The safe insertion of peripheral intravenous catheters: a mixed methods descriptive study of the availability of the equipment needed

Antimicrobial Resistance and Infection Control

Charles Vincent⁴  Alison Holmes²  Matthew Cooke³  Vashist Deelchand⁴  Bryony Dean Franklin¹ 

[1]UCL School of Pharmacy, London, UK

[2]Centre for Infection Prevention and Management, Imperial College, London, UK

[3]Warwick Medical School, University of Warwick, Coventry, UK

[4]Imperial Centre for Patient Safety and Service Quality, Imperial College, London, UK

关键词: Systems reliability;    Hospital acquired bacteraemia;    Care bundles;    Equipment;    Patient safety;    Cannulation;   

Others  :  791273
DOI  :  10.1186/2047-2994-1-15

 received in 2012-03-05, accepted in 2012-03-29,  发布年份 2012

【 摘 要 】

Background

Intravenous cannulation is undertaken in a high proportion of hospitalised patients. Much international attention has been given to the use of care bundles to reduce the incidence of infection in these patients. However, less attention has been given to the systems required to ensure availability of the equipment needed to support these care bundles. Our objectives were to assess how reliably the equipment recommended for a peripheral intravenous care bundle was available for use, and to explore factors which contributed to its non-availability.

Methods

We studied 350 peripheral cannula insertions in three NHS hospital organisations across the UK. Staff inserting cannulae were asked to report details of all equipment problems. Key staff were then interviewed to identify the causes of problems with equipment availability, using semi-structured qualitative interviews and a standard coding frame.

Results

47 equipment problems were recorded during 46 of 350 cannulations, corresponding to a reliability of 87%, or 94% if problems with sharps disposal were excluded. Overall reliability was similar in all three organisations, but the types of problem varied. Interviews revealed a variety of causes including issues associated with purchasing policies, storage facilities, and lack of teamwork and communication in relation to reordering. The many human factors related to the supply chain were highlighted. Often staff had adopted work-arounds to deal with these problems.

Conclusions

Overall, 87% of cannulations had the correct and functional equipment available. Different problems were identified in different organisations, suggesting that each had resolved some issues. Supply chain management principles may be useful to support best practice in care bundle delivery.

【 授权许可】

   
2012 Franklin et al.; licensee BioMed Central Ltd

【 参考文献 】

• [1]Maki DG: Improving the safety of peripheral intravenous catheters. BMJ 2008, 337:a630.
• [2]Boyd S, Aggarwal I, Davey P, Logan M, Nathwani D: Peripheral intravenous catheters: the road to quality improvement and safer patient care. J Hosp Infect 77:37-41.
• [3]Centers for Disease Control and Prevention: Guidelines for the Prevention of Intravascular Catheter-Related Infections. 2011.
• [4]Department of Health: High Impact Interventions. 2010. [ http://hcai.dh.gov.uk/whatdoido/high-impact-interventions/ webcite] [accessed 23 February 2012]
• [5]American Institute of Healthcare Improvement: Protecting 5 million lives from harm. Institute of Healthcare Improvement, Cambridge MA USA; 2006.
• [6]Resar R: Making non catastrophic health care processes reliable: Learning to walk before running in creating high-reliability organizations. Health Services Res 2006, 41(4 part 2):1677-1689.
• [7]Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM: Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004, 32(10):2014-2020.
• [8]Galpern D, Guerrero A, Tu A, Fahoum B, Wise L: Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery 2008, 144(4):492-495.
• [9]Muto C, Herbert C, Harrison E, Edwards JR, Horan T, Andrus M, Jernigan JA, Kutty PK: Reduction in central line-associated bloodstream infections among patients in intensive care units - Pennsylvania, April 2001 - March 2005. JAMA 2006, 295(3):269-270.
• [10]Department of Health: High Impact Intervention. Peripheral Intravenous Care Bundle. London, UK: Department of Health; 2007.
• [11]Department of Health: High Impact Intervention. Central Venous Catheter Care Bundle. London, UK: Department of Health; 2007.
• [12]Burnett S, Franklin BD, Moorthy K, Cooke M, Vincent C: How unreliable are clinical systems in the UK NHS, why and what impact does this have? A report synthesising primary research into systems reliability instudy of seven NHS organisations. BMJ Qual SafIn press
• [13]Vincent C, Taylor-Adams S, Stanhope N: Framework for analysing risk and safety in clinical medicine. BMJ 1998, 316:1154-7.
• [14]Golder M, Chan C, O’Shea S, Chrystie I, French G: Potential risk of cross-infection during peripheral–venous access by contamination of tourniquets. Lancet 2000, 355:14.
• [15]Rourke C, Bates C, Read R: Poor hospital infection control practice in venepuncture and use of tourniquets. J Hosp Infect 2001, 49:59-61.
• [16]Kyratsis Y, Ahmad R, Holmes A: Understanding the Process of Innovation Adoption in 12 NHS trusts – technology selection, procurement and implementation to help reduce HCAIs. Report to the Department of Health 2010. [ https://www.wp.dh.gov.uk/hcai/files/2011/07/Technology-Adoption-Study_DH-Approved_FINAL-EXECUTIVE-SUMMARY_07-Feb-2011.pdf webcite] accessed 23 February 2012