Developing a Nurse-Driven Vascular Access Device Order Set Using the Electronic Medical Record.

Area of Science:

• Quality Improvement
• Patient Safety
• Vascular Access Device Utilization

Background:

• Inappropriate vascular access device (VAD) utilization poses risks and increases healthcare costs.
• Standardizing VAD selection based on evidence-based guidelines is crucial for patient care.
• A Level 1 trauma center sought to optimize VAD selection and placement.

Purpose of the Study:

• To develop and implement an electronic order set for appropriate vascular access device utilization.
• To reduce the incidence of unnecessary peripherally inserted central catheter (PICC) placement.
• To increase the appropriate use of peripheral intravenous (PIV) catheters.

Main Methods:

• A prospective quality improvement study was conducted over 36 months (January 2017-December 2019).
• An algorithmic approach was developed by vascular access nurses, integrating The Michigan Appropriateness Guide for Intravenous Catheters and Infusion Therapy Standards of Practice.
• The electronic medical record was leveraged to implement the order set and track VAD utilization.

Main Results:

• Statistically significant reductions in unnecessary peripherally inserted central catheter placements were observed.
• A notable increase in appropriately placed peripheral intravenous catheters was demonstrated.
• The intervention successfully optimized VAD selection and utilization within the trauma center.

Conclusions:

• An electronic order set, driven by nursing expertise and evidence-based guidelines, effectively improves vascular access device selection.
• This approach leads to better patient outcomes by reducing unnecessary invasive procedures and optimizing device use.
• Integrating electronic health records with clinical expertise enhances patient safety across the care continuum.