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The impact of a structured assessment and decision tool (I-DECIDEDĀ®) on improving care of peripheral intravenous catheters : A multicenter, interrupted time-series study
Ray-Barruel, Gillian Chopra, Vineet Fulbrook, Paul Lovegrove, Josephine Mihala, Gabor Wishart, Michael Cooke, Marie Mitchell, Marion Rickard, Claire M.
Ray-Barruel, Gillian
Chopra, Vineet
Fulbrook, Paul
Lovegrove, Josephine
Mihala, Gabor
Wishart, Michael
Cooke, Marie
Mitchell, Marion
Rickard, Claire M.
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-DECIDEDĀ®) 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-DECIDEDĀ® tool was implemented over 3āÆmonths (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; pāÆ<āÆ0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD ā 4.4%, 95% CI ā 8.5, ā 0.3; RR 0.66, 95% CI 0.44, 0.97; pāÆ=āÆ0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD ā 5.2%, 95% CI ā 9.7, ā 0.6; RR 0.68, 95% CI 0.48, 0.96; pāÆ=āÆ0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD ā 5.2%, 95% CI ā 10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; pāÆ=āÆ0.067). Only one primary bloodstream infection occurred (post-intervention).
Conclusions
Implementation of a comprehensive device assessment and decision tool (I-DECIDEDĀ®) 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.
Keywords
intravenous assessment, decision making, documentation, peripheral intravenous catheter, idle catheters
Date
2023
Type
Journal article
Journal
International Journal of Nursing Studies
Book
Volume
148
Issue
Page Range
1-10
Article Number
Article 104604
ACU Department
School of Nursing, Midwifery and Paramedicine
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
Published as āgoldā (paid) open access
License
CC BY-NC 4.0
File Access
Open
Notes
Ā© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).