Masters of Science in Nursing Portfolio - Home



Implementation of a Standardized Pediatric Peripheral Intravenous Catheter Dressing ProcedureJessica McClusky, BSN, RN, CPNAuthor Affiliations: Infection Preventionist, Helen DeVos Children’s Hospital, Grand Rapids, MICorrespondence: Jessica McClusky, BSN, RN, CPN, Helen DeVos Children’s Hospital, 100 Michigan St NE, Grand Rapids, MI 49503 (jessica.mcclusky@) Conflict of interest statement: The author declares there are no conflicts of interest.AbstractMillions of peripheral intravenous catheters are inserted in the United States each year. Helen DeVos Children’s hospital was lacking a standardized practice for securement of these catheters, leading to an increase in dislodgements and infiltrations. This quality improvement project introduces a standardized dressing kit to be piloted in the sedation unit. Feedback was generally positive, with a request for the included tape roll to be longer to accommodate stabilizing devices needed for active pediatric patients. Future recommendations include introducing the kit to the inpatient units and developing a policy to encourage continued utilization with new staff.Key words: IV, dressing kit, pediatrics, peripheral intravenous catheter, standardizationImplementation of a Standardized Pediatric Peripheral Intravenous Catheter Dressing ProcedureMillions of peripheral intravenous (PIV) catheters are inserted in the United States each year (Billingsley & Kinchen, 2014). While these catheters are not as invasive as central venous catheters, patients report dissatisfaction related to the placement and management of these devices (Billingsley & Kinchen, 2014). The use of PIV catheters is intended to maximize patient comfort and also decrease cost for the institution (McNeill, Hines, & Phariss, 2009). To achieve this, the staff must increase the length of time a catheter is able to stay in place, as this results in less pain for the patient and less materials and nursing time for the facility. Unscheduled PIV catheter restarts due to dislodgement can cause complications such as delaying therapies, reducing amount of infused medications, and possibly prolonging hospitalization (Billingsley & Kinchen, 2014). Appropriate securement can decrease these risks. The Infusion Nurses Society recommends the use of a stabilization device whenever possible to attempt to increase the PIV catheter dwell time (Infusion Nurses Society, 2006).The American Academy of Pediatric and the American Pain Society recommend preventing or avoiding the pain of a PIV reinsertion whenever possible (Hetzler et al., 2011). Additionally, pediatric patients are more susceptible to complications related to PIV catheters, with rates up to 28% (Pettit, 2003). In contrast, only 8.5% of adults experience complications with this same device. Finally, without proper securement, the catheter can migrate out of the vein and into the surrounding tissue, causing an infusion to result in infiltration of that tissue. Pettit (2003) found that up to 78% of all pediatric PIV catheter placements can result in infiltration. More alarmingly, damage to skin, muscle, or nerves was present in 43%. Physiologic and developmental factors contribute to the increased risk in pediatrics, including fragile veins, activity, and communication limitations (Pettit, 2003). Establishing a standardized process to accomplish the goal of properly securing catheters is necessary. Da Silva, Priebe, and Dias (2010) found that implementation of a standardized PIV catheter process reduced infections, increased patient comfort, and decreased material use. On a broader level, standardization reduces variation between practices, which has been shown to provide improved patient outcomes (Butler et al., 2014). This quality improvement project introduces pre-packaged PIV catheter dressing kits to the sedation unit in a large pediatric hospital. Combining kit introduction with staff education, the purpose of this project was to standardize the method of PIV catheter securement across the nursing staff for this unit.Quality Improvement Project FocusThere was no policy, procedure, or standard of practice on any of the units at the project hospital regarding PIV catheter insertion, securement, or site care and dressing change. Securement practices vary between units and even between individuals, resulting in a number of poorly secured catheters or frequent dressing changes, as children tend to be very active even when hospitalized. This quality improvement project was focused on developing and distributing a new standard of practice for PIV catheter insertions and securement through the use of prepackaged securement kits.SettingThis project took place at Helen DeVos Children’s Hospital (HDVCH) in Grand Rapids, Michigan. HDVCH is the largest pediatric hospital in West Michigan, providing care in over 50 specialties (HDVCH, 2014a). A part of the Spectrum Health System, HDVCH is accredited by the Joint Commission and has received Magnet designation. The standard of practice was presented and piloted in the sedation unit. Sedation sees approximately 5,000 children per year (HDVCH, 2014b), providing numerous daily opportunities for PIV insertions and securements with staff feedback. Project ImplementationSecurement kits were developed from products that were already in use on the hospital units. This was intended to provide a less daunting change for nurses, as they were familiar with the products. Products in the kit included a pediatric-specific PIV catheter dressing, individual roll of tape, skin cleansing applicator, gauze, tourniquet, and paper drape. A financial evaluation revealed the cost of the kit was exactly the same as using individually packaged items, both totaling $1.46. Staff education was completed using in-services, e-mail, and the Spectrum Health Learning Institute Online (SHLIO). In-services were offered on two different days, with a morning and an afternoon option to attempt to