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Implementing the I-DECIDED clinical decision-making tool

Having been lucky enough to work on an IV team that is all hands on with every peripheral intravenous catheter (PIVC) the hospital every day, I have seen first hand how much being actively involved in decision making can be, how important daily  assessment is to good outcomes, and how knowledge influence clinical decisions to follow best evidence-based practice.  For facilities that do not have the luxury of a dedicated vascular team decision making tools are key.

Anyone that has been in vascular access or acute care nursing has heard the phrase “just in case line” and in a study by Ray-Barrue et al the discussion of “the redundant line” continues with an evidence-based  method to help reduce IV complications with a decision making tool titled I-DECIDED (2018). One of the greatest pieces of I-DECIDED is the second e “evaluate and educate,” encouraging patient involvement in care of PIVCs.  Patients are always going to be their own best advocate and if a nurse can teach a patient that a PIV is theirs and they have a right to discuss need, assess it, and request a scrub with a nurse then they can be empowered in their own care and help decrease complications such as blood stream infections.  This study helps to chip away at those lines that are not being used and a portal for infection for patients and a money pit for facilities.

Sarah Polo RN, MSN, CRNI

Read this article for yourself:

Ray-Barruel G, Cooke M, Mitchell M, et al. Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study BMJ Open 2018;8:e021290. doi: 10.1136/bmjopen-2017-021290

ABSTRACT:

Introduction Millions of acute care hospital patients need a peripheral intravenous catheter (PIVC) each year. However, up to half of PIVCs remain in situ when not being used, and 30%–50% of intravenous (IV) catheters develop complications or stop working before treatment is finished, requiring the insertion of a new device. Improved assessment could prompt timely removal of redundant catheters and prevent IV complications. This study aims to validate an evidence-based PIVC assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice.

Methods and analysis The protocol outlines a prospective, multicentre, mixed-methods study using an interrupted time-series (multiple measures preintervention and postintervention) implementation at three Australian hospitals between August 2017 and July 2018. The study will examine the effectiveness of the I-DECIDED assessment and decision-making tool in clinical practice on prompting timely PIVC removal and early detection of complications. Primary outcomes are prevalence of redundant PIVCs (defined as device in situ without a clear purpose), IV complications (occlusion, dislodgement, infiltration, extravasation and phlebitis) and substandard dressings (loose, lifting, moist or soiled); device utilisation ratios; and primary bloodstream infection rates. Secondary outcomes including staff barriers and enablers to PIVC assessment and removal, patient participation, documentation of PIVC assessment and decisions taken to continue or remove the PIVC will be recorded. Using the Promoting Action on Research Implementation in Health Services framework, we will undertake staff focus groups, bedside patient interviews and PIVC assessments and chart audits. Patients aged 18 years or more with a PIVC will be eligible for inclusion.

Ethics and dissemination Ethical approval from Queensland Health (HREC/17/QPCH/47), Griffith University (Ref No. 2017/152) and St Vincent’s Health and Aged Care Human Research and Ethics Committee (Ref No. 17/28). Results will be published.

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