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217 Intravenous Catheter Care in Non-Intensive Care Units: Education and Performance Feedback Lead to Sustained Improvements in Process Measures

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Mohamad G. Fakih, MD, MPH , St John Hospital & Medical Center, Grosse Pointe Woods, MI
Karen Jones, RN , St John Hospital & Medical Center, Grosse Pointe Woods, MI
Janice Rey, MT, (ASCP) , St John Hospital & Medical Center, Grosse Pointe Woods, MI
Dorine berriel-Cass, RN, MA , St John Hospital & Medical Center, Grosse Pointe Woods, MI
Ann Hendrich, RN, PhD , Ascension Health, St Louis, MO
Susan Szpunar, MPH, DrPH , St John Hospital & Medical Center, Grosse Pointe Woods, MI
Louis D. Saravolatz, MD , St John Hospital & Medical Center, Grosse Pointe Woods, MI

Background: Complications related to intravascular catheters (IVCs) are associated with significant morbidities.

Objective: To evaluate the effect of education and feedback to nurses on process measures to improve IVC care in the non-intensive care setting.

Methods: We implemented a process to improve the care of IVCs in 10 non-intensive care units. This included 4 periods of 3 months: baseline, followed by a staggered educational intervention of nurses initially intervening in 5 units (group A) and 5 units serving as control (group B). Both groups had formal education followed by feedback on performance over time (Table). Process measures were evaluated twice monthly and feedback was directly given to the nurse and monthly to the unit manager.

Results: Of 4924 IVCs evaluated, 90.3% were peripheral. There were no significant differences in the baseline characteristics of groups A and B. The intervention was associated with significant improvements in processes (Table), particularly the condition of the IVC dressing, and the nurses' demonstration of scrub the hub (simulation of medication infusion). These improvements were sustained with continued performance feedback. Documentation in records dropped early in the intervention period, and was associated with new implementation of electronic records. Peripheral intravenous (PIV) phlebitis rates did not significantly change.

Conclusions: Compliance with the processes to reduce the risk of IVC may be achieved and sustained by education and real time feedback to nurses.

Table: Compliance with Processes and Outcomes before and during Intervention Periods for Groups A and B

Baseline (%)

Intervention Period 1 (%) Group A education and feedback

Intervention Period 2 (%)

Groups A feedback

Group B education and feedback

Intervention Period 3 (%) Groups A and B feedback

2-sided p value (Comparing baseline to intervention periods 2 and 3)

Documentation dressing

Group A

Group B

217 (38.8)

225 (37.3)

388 (60.4)

209 (34.9)

374 (57.6)

352 (55.4)

367 (59.2)

351 (58.7)

<0.001

<0.001

Documentation records

Group A

Group B

488 (87.3)

496 (82.3)

474 (73.8)

364 (60.9)

486 (74.9)

462 (72.8)

512 (82.6)

473 (79.2)

<0.001

<0.001

Dressing intact

Group A

Group B

463 (86.4)

505 (90.5)

549 (95.1)

507 (92.2)

540 (95.4)

542 (95.1)

541 (95.2)

483 (95.1)

<0.001

0.002

Compliance with duration-PIV use

Group A

Group B

493 (92.0)

505 (90.5)

557 (96.4)

508 (92.4)

546 (96.5)

542 (95.1)

537 (94.5)

483 (95.1)

<0.001

0.002

Availability of alcohol wipes and hub caps with nurse

Group A

Group B

98 (63.6)

98 (59.8)

105 (73.9)

71 (47.0)

103 (80.5)

106 (72.1)

56 (78.9)

44 (72.1)

0.003

0.04

Compliance  with simulation of scrub the hub

Group A

Group B

75 (50.0)

86 (57.3)

143 (95.3)

98 (65.3)

135 (99.3)

121 (90.3)

173 (96.1)

143 (94.1)

<0.001

<0.001

PIV Phlebitis

Group A

Group B

12 (2.2)

15 (2.7)

16 (2.8)

31 (5.6)

16 (2.8)

15 (2.6)

9 (1.6)

11 (2.2)

0.36

0.8