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Does policy and practice for peripheral intravenous catheters match clinical standards? A point prevalence study
Josephine Lovegrove1, Sally Havers2, Jessica Schults3
1National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Southport, QLD, 4222, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, QLD, 4029, Australia; School of Nursing, Midwifery and Social Work, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, UQCCR, Herston, QLD, 4029, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Southport, QLD, 4222, Australia.
Insights
Adherence to the Australian Peripheral Intravenous Catheter (PIVC) Clinical Care Standard is low, with significant variation in practice. Improving PIVC care requires updated guidelines and strategies to ensure consistent patient safety.
Area of Science:
- Healthcare quality improvement
- Patient safety in nursing
- Clinical practice standards
Background:
- Peripheral intravenous catheters (PIVCs) are prone to complications due to inconsistent care, impacting patient safety.
- The Australian 'Management of Peripheral Intravenous Catheters Clinical Care Standard' outlines expected care protocols.
- Current adoption of this PIVC standard into hospital policy and practice remains unassessed.
Purpose of the Study:
- To evaluate the extent of adherence to the Australian PIVC Clinical Care Standard across acute hospital wards.
- To identify variations in PIVC management policies and practices.
Main Methods:
- A multi-site point prevalence study was conducted in 134 acute hospital wards across 21 hospitals.
- Adherence to the Standard's 10 Quality Statements was measured using structural and process indicators.
- Data were collected on patient characteristics and PIVC care practices.
Main Results:
- Adherence to structural indicators ranged from 19% to 43%.
- Process indicator adherence showed high rates for therapeutic use (91%) and dressing integrity (81%), but lower rates for documented insertion indication (80%) and ongoing need assessment (61%).
- Only 20% of Quality Statements achieved overall binary adherence, with 53% of PIVCs in areas of flexion and 42% with documented 8-hourly inspections.
Conclusions:
- Significant unwarranted variation exists in PIVC care policies and practices despite the established clinical standard.
- There is a critical need for reform of local guidelines and hospital processes to standardize PIVC care.
- Strategies to enhance adherence to the PIVC Clinical Care Standard are essential for improving patient safety.
Background:
Peripheral intravenous catheters (PIVCs) face complications from inadequate care, posing patient safety risks. The Australian 'Management of Peripheral Intravenous Catheters Clinical Care Standard' sets an expected level-of-care, but current adoption of the Standard into policy and practice is unknown.
Methods:
A multi-site point prevalence study was conducted in 134 acute hospital wards across 21 hospitals in 8 health services in one Australian state. Patients with ≥1 PIVC were included. Adherence to the Standard's 10 Quality Statements (QSs) was measured against the Standard's 13 structural and process indicators, and 6 additional study measures. Overall binary adherence for each QS was achieved when all indicators were met.
Results:
Adherence with Standard structural indicators ranged from 19 % to 43 %, while additional structural measures met 57.9 %-100 % adherence. For process indicators, 788 patients were included. Most had PIVCs used for a therapeutic purpose since insertion (91 %), and in the last 24-h (81 %), could identify the reason for their PIVC (86 %), and had clean, dry, secure PIVC dressings (81 %). Fewer had PIVCs inserted on the first attempt (70 %), had a documented insertion indication (80 %), or documented assessment of ongoing PIVC need (61 %). Notably, 53 % had PIVCs in an area-of-flexion and 42 % had documented PIVC inspections at least 8-hourly. Overall binary adherence was met for 2/10 (20 %) Standard QSs.
Conclusions:
Despite a clear level of expected care for PIVCs, much unwarranted variation exists in policy and practice. Reform of local guidelines, policies, and processes to standardise PIVC care across hospitals and strategies to improve Standard adherence are needed.
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