1. METHOD / EDUCATION INTERVENTIONS
Improving PIVC Complication Awareness, Prevention, and Reporting:
A Quality Improvement Project
Matthew Krabbendam
Seattle Pacific University
BACKGROUND 1
METHOD / EDUCATION INTERVENTIONS 4
CONCLUSIONS 6
Up to 63% of (PIVCs) fail prematurely.1,2
Phlebitis (P), infiltration (I) and extravasation may result in pain, bruising, scarring, nerve damage, loss of venous access, increased hospital stay, and resource cost.2,3
Dedicated vascular access teams may correlate with decreased PIVC complication rates; however, a lack of rigorous evidence fails to substantiate this finding.4 The participating healthcare organization was transitioning from this service to comprehensive management of PIVCs by bedside nurses, indicating a need for specialized training.
A multimodal education campaign: Two 40-minute classroom didactic sessions and four 20-minute clinical in-services on a medical-surgical unit.
Learning aids: A complication grading scale badge insert (a), poster, documentation guide, mannequin simulation (b), and weekly documentation compliance progress updates.
Weekly manual chart audits evaluated documentation compliance. The PIVC complication rate was obtained through automated electronic health record (EHR) reports.
The overall complication rate peaked at 10.6%. A rate below 5% is suggested for phlebitis.5 There is no recommended rate for infiltration. Manual chart audits detected more PIVC complications than were captured on the EHR reports on weeks R1, R8, and R9. The reliability in the incidence rate is supported by improved nursing documentation but hindered by limitations imposed by the EHR. Ongoing education and feedback are needed, evidenced by discrepancies in the use of grading scales and line complication management orders.
Removable Tattoo
(b) Mannequin
Simulation
(a) Badge Insert
RESULTS 5
AIM A: Not achieved. Insertion was documented more consistently than removal, and more improvement was seen in removal documentation compliance. Documenting the indication for PIVC removal, an important indicator for a PIVC complication, increased from 25.0% to 95.7%. No cases of extravasation were reported, so this element is not captured in the data.
AIM B: Achieved. The average pre-test score was 9.6/12 (19 participants), that increased to 11.8/12 (5 participants) for the post-test. Post-test participation was limited, however increased awareness is evident in improved documentation of indication for PIVC removal.
SUSTAINABILITY 7
PROBLEM STATEMENT 2
The education campaign may be repeated on other hospital units. Distributed learning aids on the participating unit remain an accessible resource for participating nurses..
The average phlebitis rate is 15.5% and infiltration is 23.9%. 3
Complication rates lack reliability due to: (1) lack of standardized assessment, (2) varying complication definitions, (3)underreporting. 6,7
Reliable PIVC complication rates are important for strategic organizational changes and evaluation of quality improvement efforts.
Therefore, improving PIVC complication awareness, prevention, and reporting promotes patient safety.
IMPLICATIONS 8
This project highlights that reliability in PIVC complication rates goes beyond underreporting. Moving forward, clarity is needed about which data fields make up the EHR algorithm. Eliminating redundant charting may enhance data capture. Finally, this project endorses the efficacy of multimodal education enhanced by regular progress feedback.
AIM 3
Achieve a 90% compliance rate of complete nursing documentation correlating with a more reliable PIVC complication incidence rate.
Increase nurse knowledge and awareness of PIVC complications and associated risk factors through multimodal education, evidenced by improved knowledge scores using a pretest/posttest method.
REFERENCES 9
Brady, T., Bruno, F., Marchionni, C., & Paquet, F. (2016). Prevalence and maintenance practices of peripheral intravenous catheters. Vascular Access, 10(2), 11 – 19. Retrieved from
Helm, R.E., Klausner, J.D., Klemperer, J.D., Flint, L. M., & Huang, E. (2015). Accepted but unacceptable: Peripheral IV catheter failure. Infusion Nurses Society, 38(3), 189 – 203. doi: /NAN
Ansel, B., Boyce, M., & Embree, J. (2017). Extending short peripheral catheter dwell time: A best practice discussion. Journal of Infusion Nursing, 40(3), doi: /NAN
Carr, P. J., Higgins, N. S., Cooke, M/ L., Mihala, G., & Rickard, C. M. (2018). Vascular access specialist teams for device insertion and prevention of failure. Cochrane Database of Systematic Reviews, 2018(3). doi: / CD011429
Ray-Barruel, G., Polit, D. F., Murfield, J. E., & Rickard, C. M. (2014). Infusion phlebitis measures: A systematic review. Journal of Evaluation in Clinical Practice, 20, 191 – 202. doi: /jep.12107
Mattox, E. (2017). Complications of peripheral venous access devices: Prevention, detection, and recovery strategies. Critical Care Nurse, 37(2), 1 – 14. doi:
Langley, G., Moen, R., Nolan, K., Nolan, T., Norman, C., & Provost, L. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). San Francisco, CA: Jossey-Boss