IHI



Charter Form

Name: Emma Godson

Team Members: Jian Quek, Emma Godson, Lareb Ali, Alison Davie, Deirdre Cameron, Vicki Tully and Peter Davey.

Project Title: Improving Compliance with Documentation of PVC Insertion and Maintenance

University/Organization Name: University of Dundee, Scotland

Health System Sponsor Name: NHS Tayside

What are we trying to accomplish?

Overall aim: 95% compliance with the documentation of Peripheral Vascular Catheter insertion and maintenance care for all patients with a Peripheral Vascular Catheter admitted to the acute surgical receiving unit, within 3 months. I am involved in working with the acute surgical receiving unit for 4 weeks in February to help achieve this goal.

Aim statement (How good? For whom? By when? 1-2 sentences):

The Acute Surgical Receiving Unit receive patients from Accident and Emergency, General Practice referrals and post-operatively. Commonly, these patients have peripheral venous catheters for IV fluids and antibiotics or other medication. The existing problem is how lack of compliance with existing insertion and maintenance documentation leads to poor communication between staff about the timely removal of peripheral venous catheters (PVCs), and ultimately PVCs staying in for longer than indicated, which is an infection risk and contributes to increased patient rehabilitation time and hospital stay length. (1) The subsystems affected are the staff time when documenting procedures, medication delivery and invasive procedures. The patient population is all the patients having PVCs inserted and maintained in the acute surgical receiving unit.

1. Frampton GK, Harris P, Cooper K, Cooper T, Cleland J, Jones J, et al. Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation. Health Technol Assess 2014;18(15). Chapter 1.

Problem to be addressed (Defines WHAT broadly; 2-3 sentences)

Reason for the effort (Defines WHY; 4-5 sentences)

Maintaining high standards of evidence based care for PVCs is important for patients as it improves patient’s comfort, reduces infection risk and reduces length of hospital stay. The introduction of the Visual Infusion Phlebitis score is recommended by the Royal College of Nursing (2) as a tool for monitoring infusion sites for timely removal. Also, under a new recommendation from epic3 the Journal of Hospital Infection’s National Evidence-Based Guidelines for Preventing Healthcare Associated Infections (IVAD28) “Peripheral vascular catheter insertion sites should be inspected at a minimum during each shift, and a Visual Infusion Phlebitis score should be recorded. The catheter should be removed when complications occur or as soon as it is no longer required. ” (3)

By improving staff compliance with documentation and introducing the VIP score it will make it easier to recognize when a PVC should be removed, prompt staff to assess the PVC site more frequently and improve communication between staff.

By improving the method of measuring compliance, with a new audit tool that incorporates patient observations, there will be greater assurance for PVC care and it will be clearer where the improvement effort for PVC care should be targeted in order to achieve better patient care across all areas.

The potential downsides for patients are that the staff will have less time to spend with the patients if they are spending more time documenting care. Background information for this effort is from the Tayside Patient Safety Team’s (4) report for the clinical quality forum, which was written after success during the maintenance testing phase in Ninewells. It is also supported by the NHS Scotland’s Preventing CRBSIs and other complications from PVCs which recommends documentation of all PVC procedures as well as the other aspects required for high quality care.

2. Gallant P and Schultz AA (2006) Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. Journal of Infusion Nursing. vol. 29, no. 6, p. 338-45.

3. NHS Scotland. Preventing CRBSIs and other complications from PVCs. [homepage on the Internet]. January 2013 [cited: February 2016]. Available from:

4. NHS Tayside. Clinical Quality Forum. Peripheral Vascular Catheter Bundle Update. January 2016. [cited: February 2016]

Expected outcomes/benefits (Defines WHAT specifically, still not HOW; 3-4 sentences)

We will work with the patient safety team as part of their project, but our specific objectives over 4 weeks are to implement a new method of documenting PVC maintenance through staff education and raising awareness by the 18/2/16, establish the barriers associated with documenting insertion of PVC by the 15/2/16, develop new strategies to overcome this by testing changes for insertion documentation by the 23/2/16 and to measure compliance with maintenance and insertion throughout the project.

How do we know that a change is an improvement?

(Identify outcome, process, and balancing measures; 4-5 sentences)

The outcome measures are a reduction in PVC-related staph aureus bacteremia infection rates and PVC-related phlebitis rates. The process measures are percentage compliance with PVC maintenance documentation and percentage compliance with PVC insertion documentation. The balancing measures are patient nurse contact time, staff satisfaction with the methods of recording PVC care and resource cost in producing the new documentation.

What changes can we make that will lead to improvement?

(Initial changes, barriers, key stakeholders; 4-5 sentences)

Initial changes: implement the new maintenance documentation method, raising staff awareness through various methods and to test new methods for insertion documentation to improve compliance. The new maintenance method has been tested in other wards and improved compliance, whilst being received well by staff. We will use a cause and effect diagram to identify areas where we could target changes for improving insertion compliance.

The barriers to the success of our project include making changes and collecting sufficient data over a limited period of four weeks, limited time and continuity of staff and the difficulty of approaching staff on a busy ward as an inexperienced student.

Key stakeholders: nursing staff and junior physicians are the main stakeholders, but we aim to collect patient’s opinions and feedback as well.

Read the following statement and check the box below before submitting this charter to the IHI Open School.

☐ I certify that my faculty advisor has reviewed and approved this charter.

Charter Assessment

---DO NOT COMPLETE THIS PAGE – FOR IHI USE ONLY---

|What are we trying to accomplish? |Needs Improvement|Meets |Exceeds |

| | |Expectations |Expectations |

|Aim statement is clear and answers how good, by when, and for whom. |x | | |

|Problem to be addressed clearly justifies need for improvement. | |x | |

|Identifies aspect of care that will be improved and subsystems that will be affected. | |x | |

|The impact (positive and negative) on patients is clear. | |x | |

|Supportive background information is provided. | |x | |

|Specific objectives and numerical goals are clearly defined. | |x | |

|Project can be completed within time frame. | |x | |

|Addresses anticipated products, tools, and deliverables that will be used in process. | |x | |

|How do we know that a change is an improvement? |Needs Improvement|Meets |Exceeds |

| | |Expectations |Expectations |

|An appropriate family of measures is identified (minimum of 1 outcome measure, 2-3 process measures and a | |x | |

|minimum of 1 balancing measure). | | | |

|Measures identified are directly related to the project description, objectives, and goals. | |x | |

|Each measure is appropriately operationally defined. | |x | |

|Data collection on metrics is reasonable and practical given scope of QI project. | |x | |

|What changes can we make that will lead to improvement? |Needs Improvement|Meets |Exceeds |

| | |Expectations |Expectations |

|Initial changes to be tested are clear and well defined. | |x | |

|Specific strategy/methodology (i.e. driver diagram) used in selecting change is identified and explained. | |x | |

|Project constraints/barriers are defined including how they will be addressed. |x | | |

|Identifies key stakeholders and explains their role in the process. | |x | |

-----------------------

[pic]

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download