None listed
Conditions
Brief summary
Aim: To test the effectiveness of an invasive device assessment and removal tool (I-DECIDED) in improving Intravenous (IV) catheter care in hospital patients. Significance: Each year in Australia, almost 10 million patients are admitted to hospital. Around 70% will need an IV catheter for fluids or medicines. Yet 30-50% of IVs have painful complications or stop working before treatment is finished. Complications leading to failure include infiltration, extravasation, occlusion, accidental removal, or symptoms of phlebitis (pain, redness, swelling, palpable cord, hardness of the vein, red streak along the vein, and/or purulence). The failure of an IV catheter before treatment is completed requires the re-siting of a new device, leading to discomfort for the patient and often delays in treatment. A recent economic analysis of data from a multi-site Queensland randomised trial showed the mean cost of catheter replacement was approximately $70 when staff time and equipment was calculated. Expected outcomes and benefits: As well as being an assessment tool, the I-DECIDED mnemonic encourages patient participation. I-DECIDED is also an audit and education tool, teaching nurses and doctors the essential components of IV care. A structured and comprehensive approach to IV assessment and care would promote early detection of complications, and prompt removal of IV catheters when no longer needed. This will reduce unnecessary pain and suffering for patients, decrease the risk of potentially deadly bloodstream infection, and reduce treatment delays and hospital costs. This could benefit millions of Australians annually. Future directions The proposed study will test the utility of the I-DECIDED tool in guiding assessment and care of peripheral IV catheters. Following the collection of pilot data and feedback from staff and patients, it is likely that the study will be expanded to test the tool for assessing other IV catheters (non-tunnelled central venous catheters, peripherally-inserted central venous catheters) in other hospital units. Additional approvals will be sought at that time, as appropriate. I will work towards I-DECIDED being implemented in partnership with the Australian Commission of Safety & Quality in Healthcare. I-DECIDED will provide a platform for innovation and research projects in other invasive medical devices, including urinary catheters. The mnemonic I-DECIDED works in Spanish, Portuguese, French and Italian, and could be made global. Nurse collaborators from my existing Australian and international research networks have expressed interest in trialling the I-DECIDED tool.
Interventions
Interrupted time-series study to assess the effect of the introduction of a peripheral intravenous catheter (PIVC) device assessment and removal tool in 3 Queensland hospitals.
There will be four study phases, Pre-baseline (T0) (one month), and Baseline (T1), Intervention (T2), and Evaluation (T3), each of 4 months duration.
Pre-baseline (T0) - 1 month. . Clinicometric testing of the I-DECIDED tool will be undertaken, including content validity assessment, clinical utility and feasibility, inte
Interrupted time-series study to assess the effect of the introduction of a peripheral intravenous catheter (PIVC) device assessment and removal tool in 3 Queensland hospitals. There will be four study phases, Pre-baseline (T0) (one month), and Baseline (T1), Intervention (T2), and Evaluation (T3), each of 4 months duration. Pre-baseline (T0) - 1 month. . Clinicometric testing of the I-DECIDED tool will be undertaken, including content validity assessment, clinical utility and feasibility, inter-rater and intra-rater reliability assessments. Baseline (T1) - 4 months. Baseline observations will include: usual clinical practice of PIVC assessment and documentation; device utilisation ratios; prevalence of redundant PIVCs; IV complications; loose, moist or soiled dressings; primary BSI data. Consultation with key stakeholders, staff focus groups (n = 7 groups), bedside interviews with patients (n = 24), PIVC assessments (n = 480), and chart audits (n = 480) will be conducted. Implementation (T2) - 4 months. The I-DECIDED tool will be implemented in 7 wards across 3 hospitals. Regular meetings with key local opinion leaders will continue during this period. Two staff champions per ward will be identified and trained to support other staff in the use of the tool and facilitate implementation. Education sessions for staff and education brochures for patients will be developed and provided. Regular ward updates, and informal discussions about the I-DECIDED study will be conducted. Data collection will not occur during this phase. Evaluation (T3) - 4 months. During this period the tool will continue to be used and the activities of T1 (staff focus groups (n = 7), IV assessments (n = 480), chart audits (n = 480), and patient bedside interviews (n = 24)) will be repeated. Regular meetings with key local opinion leaders will continue, and ongoing education and feedback to staff will be provided at ward in-service sessions. The purpose of this phase is to determine the effectiveness, feasibility and acceptability of the I-DECIDED tool for IV assessment, management and documentation of IV care.
Sponsors
Dr Gillian Ray-Barruel
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Educational / counselling / training
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria • Vascular access experts and clinicians with experience in PIVC assessment who provide informed consent to participate in the content validity assessment. • Staff nurses who provide written informed consent to participate in the ‘think aloud’ assessment. • Patients over 18 years with a peripheral intravenous catheter and able to provide informed verbal consent to participate in PIVC assessments and chart audits • Patients over 18 years with a peripheral intravenous catheter and able to provide informed written consent to participate in bedside interviews • Nurses working clinically on the medical and surgical wards where the project will take place, and who provide informed written consent to participate in focus groups
Exclusion criteria
1. Patients admitted for palliative treatment or who are on a care of the dying pathway
Outcome results
None listed