capture the largest audience possible. This allowed staff to see the new PIV catheter dressing kits and ask clarifying questions. Utilizing the SHLIO platform allowed for tracking compliance of those who completed the module and gave the staff a reference to review if needed. This module consisted of a self-paced education with explanation for change, as well as a video demonstration of using the new kits. Finally, an e-mail was sent to the sedation staff one week prior to project implementation. This directed them to the SHLIO for reference, and provided contact information for questions. On the day of implementation, the kits were stocked in a highly visible area of the unit, where the nurses prep medications and selected PIV catheter size. This location was chosen by nursing staff. Daily rounding was conducted to ensure an adequate number of kits stocked and to touch base with staff to answer questions. Charge nurses were given a contact number if they ran low during a shift. Staff was very vocal during daily rounds with helpful feedback. The pilot ran for a total of 14 consecutive days. Project EvaluationThe success of the project pilot was evaluated through rounding and discussion with staff about the ease of the standardized dressing kit. The biggest concern prior to implementation included insufficient amount of tape, since the roll provided in the kit was a single patient use roll. Through rounding and discussions, the tape length seemed to be the biggest barrier to utilizing the kit as a whole. Because of the use of the kit on pediatric patients, many patients needed a stabilizing device, such as an arm board, to keep their PIV catheter functional. The single patient use tape roll did not provide enough tape to successfully secure an arm board. Other components of the kit were well received and said to be easy to use.At the beginning of the pilot period, there were 50 kits available for staff use. After the 14-day pilot period, only 2 kits remained unused. This means around three kits were used per day, which is much less than the average of 20 patients, and therefore PIV catheter insertions needed, per day. The low utilization is discouraging, and staff cited lack of knowledge about the pilot as their reason for not using the kits. Though in-services, e-mail, and the SHLIO platform were utilized, a daily reminder at the unit’s morning huddle may have been more helpful throughout the pilot period.RecommendationsThough the kit seemed to be generally well received and successful, due to the low utilization on the sedation unit, another pilot on an inpatient unit would be appropriate to determine if the kit meets the needs of the inpatient nurses. However, feedback from the sedation unit should be considered, and a longer roll of tape should be substituted into the kits to allow for proper PIV catheter securement in an active pediatric patient. Recommendations for a successful pilot include prior in-service education, reminder e-mails, and daily huddles at the start of each shift to encourage kit utilization. Also, these kits should be stocked in the same area nurses would currently go to gather PIV catheter insertion supplies, in order to minimize disruptions to daily workflow.HDVCH Central Shared Leadership Council (CSLC) previously called for a policy related to PIV catheters. If an inpatient pilot is successful, the project plan should be presented to CSLC for support prior to a house-wide go-live. The members of the council will then act as champions for the new process, and will be able to answer questions on the units. Finally, if adapted house-wide, it is important to create a policy based on the kit utilization to be used as a reference for teaching future nurses how to secure PIV catheters. Continued education will be key in the success of incorporating this new process into daily workflow.ReferencesBillingsley, L. & Kinchen, L. (2014). Peripheral intravenous catheter protection: Are we using best practice? Journal of Continuing Education in Nursing, 45(8), 338-339.Butler, T., Firestone, K. S., Grow, J. L., & Kantak, A. D. (2014). Standardizing documentation and the clinical approach to apnea of prematurity reduces length of stay, improves staff satisfaction, and decreases hospital cost. Joint Commission Journal on Quality & Patient Safety, 40(6), 263-269.Da Silva, G., Priebe, S., & Dias, F. (2010). Benefits of establishing an intravenous team and the standardization of peripheral intravenous catheters. Journal of Infusion Nursing, 33(3), 156-160. doi:10.1097/NAN.0b013e3181d9c942Helen DeVos Children’s Hospital. (2014a). HDVCH Floor-by-floor. Retrieved from DeVos Children’s Hospital. (2014b). Sedation Services. Retrieved from . sedationservices.Hetzler, R., Wilson, M., Hill, E. K., & Hollenback, C. (2011). Securing pediatric peripheral IV catheters: Application of an evidence-based practice model. Journal of Pediatric Nursing, 26(2), 143-148.Infusion Nurses Society. (2006). Infusion nursing standards of practice. Journal of Infusion Nursing, 29(1), S1-S90.McNeill, E. E., Hines, N. L., & Phariss, R. (2009). A clinical trial of a new all-in-one peripheral short catheter. Journal of the Association for Vascular Access, 14(1), 46-51. doi: 10.2309/java.14-1-8Pettit, J. (2003). Assessment of the infant with a peripheral intravenous device. Advances in Neonatal Care, 3, 230-240.Shirey, M. R. (2013). Strategic leadership for organizational change. Lewin's Theory of Planned Change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72. doi:10.1097/NNA.0b013e31827f20a9HighlightsLiterature supports standardized peripheral intravenous catheter dressings.A dressing kit was developed and distributed to a pediatric sedation unit.After education and kit introduction, staff feedback was generally positive.Future recommendations include kit introduction to all hospital units. ................
................

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

Google Online Preview   Download