Campaign for best practice in intravenous therapy

Nursing Practice Innovation Infection control

Keywords: Intravenous/Infection prevention and control/Education

This article has been double-blind peer reviewed

An education campaign used a simple acronym to reduce the risk of healthcare-associated infection posed by intravenous procedures

Campaign for best practice

in intravenous therapy

In this article...

The risks associated with infusion therapy How the campaign helped health professionals reduce infection Feedback and advice for future practice

Authors Wayne Baldwin is practice development nurse; Jayne Murphy is practice education facilitator; David Shakespeare is head of infection control; Chris Kelly is professional development unit manager; Louise Fox is lead infection prevention and control nurse; Matthew Kelly is practice development nurse; all at Walsall Healthcare Trust. Abstract Baldwin W et al (2013) Campaign for best practice in intravenous therapy. Nursing Times; 109: 33/34, 22-23. Intravenous therapy is an integral part of nursing care but is associated with a high risk of infection. This article outlines a campaign that aimed to increase awareness of best practice for IV therapy and reduce the risks of healthcare-associated IV infections in hospital and community settings.

Infusion therapy is very much part of the nurse's role and is referred to as an "integral part of professional practice" (Royal College of Nursing, 2010). Intravenous cannulation and administration of IV therapy are also seen as common practice (Lavery, 2010), with Curran (2011) referring to the preparation of IV drugs as a "common nursing procedure". However, these therapies carry a high risk of infection:

"Bloodstream infections are serious infections that increase patient morbidity. They are frequently associated with the use of intravenous devices." (RCN, 2010)

Higginson (2011) highlights a link between IV care delivered in the community and a rise in infection risk. Healthcare-associated infections can adversely affect patients' experience of health services, increase morbidity and prolong stay.

Due to this identified risk and the widespread use of IV therapy, the professional development unit and infection prevention and control team at Walsall Healthcare Trust devised and implemented a trustwide education-based focus campaign to: ? Increase awareness of best practice in

hospital and community settings; and ? Implement strategies to minimise the

risk of cannula-related bacteraemia and other IV-associated infections.

About the campaign The campaign used a simple acronym ? CLEAN IT ? to describe and raise awareness of best practice. Each letter relates to a particular stage in the IV therapy journey (Fig 1). Key messages are attached to each letter and cover key considerations, such as: ? How long the cannula should be in situ; ? Assessment of the cannula site using a

visual infusion phlebitis (VIP) score; ? Accurate labelling of the IV line, among

other relevant issues. The overall focus was on raising awareness, providing information and educating staff about the importance of aseptically delivered IV care that is correctly evaluated, recorded and observed for complications. The campaign was underpinned by best practice principles from a number of sources, including the Department of Health (2007; 2003), Pratt et al (2007) and the RCN (2010). The campaign was launched in December 2011 in a staged approach across the trust's acute and community services. It was planned to last six months, completing in July 2012 after the priority issues were chosen in January 2012. The project group chose a flexible approach offering more than one option for disseminating

5 key points

1Intravenous therapy is widely practised in many healthcare settings

2It carries an inherent risk of healthcareassociated infections

3A relevant acronym is useful to help staff recall and retain key education messages

4Flexibility is key to delivering effective clinical teaching in a range of settings, from community health services to busy ward areas

5It is important to get key messages of education campaigns to staff quickly and in as many different ways as possible

Cannulation carries a high risk of infection, adherence to best practice is vital

22 Nursing Times 21.08.13 / Vol 109 No 33/34 /

Alamy

"Take every opportunity for more education"

June Girvin p28

FIG 1. The "Clean It" key messages Clean It Increasing awareness of best practice or intravenous therapy

1.Cannula site cleaned for a minimum of 30 seconds and allowed to dry before

device is inserted

2. Cannula site cleaned with a chlorhexidine-based product

C

CANNULA

3. Cannula port cleaned before use and instillation of any medication

4.Cannula insertion and management using an aseptic non-touch technique

5.Cannula removed within 72 hours of insertion or record reason for prolonged

dwell time

L

LINE

1.Line labelled on use 2. Line labelled with date and time 3. Line changed according to best practice guidance 4.Lines disposed of after disconnection and not left hanging between infusions 5. Line disposed of when infusion complete 6. Line managed with an aseptic non-touch technique

1.Evaluate effectiveness of treatment daily; discontinue when no longer required

E

EVALUATE

2. Evaluate patency of the cannula on use

3.Evaluate vascular access device in use ? would any other device be preferable?

