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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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Hulse A, Cochrane J. Impact of educational leadership and interprofessional learning on vascular access training. ACTA ACUST UNITED AC 2019; 27:S4-S18. [PMID: 30346818 DOI: 10.12968/bjon.2018.27.19.s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Educational leadership supports the effective transfer of knowledge and clinical skills between practitioners. Evaluation of training is imperative to ensure safe and effective transfer of learning into clinical practice. This study explores and critically evaluates the impact of educational leadership on practitioner development and clinical practice, focusing specifically on paediatric vascular access. An educational intervention, consisting of theory and practical simulation of venepuncture and cannulation, followed by interprofessional mentorship and supported practice in the clinical setting, was provided to 18 foundation doctors. Data regarding knowledge and skills before and after the intervention, evaluation of expert facilitation and practitioner development was collected through a three-stage process: before and after the training, and in a short semistructured interview six weeks after the intervention. Overall, practitioners' knowledge and clinical skills were improved, which illustrates the benefits of collaborative learning. Findings also show there is a need for specialist education and training, and that educational leadership needs to be promoted in healthcare settings. There are benefits in having education delivered in collaborative partnerships and by experts and skilled practitioners. This study also highlights that vascular access training within paediatrics varies a widely.
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Affiliation(s)
- Anna Hulse
- Vascular Access Nurse Specialist and Trainee Advanced Paediatric Nurse Practitioner, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Jill Cochrane
- Senior Lecturer Medical Education, PGMI, Edge Hill University, Ormskirk, Lancs
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Høvik LH, Gjeilo KH, Lydersen S, Rickard CM, Røtvold B, Damås JK, Solligård E, Gustad LT. Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ). BMC Health Serv Res 2019; 19:636. [PMID: 31488150 PMCID: PMC6729030 DOI: 10.1186/s12913-019-4497-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/30/2019] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality. METHODS The Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2-5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott's pi. RESULTS Sixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was "pain and tenderness" (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance. CONCLUSIONS Our study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.
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Affiliation(s)
- Lise Husby Høvik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway. .,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway.
| | - Kari Hanne Gjeilo
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Department of Cardiothoracic Surgery, Department of Cardiology and National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Claire M Rickard
- Alliance for Vascular Access teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Benedikte Røtvold
- Department of Anesthesia, Levanger Hospital, Clinic of Surgery, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jan Kristian Damås
- Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Infectious Diseases, St. Olavs Hospital, Trondheim, Norway
| | - Erik Solligård
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Medicine, Levanger Hospital, Clinic of Medicine and rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
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