A study to test the effectiveness of the I-DECIDED device assessment tool in improving care and prompt removal of invasive devices in adult hospital patients.

Interrupted time-series study to assess the effect of the introduction of a device assessment and removal tool in 1 Queensland hospital. There will be 3 study phases: Baseline (2 months) (T1), Intervention (1 month) (T2), and Evaluation (2 months) (T3). Total 5 months duration. T1. Baseline: Staff will not yet be using the I-DECIDED® tool for all devices; therefore, this comparison will examine the usual practice of device assessment, as documented in the patient’s integrated electronic medical record (iEMR). • Consultation with key stakeholders (nursing and medical directors, nurse unit managers, nurse educators and clinical facilitators, vascular access experts, infection prevention team) will be conducted to determine current invasive devices policy including education, device assessment tools in use, and required documentation for device surveillance. • Invasive devices audits: The ReN will audit 5 devices per 5 wards per week for 8 weeks. Using the I-DECIDED® audit tool, the ReN will assess each device for indication, complications, dressing integrity, and documentation. The ReN will ask the patient’s nurse about the functional status of the device. Patients will be asked if the device has been assessed in the past 24 hours, and any concerns will be directed to the patient’s nurse. Data will be entered using hand-held devices and a Queensland Health-supported Microsoft Office Forms database for contemporaneous data entry. The ReN will then audit the patient’s chart for evidence of recent device assessment. Informed verbal consent will be sought from each eligible patient. All eligible patients will be provided with a Participant Information Sheet, and the study will be explained by the ReN and any questions will be addressed. No identifiable patient information will be collected. • Device utilisation ratios will be calculated. • Device complication data will be checked through the RiskMan database reports. • Blood stream infection, CLABSI and CAUTI data will be requested from the hospital infection prevention and management service. T2. Implementation phase: The I-DECIDED® tool will be implemented with a multimodal education roll-out (tool, training, iEMR documentation). Weekly 15-minute meetings with key local stakeholders will continue. • Two extra Project Champions per ward will be identified and trained to support other staff in the use of the tool and facilitate implementation. Champions will attend a one-off 30-minute face-to-face training session with the nurse educators with support from CI Ray-Barruel. During this time, Champions will watch a 15-minute training webinar and have a 15-minute discussion period with time for questions. Further training will be provided if requested. • During the first two weeks of T2, two weekly 30-minute face-to-face education sessions for ward staff will be provided by hospital educators, clinical facilitators and Project Champions, with support from CI Ray-Barruel. Educational materials (webinar, posters, lanyard cards, etc.) will be provided to all wards. • Nurses will be asked to assess “Every day, Every patient, Every device”, using the I-DECIDED® tool, and document their assessment and device plan in the patient’s iEMR. • Medical staff will be asked to consider line removal (“Every day, Every patient, Every device”) as part of their routine medical assessment. • Data collection will not occur during this phase. T3. Evaluation phase: During this period the I-DECIDED® tool will continue to be used by staff to conduct invasive devices assessments. Nurses will continue to assess all invasive devices using the I-DECIDED® tool and document their assessment and device plan in the patient’s iEMR. Medical staff will continue to consider device removal as part of their routine medical assessment. Weekly 15-minute meetings with key local opinion leaders will continue, and ongoing education and audit feedback to staff will be provided. • Invasive devices audits, as per T1 • Device utilisation ratios will be calculated, as per T1 • Device complication data will be checked through the RiskMan database reports. • Blood stream infection, CLABSI and CAUTI data will be reviewed, as per T1. • 30 minute Focus groups with staff (in a quiet room away from the clinical area) will investigate the acceptability and feasibility of the I-DECIDED® tool for all devices. Informed written consent will be sought from focus group participants.