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Learning Objective 1: (1) Understand the importance of a systematic approach to collect and utilize quality improvement data over time to inform evidence-based decisions about peripheral intravenous catheters
Learning Objective 2: (2) Describe an approach that facilitates communication among staff, nurse educators, and administration in an acute care facility
Background: IV starts are every day occurrences for nurses and patients in acute care hospitals. Quality indicators such as number of attempts, initiating timely therapy and monitoring untoward events require continuous monitoring. The primary investigator developed a data collection tool (IV Start card) to monitor quality indicators for IV starts. The Peripheral IV scale developed and validated by Gallant (2006) was used with the IV card to further identify untoward events.
Evaluation: Use of the IV card has allowed us to evaluate and continuously monitor the quality of IV insertions and implement education and practice changes if indicated.
Key Issues/Results: Initial IV card data showed nurses inserted PIVs on the first insertion 54% of the time; and >70% of nurses were able to start the IV with one attempt (M=1.7). All units showed >86.5% success rate with IV starts. This information was useful in the event of recent practice changes, in which a different type of IV catheter was introduced. Quality monitoring was utilized to identify specific areas of concern including leaking, reduced IV dwell time, and increased phlebitis rates. The IV card and PIV data showed IV insertion success rate decreased to 40% and therapy was delayed in 34% of patients with the introduction of a new IV catheter. These problems persisted beyond a 6-month staff education and resulted in re-evaluation of the use of the product.
Implications for future: Using the described process and data collection tools helped to quickly identify changes in PIV quality indicators and to obtain objective data for improving and modifying practice.
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