A

ASSESS

1.Assess cannula site twice a day and record findings on the appropriate chart 2.Assess VIP score twice a day and act appropriately, remove if indicated 3.Assess sites of previous cannulations for any complications post removal

observation was made on the increased awareness and discussion the campaign generated and this was seen as beneficial for raising the profile of IV therapy.

Recommendations Clean It is flexible and can be used in other healthcare environments. However, some changes could be considered for future use: ? Ensure key messages meet specific

circumstances; ? Undertake clinical audits relevant to

the clinical situation to help finalise the campaign messages; ? Be clear from the start how the scheme will be evaluated, specifically how clinical colleagues perceive the support; ? Involve in-house communications professionals early and seek their support to promote the campaign.

N

NOTES

1. Note the date and time of insertion of cannula on the record chart 2. Note the VIP score twice a day on recommended record sheet 3. Note any untoward occurrence in the patient's record 4.Note any indication of infection or other complications and act accordingly

1. Intravenous therapy given using an aseptic non-touch technique

IT

IV THERAPY

2. Intravenous therapy flushed pre and post administration 3. Intravenous therapy prescribed in line with best practice 4. Intravenous therapy given and managed according to best practice

5. Remember "Clean It" when dealing with intravenous therapy

key information as the most effective course of action. It was seen as vital to use straightforward and clear messages.

Once the key areas for action had been highlighted, the infection prevention and control team devised an updated bedside chart for recording cannula insertion details that incorporated the VIP score.

An integrated IV therapy protocol was also developed in May 2012 to support evidence-based clinical practice across the organisation and standardise clinical practice of IV cannula care and IV line management. This was supported by an audit tool that was developed with the infection control team to enable clinical teams to monitor their own practice in the future.

The essential aim of the campaign was to deliver the key messages to frontline clinical staff as often, and in as many different ways, as possible. It launched with a poster campaign in all clinical areas. Awareness sessions of 10-15 minutes were delivered in clinical areas on a one-to-one basis or in a small group. These had the greatest impact when it was possible to observe professionals in practice, such as when completing an IV cannula assessment or changing an IV line. Participants made positive comments about these sessions.

An awareness session was also added to the administration of IV therapy and annual refresher courses that were already available to staff. A PowerPoint presentation was

created for use in these sessions to facilitate further discussion and exploration of key issues. This was also used to update staff working in critical care.

Key campaign messages and materials were included in all relevant clinical teaching sessions throughout the campaign, and added to the trust's mandatory clinical update to reach a wider audience across the organisation. The campaign was included in the trust's 2012 annual conference and details of its implementation and progress were shared with all departments.

Feedback Clean It was well received by clinical staff. One main strength was the flexible approach used to deliver key messages; these could be presented swiftly when necessary ? such as in the clinical area ? with minimum disruption to clinical duties, or discussed in more detail in a classroom or lecture theatre.

Senior staff in critical care said: "It is very useful as a refresher to existing knowledge." "The training materials and audit tool is a great reminder for the ongoing delivery of best practice and safe care."

The acronym provided a versatile focus for the campaign and staff said they found it relevant and memorable, enabling them to recall the key messages quickly. A general

Conclusion The Clean It poster was a winning entry at the trust's 2012 conference and praised for the impact of its clear, strong messages. The acronym and associated messages will continue to be used in the trust's IV therapies training programme and update, clinical update and other appropriate educational sessions. We will also encourage all clinical areas to use the audit criteria on a regular basis to monitor practice standards and ensure they meet requirements.

We are considering the production of a Clean It DVD and other materials, such as stickers, to keep the campaign's messages at the forefront of people's minds. We also plan to explore further the use of acronyms or slogans to promote key messages for other trust-wide education campaigns. NT

This initiative was a finalist

in the Nursing Times Awards

2012 Infection Prevention

and Control category

References Curran E (2011) Intravenous drug preparation: the infection risks. British Journal of Nursing; 20: 14, S4-S8. Department of Health (2007) High impact Intervention No 2. Peripheral intravenous cannula care bundle. In: Saving Lives: Reducing Infection, Delivering Clean and Safe Care. London: DH. Department of Health (2003) Winning Ways: Working Together to Reduce Associated Healthcare Infection in England. London: DH. Higginson R (2011) IV therapy and infection control in patients in the community. British Journal of Nursing; 20: 3, 152-155. Lavery I (2010) Infection control in IV therapy: a review of the chain of infection. British Journal of Nursing; 19: 19, S6-S14. Pratt RJ et al (2007) Epic 2: national evidencebased guidelines for preventing healthcareassociated infections in NHS hospitals in England. Journal of Hospital Infection; 655, S1-S64 (III). Royal College of Nursing (2010) Standards for Infusion Therapy. London: RCN. RCN-infusion-standards

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