Developing a practical Hospital Intravenous Therapy Quality Assessment Tool: Design, refinement, and feasibility

Intravenous therapy involves high-volume, invasive procedures that are inherently associated with patient discomfort and distress. When not managed optimally, such procedures can directly impact treatment efficacy and carry risks of severe complications. Intravenous therapy quality monitoring is essential for patient safety, yet standardized, practical tools for hospital-wide audits remain a critical gap.

This study aimed to develop and refine a practical, electronic quality assessment tool for hospital-wide intravenous therapy surveillance, and to evaluate its feasibility in clinical practice. This is Phase I of a larger project; Phase II will apply the tool to identify outcome gaps and drive improvement.

A multidisciplinary team developed the initial Hospital Intravenous Therapy Quality Assessment Tool (HIT-QAT) based on international and national standards. The tool underwent 14 iterative refinement cycles through hospital-wide cross-sectional surveys from June 2016 to May 2023. Each cycle involved: pilot testing, standardized auditor training, full-scale audit, data analysis, feedback sessions, and tool revision. Feasibility metrics included audit completion time, data completeness, and user acceptance.

The finalized HIT-QAT structure comprises seven sections: Introduction, Infusion Status Basics, Medication Usage, Vascular Access Device (VAD) Selection, VAD Insertion & Management (Butterfly devices, Peripheral intravenous catheter (PIVC), Midline catheter, CVC, PICC, PORT, Other devices), Infusion Device Usage, Instructions. HIT-QAT is an electronic, mobile-accessible survey with automated skip logic. Across 14 audits conducted from 2016 to 2023, A total of 22,789 VADs were assessed by 67-76 trained audit liaisons per cycle. All audit liaisons completed a standardized 1-h training with zero resistance.

The HIT-QAT is a feasible, practical, and efficient electronic tool for hospital-wide intravenous therapy quality assessment. This paper reports Phase I: tool design, refinement, and feasibility testing. Future studies (Phase II) will apply the tool to systematically identify practice deficiencies, track outcomes, and evaluate quality improvement interventions.