Hello all! For my CNS program I have to design a quality improvement project. On the unit in which I currently work, our IV catheter/tubing change date compliance is very poor (about 20-30%)- most of the time they are not even labeled with a date at all. Our policy is tubing is to be changed every 72 hours while catheters can be changed within 72-96 hours. I have come up with a few ways to improve this percentage, just looking for some input/other ideas.
1. Tape the tubing labels to the IV admin set (they do not come in the set and the labels are currently in a completely different room than the IV admin sets)
2. Implement a checklist for RN's to complete (Iv/tubing labeled, functioning properly, etc. There is no good place in our charting system to do this)
3. Require RN's to write IV and tubing change dates on the pt's white board (currently some RN's write the catheter change date, but not all)
4. Have an inservice to educate staff (a lot of RN's aren't sure what the policy actually is.)
Any ideas/criticism is appreciated!
Feb 14, '14
My first thought is why are you changing the tubing every 72 hours and what kind of tubing? Are we talking continuos, secondary, intermittent etc etc? What was running through that line? ABX, TPN, fluids? I would first explore of the standards of practice from the INS and see what the CDC says on the topic.
Why change the tubing at all? If it is related to infection prevention then what are your infection rates? You probably will not be able to pull up a bacteremia report relating to PIVs but I am sure you can access your facility CLABSI rate. What do the studies say about infection rates and IV tubing? Is there any research?
Can you run a cost/benefit analysis on changing IV tubing rates v. infection rates? Maybe the most cost effective approach is to change the tubing everyday, or maybe it is to change it every 96 hours? How much does your tubing cost?
As far as an actual intervention, adding more tasks and more checklists will not improve adherence to existing policy. You have to create a solution that requires a very minimum of effort along with strenuous educational reinforcement. Just teaching nurses the difference between a vesicant and an irritant, extravasation and an infiltration, pH, Osm, and the myriad of other infusion related factors is difficult enough.
Think simple, fast, and easy. What is an easy way for anyone to walk into the patient's room know instantly when that tubing needs to be changed?
More research, more assessment of the situation, more analysis of the problem, and more thought on a simple solution for a complex issue.
Feb 17, '14
Thank you Asystole! I have no idea what to do for my project anymore. After delving into the research I've found that the current CDC guidelines regarding IV catheter change dates may be a little behind the times. Some compelling research within the last few years suggests that changing IV's when clinically indicated only did not show an increase in blood stream infections, increased pt satisfaction, and reduced facility costs. I have emailed my professor to see about modifying my original project. We were supposed to "Identify something in need of improvement in our current work setting and develop a QI plan using the model for improvement and propose changes to test and implement." I think the research is very compelling and I would like to use it somehow, but the only way for me to do that would be to hypothetically change the current policy and go from there regarding changes to test, etc. Thank you so much for the response and input. This is my first semester of grad school and I am feeling extremely overwhelmed!
Feb 17, '14
What were the CDC recommendation classes?
This new research, does it have a significant population with a diverse population to support it's findings? Did they specify what was being infused? Are they continuous or intermittent infusions? Primary or secondary? Meta-analysis?
How many tubing sets would you have to save in order to equal the average cost of a single CLABSI, should one result?
To be honest to you, your topic is a rather hotly contested topic at the current time. I would personally look for a topic with lots of research and hopefully a meta-analysis behind it. It would be a very rocky road to write about a topic that is so controversial.
Pro-tip: Pick a topic with TONS of research behind it because you can likely expand upon the topic in later assignments/classes. I like to look for meta-analysis first, examine what topics are available, and then choose from there. Find a single MA and you just sourced a ton of research.
Feb 17, '14
I have kind of decided to "botch" the tubing idea as there is not much evidence regarding that, however there is quite a bit of research specifically about the IV catheter change dates, including a meta-analysis. It was updated in 2013- "Clinically-indicated replacement versus routine replacement of peripheral venous catheters" published by Wiley.
The CDC recommends-
Replacement of Peripheral and Midline Catheters
There is no need to replace peripheral catheters more frequently than every 72-96
hours to reduce risk of infection and phlebitis in adults [36, 140, 141]. Category 1B
No recommendation is made regarding replacement of peripheral catheters in adults
only when clinically indicated [142
144]. Unresolved issue
-----I am not exactly sure what "unresolved issue" means. I've read that the CDC needs more information about this before they can make a final recommendation? I know that in my current work setting the policy is to change the IV every 72-96 hours regardless of whether it works or not.
---I am ultimately stuck. I have already done a QI project in undergrad regarding hourly rounding. I can not think of anything else on our unit specifically that could use improvement that as nurses we have the ability to change (obviously I can't improve staffing, change policies, etc.) I was under the impression that for this project we had to find something that nursing interventions could specifically improve. Our fall scores have improved, pt satisfaction is up, and our pressure ulcer rates are below standard. I am racking my brain to try to think of something worth writing about. Thank you again Asystole.
Feb 17, '14
An unresolved issue is simply a controversial issue which no hard evidence as to the best practice.
PIV changes is a good topic, heparin flushing of central lines, having IV teams is another.
What about reducing CLABSI rates? You can do a cost/benefit analysis of scrubbing the NAP with alcohol v. using alcohol impregnated caps and reducing CLABSIs?
Apr 19, '15
OneDay, I realize it is now April and I am not sure where you are with your project. I just came across your posting and wanted to comment. Don't get caught up in what others are saying in terms of what the evidence is showing. Your project is not about revising P&P to reflect the evidence. Your project is about what the current P&P dictates and compliance to the current P&P, do not lose sight of that.