• Based on the hypothesis that a PIV5Rights bundle and standard work would increase dwell time and reduce PIVC overall complications to achieve one PIVC per patient visit the results of the experimental group demonstrated 89 % success with patients reaching the end of treatment with one PIVC by applying the PIV5Rights bundle of practices .
How is PDSA Done ?
• P – Plan an approach for the delivery of reliable vascular access designed to improve outcomes and reduce cost . Evaluate the problems , collect baseline data and determine objectives ( i . e ., inconsistency , waste and risk ) and plan the intervention answering who , what , where and when with expectations of outcomes defined . Perform data collection and evaluation of current practices . Evaluate practices within the emergency department ( ED ) for consistency and whether study should include PIVC insertions by specialists within the ED . Analyze documentation practices within the ED and general floor units in relation to PIVC insertion practices , number of attempts , etc . Determine study period and optimal number of patients to be enrolled in each group that establish adequate power for statistical significance . Determine total admissions per year . Collect data on PIVC usage / consumption and supplies used with insertions x one year . Gain approval for products within the PIV5Rights , not already in use . Determine Institutional Review Board requirements for submission and study process with performance improvement initiative if there is an intention to publish .
• D – Select optimal unit and staff ( proficient inserters and daily assessment staff ) within the hospital to begin the study . Begin the intervention within designated unit and rooms and provide education ( i . e ., PIV5Rights ). Collect results of the intervention with data collection through paper tools or digital processes . Determine supplies and products used in comparison to PIV5Rights .
• S – Study and evaluate the evidence / data comparing the results to current practice and expectations to see if the problem is corrected and standardization achieved . Analyze data to determine what is needed , what supply substitutions would apply and evaluate policies for when a PIV is restarted ( e . g ., loose dressing , non-standard dressing with tape or lack of securement , patient complaint of pain or discomfort , location not consistent with INS Standards , etc .). Work together with the research department for statistical review and study conclusions . Summarize what was learned .
• A – Act to determine gaps , areas still needing improvement and if additional education or intervention is needed . If areas are identified for continued improvement begin the PDSA again with a goal to promote even better results in the next cycle . Complete the cycle by expanding the application and implement the process like the PIV5Rights bundle hospital wide .
PDSA Results
Nancy Moureau , RN , PhD , CRNI , CPUI , VA-BC , is the chief executive officer at PICC Excellence , Inc ., a research member of the Alliance for Vascular Access Teaching and Research ( AVATAR ) Group , and an adjunct associate professor at Griffith University in Brisbane , Australia .
References :
Bahl A , Hang B , Brackney A , et al . Standard long IV catheters versus extended dwell catheters : a randomized comparison of ultrasound-guided catheter survival . Am J Emergency Med . 2019 Apr 1 ; 37 ( 4 ): 715-21 .
DeVries M . Beyond Bean Counting : Gathering and Using Data to Drive Improvements . J Infusion Nurs . 2021 Jan 1 ; 44 ( 1 ): 41-8 .
Elli S , Abbruzzese C , Cannizzo L , Lucchini A . In vitro evaluation of fluid reflux after flushing different types of needleless connectors . J Vascular Access . 2016 Sep ; 17 ( 5 ): 429-34 .
Gibson SM , Primeaux J . Do Needleless Connector Manufacturer Claims on Bidirectional Flow and Reflux Equate to In Vitro Quantification of Fluid Movement ? JAVA . 2020 Dec 1 ; 25 ( 4 ): 28-36 .
Hadaway L , Richardson D . Needleless connectors : a primer on terminology . Journal of Infusion Nursing . 2010 Jan 1 ; 33 ( 1 ): 22-31 .
Hadaway L . Needleless connectors : improving practice , reducing risks . JAVA . 2011 ; 16 ( 1 ): 20-33 .
Helm RE , Klausner JD , Klemperer JD , Flint LM , Huang E . Accepted but unacceptable : peripheral IV catheter failure . J Infusion Nurs . 2015 May 1 ; 38 ( 3 ): 189-203 .
Hull GJ , Moureau NL , Sengupta S . Quantitative assessment of reflux in commercially available needle-free IV connectors . J Vascular Access . 2018 Jan ; 19 ( 1 ): 12-22 .
Jasinsky LM , Wurster J . Occlusion reduction and heparin elimination trial using an antireflux device on peripheral and central venous catheters . J Infusion Nurs . 2009 Jan 1 ; 32 ( 1 ): 33-9 .
Jones RK . Short peripheral catheter quality and economics : the intravenous quotient . J Infusion Nurs . 2018 Nov 1 ; 41 ( 6 ): 365-71 .
Marsh N , Webster J , Larson E , et al . Observational Study of Peripheral Intravenous Catheter Outcomes in Adult Hospitalized Patients : A Multivariable Analysis of Peripheral Intravenous Catheter Failure . J Hosp Med . 2017 Oct 18 ; 13 ( 2 ): 83-9 .
Maunoury F , Motrunich A , Palka-Santini M , etal . Cost-effectiveness analysis of a transparent antimicrobial dressing for managing central venous and arterial catheters in intensive care units . PLoS One . 2015 Jun 18 ; 10 ( 6 ): e0130439 .
Morrell E . Reducing risks and improving vascular access outcomes . J Infusion Nurs . 2020 Jul ; 43 ( 4 ): 222 .
Sabri A , Szalas J , Holmes KS , et al . Failed attempts and improvement strategies in peripheral intravenous catheterization . Bio-medical Mat Engineering . 2013 Jan 1 ; 23 ( 1-2 ): 93-108 .
Steere L , Ficara C , Davis M , Moureau N . Reaching one peripheral intravenous catheter ( PIVC ) per patient visit with lean multimodal strategy : the PIV5Rights™ Bundle . JAVA . 2019 ; 24 ( 3 ): 31-43 .
Steere L , Rousseau M , Durland L . Lean six sigma for intravenous therapy optimization : a hospital use of lean thinking to improve occlusion management . JAVA . 2018 Mar 1 ; 23 ( 1 ): 42-50 .
Wallis MC , McGrail M , Webster J , et al . Risk factors for peripheral intravenous catheter failure : a multivariate analysis of data from a randomized controlled trial . Infect Control Hosp Epidemiol . Jan ; 35 ( 1 ): 63-8 . 2014 .