I-DECIDED®—a decision tool for assessment and management of invasive devices in the hospital setting
Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.
Approximately 420 million patients annually are admitted to hospital (World Health Organization, 2019). A US prevalence study identified 91% of hospitalized adults had at least one invasive device, such as central venous access device (CVAD), peripheral intravenous catheter (PIVC), or indwelling urethral catheter (IUC), with many patients requiring multiple devices concurrently (Chenetal, 2021). Despite the high prevalence of devices, this practice is not risk-free. Invasive devices breach the normal protective mechanisms of the body (eg skin, mucous membranes) and pose a risk for introduction of microorganisms, potentially leading to local or bloodstream infection (Schreiber et al, 2018). Furthermore, many devices are left in when no longer medically indicated, placing patients at risk of healthcare-associated complications and infection, increased morbidity and mortality, extended hospital stay and financial burden for the healthcare system, and personal and economic consequences for the patient (Becerra et al, 2016; Meddings et al, 2014; Patel et al, 2018; Xiong and Chen, 2018).
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