impact of a structured assessment and decision tool (I-DECIDED®) on improving care of peripheral intravenous catheters: A multicenter, interrupted time-series study. Int J Nurs Stud 2023; 148:104604. [PMID: 37801935 DOI: 10.1016/j.ijnurstu.2023.104604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most widely used invasive device in hospitals but have serious risks. OBJECTIVE To determine if a structured assessment and decision tool (I-DECIDED®) improves daily peripheral intravenous catheter assessment and care decisions. DESIGN Prospective, interrupted time-series study. SETTINGS Seven adult inpatient wards in three Australian hospitals. PARTICIPANTS 825 adults with 867 peripheral intravenous catheters. METHODS Between August 2017 and December 2018, peripheral intravenous catheter assessments and chart audits were undertaken with informed patient consent. Following a 4-month pre-intervention period (with 2-weekly measures), the I-DECIDED® tool was implemented over 3 months (no data collection) using multiple strategies (stakeholder meetings, vascular access device form, education sessions, ward champions, lanyard cards, and posters), followed by a 4-month post-intervention period (with 2-weekly measures). Primary outcomes were device utilization (number of peripheral intravenous catheters per total number of patients screened); idle/unused catheters; insertion site complications, substandard dressing quality; and primary bloodstream infections. RESULTS Of 2055 patients screened, 1175 (57.2%) had a peripheral intravenous catheter, and 825 patients (867 catheters) consented and were included in the final analysis. Device utilization increased from 42.0% of catheters at baseline to 49.6% post-intervention (absolute risk difference [ARD] 7.5%, 95% confidence interval [CI] 4.8, 10.3; relative risk [RR] 1.18, 95% CI 1.11, 1.25; p < 0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD -4.4%, 95% CI -8.5, -0.3; RR 0.66, 95% CI 0.44, 0.97; p = 0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD -5.2%, 95% CI -9.7, -0.6; RR 0.68, 95% CI 0.48, 0.96; p = 0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD -5.2%, 95% CI -10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; p = 0.067). Only one primary bloodstream infection occurred (post-intervention). CONCLUSIONS Implementation of a comprehensive device assessment and decision tool (I-DECIDED®) reduced idle catheters and catheter complications, despite higher device utilization. Dressing quality improved but was not statistically significant. Further implementation of the tool could improve hospital safety for patients with an intravenous catheter. ANZCTR TRIAL REGISTRATION ACTRN12617000067370. Date of registration 13 January 2017. Date of first data collection 3rd August 2017. TWEETABLE ABSTRACT #IDECIDEDassessment reduces prevalence of idle peripheral catheters and device complications.
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Affiliation(s)
- Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; National Health & Medical Research Council Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
| | - Gabor Mihala
- Centre for Health Services Research, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Michael Wishart
- Infection Prevention and Control, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; National Health & Medical Research Council Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
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Xu HG, Ullman AJ, Rickard CM, Johnston A. Factors impacting emergency department clinicians' peripheral intravenous catheter practice: A qualitative analysis. Int Emerg Nurs 2023; 71:101366. [PMID: 37852059 DOI: 10.1016/j.ienj.2023.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are commonly used devices in emergency departments (EDs), and yet relatively little is known about factors influencing Australian clinicians' adherence to the national PIVC quality and safety Standard. AIMS To explore attitudes and experiences of ED clinicians around PIVC insertion and care processes. METHODS This study used an exploratory qualitative approach to analyse written responses to open-ended questions included in an online national (mixed data) survey. Snowballing methods were used to gather responses. Deductive analysis was used to analyse open-ended questions regarding practice and Standard adherence. RESULTS There were 340 written responses, mainly from nurses in public EDs, who reported suboptimal practices regarding idle catheters, lack of patient participation in care, antecubital fossa insertion, multiple insertion attempts, inadequate site preparation, poor documentation and insufficient review of PIVC. The main factors inhibiting ED clinicians from adhering to the Standard includes inadequate knowledge, perceptions of infeasibility, disbelief in evidence, ambiguous responsibilities, habitual practice, insufficient training, lack of recognition of good practice and inadequate engagement. CONCLUSION The factors that impact ED clinicians' PIVC Standard adherence are complex and multifactorial. Strategies and interventions are needed to facilitate the implementation of the Standard into daily practice and achieve sustainable behaviour change.
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Affiliation(s)
- Hui Grace Xu
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia; Centre of Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; Emergency Department, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Brisbane, Australia.
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia; Centre of Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, Brisbane, Australia
| | - Amy Johnston
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Emergency Department, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
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Ray-Barruel G, Alexander M. CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management. Am J Nurs 2023; 123:32-37. [PMID: 37718967 DOI: 10.1097/01.naj.0000905568.37179.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Peripheral intravenous catheters (PIVCs) are among the most common invasive devices used in hospitalized patients, with over 300 million sold in the United States each year. However, about one-fourth of PIVCs are left in situ with no prescriber orders for IV medications or solutions, "just in case" they might be needed. PIVC insertion can be painful, is often unnecessary, and may increase a patient's risk of developing a bloodstream infection. This article reviews the evidence for the appropriate use of short PIVCs in hospitalized patients, assesses the ongoing need for PIVCs, provides recommendations for alternative options, and argues for promptly removing a PIVC that is no longer in use.
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Affiliation(s)
- Gillian Ray-Barruel
- Gillian Ray-Barruel is a senior research fellow at the Herston Infectious Diseases Institute and the University of Queensland School of Nursing, Midwifery and Social Work in Brisbane, Queensland, Australia; an adjunct senior research fellow at the Griffith University School of Nursing and Midwifery; education director at the Alliance for Vascular Access Teaching and Research (AVATAR); and associate editor of Infection, Disease and Health. Mary Alexander is chief executive officer of the Infusion Nurses Society in Norwood, MA. Contact author: Gillian Ray-Barruel, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Pre-hospital peripheral intravenous catheter insertion practice: An integrative review. Australas Emerg Care 2022:S2588-994X(22)00067-7. [DOI: 10.1016/j.auec.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022]
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Ray-Barruel G. I-DECIDED ®-a decision tool for assessment and management of invasive devices in the hospital setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S37-S43. [PMID: 35439078 DOI: 10.12968/bjon.2022.31.8.s37] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.
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Evison H, Carrington M, Keijzers G, Marsh NM, Sweeny AL, Byrnes J, Rickard CM, Carr PJ, Ranse J. Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study. BMJ Open 2022; 12:e054927. [PMID: 35273050 PMCID: PMC8915296 DOI: 10.1136/bmjopen-2021-054927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Rates of unused ('idle') peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians' decision-making on whether to insert or use a PIVC in the emergency care setting. DESIGN A qualitative descriptive study using in-depth semistructured interviews and thematic analysis. SETTING Gold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service. PARTICIPANTS Participants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs. RESULTS From the 15 clinicians interviewed 4 key themes: knowledge and experience, complicated and multifactorial, convenience, anticipated patient clinical course, and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as knowledge and experience, and decisions being complicated and multifactorial. The remaining two themes related to the actions clinicians took such as convenience and anticipated patient clinical course. CONCLUSION The decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician's own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.
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Affiliation(s)
- Hugo Evison
- Gold Coast Region, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
| | - Mercedes Carrington
- Department of Emergency Medicine, Robina Hospital, Robina, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Centre Research Centre, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Menzies Health Institute, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Amy Lynn Sweeny
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Joshua Byrnes
- School of Medicine, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Centre Research Centre, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
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