References
Implementation of the I-DECIDED® tool for PIVC assessment and decision making: discussion paper
Abstract
HIGHLIGHTS
PIVCs often cause pain, irritation, or infection.
Regular and careful catheter checks can decrease complications and improve patient outcomes.
Implementation of the I-DECIDED® tool led to fewer idle catheters and complications.
We present ideas for implementing the tool and how to overcome some common barriers.
Introduction:
Peripheral intravenous catheter (PIVC) assessment and decision making should be evidence based to minimize risks and enhance patient care. Exploring implementation strategies from successful outcome studies can raise health care professionals' awareness, boost adherence to evidence-based protocols, and elevate PIVC care standards.
Aim:
To describe the implementation of the I-DECIDED® device assessment and decision tool for PIVC management in the Australian and Brazilian contexts.
Methods:
The Promoting Action on Research Implementation in Health Services (PARIHS) framework (evidence, context, facilitation) was used to prospectively plan the implementation of the tool in adult inpatient units in Australia and to retrospectively analyze the implementation of the tool in a pediatric inpatient unit in Brazil. Similarities and differences in the implementation studies were explored.
Results:
Implementation of the tool in Australia and Brazil demonstrated that prevention and early detection of PIVC complications is achievable with standardized assessment and decision prompts. Both contexts witnessed a reduction in idle PIVCs, decreased insertion site complications, improved dressing quality, and significant improvements in documentation following implementation. Common implementation strategies included champions, education, badge cards, and posters. Enabling flexibility and context-specific education strategies was essential.
Conclusion:
Standardization of PIVC assessment and decision making using the I-DECIDED® tool reduced the prevalence of idle catheters and complications in Australia and Brazil. Implementation of the tool in different contexts confirms its utility and relevance for PIVC management in diverse health care settings. Promotion and adoption of the tool as a PIVC management bundle could increase patient safety and reduce health care costs.
In 2021, the Australian Commission on Safety and Quality in Health Care released a national Clinical Care Standard to promote safe use of peripheral intravenous catheters (PIVCs).1 This was in response to overwhelming evidence that PIVC outcomes globally are unacceptable.2 As Australian health care providers are expected to implement and comply with the standard, quality improvement efforts are underway in many settings to improve PIVC care and outcomes.
In Brazil, the National Health Surveillance Agency (ANVISA) is responsible for promoting activities relevant to the protection of the population's health. In 2017, ANVISA published Measures for Prevention of Healthcare-Associated Infections; this guide presents evidence-based measures, adjusted to the reality of Brazilian health care, that must be taken to mitigate health care–associated infections in health care facilities. It includes recommendations to prevent bloodstream infections caused by PIVCs.3
A historic perception of PIVCs as low risk has led to suboptimal care.4 Evidence over the past decade confirms PIVCs pose a bloodstream infection risk like central venous catheters when volume of usage is considered.5,6 Therefore, PIVC assessment and decision making must be evidence based to reduce risks and improve patient care.7,8
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