Tricia M Kleidon1,2, Paula Cattanach1, Gabor Mihala3,4, Amanda J Ullman2,5,6. 1. Children's Health Queensland, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia. 2. Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia. 3. Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, Queensland, Australia. 4. School of Medicine, Griffith University, Brisbane, Queensland, Australia. 5. School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia. 6. Paediatric Critical Care Research Group, Children's Health Queensland, Brisbane, Queensland, Australia.
Abstract
AIM: To improve paediatric peripheral intravenous catheter (PIVC) care through the implementation of care bundles. METHODS: A pre-post study using mixed methods (clinical audit, staff survey, parent interviews) in 2016 at a tertiary paediatric hospital in Brisbane was conducted to evaluate the effectiveness of a PIVC insertion and maintenance bundle to improve PIVC insertion, promote function and support practice. Participants included children with PIVC, parents and staff inserting and managing PIVCs. A mnemonic care bundle, SUCCESS PIVCS (At insertion: Skills, Understand and prepare, Consent, Clean site, Escalate, Secure, Sign and document. During management: Prompt removal, Inspect hourly, Vein patency, Clean hands and Scrub the hub), was developed and implemented via visual aids, workshops and change champions. During audit, PIVC first-attempt insertion success, PIVC failure, PIVC dwell, escalation to senior clinicians and insertion and management procedures were measured. RESULTS: Pre-implementation audit (n = 102) and survey (n = 117) data described high rates of PIVC failure (n = 50; 49%), difficulty obtaining equipment (n = 64; 55%) and pressure to insert (n = 50; 43%). Parent interviews (n = 15) identified lack of communication, fear, appreciation of skilled technicians and technology and care giver roles as key to improving the experience. After implementation first-attempt insertion success (45 vs. 62%; risk ratio 1.37, 95% confidence interval 1.05-1.78), first-attempt escalation to senior clinicians (junior doctor 72 vs. 41%; P = <0.001) and median PIVC dwell (40 vs. 52 h; P = 0.021) improved. CONCLUSION: This multi-level care bundle demonstrated improvements in the insertion and management of PIVCs; however, PIVC failure remained high.
AIM: To improve paediatric peripheral intravenous catheter (PIVC) care through the implementation of care bundles. METHODS: A pre-post study using mixed methods (clinical audit, staff survey, parent interviews) in 2016 at a tertiary paediatric hospital in Brisbane was conducted to evaluate the effectiveness of a PIVC insertion and maintenance bundle to improve PIVC insertion, promote function and support practice. Participants included children with PIVC, parents and staff inserting and managing PIVCs. A mnemonic care bundle, SUCCESS PIVCS (At insertion: Skills, Understand and prepare, Consent, Clean site, Escalate, Secure, Sign and document. During management: Prompt removal, Inspect hourly, Vein patency, Clean hands and Scrub the hub), was developed and implemented via visual aids, workshops and change champions. During audit, PIVC first-attempt insertion success, PIVC failure, PIVC dwell, escalation to senior clinicians and insertion and management procedures were measured. RESULTS: Pre-implementation audit (n = 102) and survey (n = 117) data described high rates of PIVC failure (n = 50; 49%), difficulty obtaining equipment (n = 64; 55%) and pressure to insert (n = 50; 43%). Parent interviews (n = 15) identified lack of communication, fear, appreciation of skilled technicians and technology and care giver roles as key to improving the experience. After implementation first-attempt insertion success (45 vs. 62%; risk ratio 1.37, 95% confidence interval 1.05-1.78), first-attempt escalation to senior clinicians (junior doctor 72 vs. 41%; P = <0.001) and median PIVC dwell (40 vs. 52 h; P = 0.021) improved. CONCLUSION: This multi-level care bundle demonstrated improvements in the insertion and management of PIVCs; however, PIVC failure remained high.
Authors: Jessica A Schults; Tricia M Kleidon; Victoria Gibson; Robert S Ware; Emily Monteagle; Rebecca Paterson; Karina Charles; Adam Keys; Craig A McBride; Steven McTaggart; Benjamin Lawton; Fiona Macfarlane; Chloe Sells; Claire M Rickard; Amanda J Ullman Journal: BMC Health Serv Res Date: 2022-02-17 Impact factor: 2.655