clinical focus
Setting the standard
It ’ s time for a clinical care standard to ensure best practice use of PIVCs .
By Marghie Murgo and Gillian Ray-Barruel
Peripheral intravenous catheter ( PIVC ) or cannula insertion is the one of the most common medical procedures in Australia , experienced by 7.7 million patients each year . 1 While it is a well-practiced procedure , research reveals significant issues in the way that PIVCs are managed , flagging the need for quality improvement and a rethink of our approach .
Quality and safety issues identified include frequent unnecessary cannulation , multiple insertion attempts , and a high rate of removal due to complications . Also , one third of adults have veins that are difficult to access .
Major policy levers for effecting consistent best practice in Australian health care include the National Safety and Quality Health Service ( NSQHS ) Standards 2 and Clinical Care Standards , developed by the Australian Commission on Safety and Quality in Health Care ( the Commission ). Together , these standards provide a foundation for safe , high-quality health care in Australia .
With PIVC insertion so common during hospital admission , it is important to understand the potential impact of the Commission ’ s new Management of Peripheral Intravenous Catheters Clinical Care Standard released in May .
STANDARDS SPOTLIGHT PATIENT CARE Clinical care standards were introduced to Australia in 2013 by the Commission to improve patient care by reducing unwarranted practice variation and optimising the uptake of evidence-based care . Collaborative and consultative methods are used to develop content and ensure clinical relevance and engagement
20 agedcareinsite . com . au across all levels of the health care system . 3 Evaluation indicates that not only are the clinical care standards relevant and feasible , they have led to muchneeded practice changes in the clinical environment . Standards are recognised as an important method for improving the provision of health care and supporting reliable performance when they allow for flexible standardisation . 4 Clinical care standards are intended to support quality improvement locally , with indicators for local level measurement to help identify and address specific barriers and enablers to best-practice care .
FACING UP TO COMPLICATIONS Most hospital patients in Australia receive at least one PIVC during their admission . However , national and international research literature shows that PIVC insertion and management is often inconsistent with evidence-based practice . 5
Often viewed by healthcare staff as a simple procedure , up to 33 per cent of PIVCs are inserted in patients unnecessarily in case they are needed : a waste of medical resources and staff time . 6 Unfortunately , PIVC complications are also common . Almost two-thirds become blocked , dislodged , inflamed or infected long before therapy is complete , causing discomfort and additional risk to patients . 7 Repeated PIVC insertions can be painful and traumatic for the patient , 8 as well as time-consuming for staff and costly for the healthcare service . 9
It is important that staff are properly trained in PIVC insertion and management to reduce unwanted variations in care . The new PIVC clinical care standard supports a nationally consistent approach to care and is a substantial step towards improving clinical management of PIVCs . Developed
“ Nurses have a
key role in every stage of caring for patients with cannulas .
by a roundtable of vascular access experts , healthcare managers , infection control clinicians and consumers , the clinical care standard pulls together the best evidence and sets key expectations for PIVC insertion and management .
APPROPRIATENESS OF CARE The PIVC clinical care standard includes 10 quality statements and 10 corresponding monitoring indicators . It focuses on preserving a person ’ s vessel health by promoting prudent insertion and appropriate care for those who receive a PIVC . The first six statements focus on competency and insertion .
The quality statements reinforce steps to ensure people receive PIVCs only when clinically appropriate , and that they are inserted by trained and competent clinicians in order to avoid repeated insertion attempts . The remaining statements relate to ongoing management and removal of the device when it is no longer required .
The tendency to view PIVC insertion as a simple , routine medical procedure can lead to high risk of human error .
Relying on unconscious or automatic decision making can contribute to truncated clinical decisions and skills-based slips and lapses . 10
The case standard is expected to reduce the risk of these errors and improve patient outcomes .
It provides clear guidance to support healthcare professionals in working together to reduce the number of unnecessary cannulations , maximise first insertion success and reduce the risk of infection from PIVCs . Nurses have a key role in every stage of caring for patients with cannulas .
The new standard requires policy and leadership support for implementation as well as capacity to measure implementation success . While the new standard targets PIVCs , it presents future opportunities to apply the same principles to all other invasive vascular devices .
For references go to www . nursingreview . com . au . ■
Marghie Murgo is a senior nursing advisor at the Australian Commission on Safety and Quality in Health Care . Dr Gillian Ray-Barruel is adjunct senior fellow at the School of Nursing , Midwifery and Social Work , The University of Queensland .