404 / A multifaceted intervention to reduce short peripheral venous catheter-related adverse events

SPAIN
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Handling of catheters
Surgical / Invasive procedures There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
The insertion of peripheral vein catheter (PVCs) is the most frequently performed invasive procedure in hospitals. It is estimated that over 150 million peripheral catheters are inserted annually in the United States. Unfortunately, this procedure is not risk free, and PVC-related adverse effects, such as peripheral vein phlebitis (PVP) and infiltration occur in up to 30% of inserted PVCs.
Paradoxically, reported interventions targeted to reduce PVC-related adverse events are scarce. We report the development, implementation and results of a successful hospital-wide multifaceted strategy aimed to reduce adverse events to PVC, mainly PVP and PVC-related BSI over a period of 7 years.
Description of the Patient Safety Practice
 
Setting: Delfos Hospital is a private 200-bed hospital with teaching nursing activity with about 12,000 admissions and 50,000 patient-days each year. Almost 90% of the rooms are single. There are eight medical-surgical wards and a polyvalent intensive care unit (UCI). A Nosocomial Infection control Unit (NICU) was created in 2002 as part of the Infection Committee, formed by a full-time specialist in epidemiology and infectious diseases and an infection control nurse.
Study design: Patients with short (length < 3 inches) PVC inserted during 2004 to 2011 period were included. We used a quasiexperimental design in which the impact of interventions was measured by using control charts.

Interventions: a) Preintervention period (January 2004 throughout February 2005) b) Intervention period (March 2005 throughout December 2011) which include: a) Education and training b) Bundle for appropriate maintenance of PVC : Daily monitoring of phlebitis; withdrawal of idle catheter, catheter exchange policy (every 5 days) c) Surveillance of PVC-related adverse every was conducted every November since 2005. Feedback was provided to directors, nursing supervisor department, physicians and ward nurses.
Outcomes variables: The main outcome variables were quarterly dynamics of suspected PVC-related BSIs and incidence of PVP (proportions and rates) in both periods. As secondary outcomes, we measured quarterly health care-acquired Saureus BSI and quarterly CVC-related BSI during 2004 to 2001.
Results:
During the preintervention period, a prevalence PVP surveillance was performed (July 2004). In this survey, 120 patients and 180 PVC inserted on wards were followed (896 catheters-days) and 34 PVP were detected (23.3 per 100 catheters) During the intervention period, 7 period prevalence studies were conducted and 2,145 catheters inserted on wards in 1511 patients were prospectively evaluated. During this period, 259 PVP were detected with a median of 12,1 PVP per 100 catheters. A significant incidence reduction in PVC-related BSIs and health care-acquired Staphylococcus aureus BSIs was also achieved.

Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
Gabriel Mestre, Cristina Berbel, Purificación Tortajada, Margarita Alarcia, Roser Coca, Mari Mar Fernández, Gema Gallemi, Irene García, Mari C.Aguilar, Jesús Rodriguez-Bano, Jose A.Martínez Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: A quasiexperimental cohort study. American Journal of Infection Control 2012.
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
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List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Gabriel Mestre
Country: SPAIN
Organisation: Hospital Delfos, Catalonia
E-mail: mestre.ucin@delfos.cat
Phone: 650 22 79 21
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