Date of Award

Summer 8-2020

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Dr. Mary Coucoules

Faculty Reader

Dr. Lorie Wild

Executive Summary

Executive Summary

Background and Significance: Complications from indwelling peripherally inserted venous catheters (PIVCs) include phlebitis, infiltration, and extravasation. Consequences may include pain, bruising, scarring, tissue necrosis, nerve damage, loss of viable venous access, prolonged hospital stays, excess resource utilization, decreased insurance reimbursement, and possible litigation due to patient harm (Ansel, Boyce, & Embree, 2017; Helm, Klausner, Klemperer, Flint, & Huang, 2015; Bhananker, Liau, Kooner, Posner, Caplan, & Domino, 2009).

Purpose Statement: Reports of PIVC complication rates are often unreliable due to varying clinical definitions, measures, inaccurate nursing documentation, and underreporting (Ray-Barruel, Polit, Murfield, & Rickard, 2014; Mattox, 2017). The actual incidence of PIVC complications may be higher than expected. Application of current standards of practice in PIVC management, identification of risk factors for the development of complications, and promoting reliable data capture, are foundational to safe patient care. To this end, the purpose of this project was to pilot an educational program designed to equip bedside nurses with the knowledge, psychomotor skills, and resource tools necessary to prevent, identify, and report PIVC complications. Project aims were (1) achieve 90% overall documentation compliance and (2) increase nurse awareness of PIVC complications.

Methods: A multimodal nursing education campaign was piloted on one medical-surgical unit over eleven weeks. Interventions included classroom didactic, clinical in-services, and quick reference materials including a poster, badge insert, documentation guide, and performance audits and feedback. The number of PIVC complications, an outcome measure, was obtained through weekly automated electronic health record (EHR) reports. The level of nurse PIVC documentation compliance, a process measure, was determined through weekly manual chart audits. These measures were compared to estimate the degree of reliability of complication incidence rates. The education campaign was evaluated using a pretest-posttest design comparing nurses’ knowledge performance on a 12-question survey.

Analysis: The goal of 90% overall PIVC documentation compliance was not achieved, though an increase from 43.8% to 86.4% was observed. High compliance with documenting the indication for PIVC removal supports a greater degree of complication rate reliability; however, on week one, eight, and nine of routine data collection, manual chart audits revealed more PIVC complications than the rate captured in the EHR automated reports. This suggests that the reliability of PIVC complication incidence rates is not only reliant on nurse charting compliance but involves the functionality of EHR systems and automated report algorithms. The average pretest score was 9.6/12, which increased to 11.8/12 on the posttest, though the posttest had limited participation. Improvement in nurse awareness of PIVC complications was corroborated by an increase from 20.0% to 94.1% in documenting the indication for PIVC removal- a critical documentation component for identifying complications.

Sustainability: The education campaign is reproducible and may be repeated on other hospital units. Learning aids developed for the education campaign remain a tangible and accessible resource for nurses on the hospital unit.

Implications for Nursing: Understanding gaps in PIVC complication reporting and reliability of PIVC complication rates must continue to be a phenomenon of interest for future quality improvement initiatives. Moving forward, EHR systems should be designed to streamline nurse documentation. Eliminating redundant charting may enhance data capture. Further, clarity is needed about which data fields make up the EHR data capture algorithm.

References:

Ansel, B., Boyce, M., & Embree, J. (2017). Extending short peripheral catheter dwell time: A best practice discussion. Journal of Infusion Nursing, 40(3), 143-146. doi:10.1097/NAN.0000000000000137

Bhananker, S. M., Liau, D. W., Kooner, P. K., Posner, K. L., Caplan, R. A., & Domino, K. B. (2009). Liability related to peripheral venous and arterial catheterization: A closed claimsanalysis. Anesthesia & Analgesia, 109(1), 124-129

Helm, R.E., Klausner, J.D., Klemperer, J.D., Flint, L. M., & Huang, E. (2015). Accepted but unacceptable: Peripheral IV catheter failure. Infusion Nurses Society, 38(3), 189 – 203. doi:10.1097/NAN.0000000000000100

Mattox, E. (2017). Complications of peripheral venous access devices: Prevention, detection, and recovery strategies. Critical Care Nurse, 37(2), 1 – 14. doi:https://doi.org/10.4037/ccn2017657

Ray-Barruel, G., Polit, D. F., Murfield, J. E., & Rickard, C. M. (2014). Infusion phlebitis assessment measures: A systematic review. Journal of Evaluation in Clinical Practice, 20, 191 – 202. doi:10.1111/jep.12107

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