Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Lui CW (1), Chu ST (1), Chung SW (2), HO OY (2), Leung SH (2), Li CY (2), Lee WS (1)
Affiliation :
(1) Accident and Emergency Department, United Christian Hospital, (2) Department of Medicine & Geriatrics, United Christian Hospital
Introduction :
PIVC is frequently performed on patients of various diseases for treatment in the emergency department, taking the Accident and Emergency Department of the United Christian Hospital (UCH AED) as an example, everyday UCH AED performs around 100-150 PIVC procedures. Unlike recent international studies, there is no performance indicator adopted in Hong Kong for PIVC, the local success rate of PIVC remains uncertain. However, an unsuccessful attempt often has negative impacts including patient dissatisfaction. It is also important to identify any knowledge or performance gap by local performance reviews. There are methods suggested in literature to improve the success rate, yet, they are not implemented in our local practice. The project is introducing measures to improve the performance of PIVC in UCH AED.
Objectives :
- To evaluate the baseline PIVC success rate in ED - To improve the PIVC success rates in ED by 1) Staff training on insertion technique 2) Introducing warming pack application 3) Use of Cue card for PIVC recommended practice - To identify a review mechanism on PIVC performance
Methodology :
The improvement program was developed following the Focus-Analyze-Develop-Execute (FADE) model for Continuous Quality Improvement. The baseline PIVC success rate was assessed by evaluating the success rate of random PIVC episodes performed by AED RNs and phlebotomists, and reviewed by a team of 8 APNs as performance reviewers. The PIVC success rate is measured by successful peripheral line insertion during the first attempt and within 2 attempts. Staff training on insertion technique Production of a 30-minute training video in Cantonese, addressing current PIVC performance gaps, vein assessment, and evidence-based measures to enhance venodilation and vein visualization for AED RNs and phlebotomists. Standardized warming pack application Standardization by utilizing double zipper plastic bags containing 39-42℃ warm water with a 5-minute application to the targeted PIVC area. Use of Cue card for PIVC recommended practice PIVC cue cards were developed and posted on every injection trolley at UCH AED, providing practical tips and measures to enhance the success rate as a reminder for practitioners. Practitioner performance was assessed after completing the training. Evaluations of patient and staff outcomes were conducted based on pre and post comparisons using self-designed and validated measurement tools( 'PIVC Performance Review Form' & 'Staff knowledge Test on Enhancing PIVC Success Rate'.
Result & Outcome :
The UCH AED successfully implemented all action plans, with the staff training achieving a 72.5% coverage of targeted staff. The overall first-time PIVC success rate increased to 80% from the baseline of 76% (N=50 PIVC episodes, convenience sampling), with a significant increase in PIVC success within 2 attempts to 94% from 86%. Staff＇s compliance with recommended PIVC practices rose from 78% to 96%, and staff’s knowledge levels improved from a mean score of 69.8 to 94.5/100 (N= 47 PIVC practitioners). The introduction of a warming pack for venodilation was well-received, with positive feedback from both practitioners and patients, leading to successful challenging IV procedures. This pilot project serves as a stepping stone for a larger hospital-wide initiative, promoting clinical excellence to regular review and enhancement on PIVC success rate.
