IV Quality Improvement

Quality Improvement Data

Intravenous therapies are at times a necessary evil in the clinical setting today, I have never met a patient that was excited about receiving an intravenous line for medical therapies. The insertion of an IV is traumatic, painful, and intimidating in many clinical situations; there is no better way to destroy the trust your patient has in you after many failed IV attempts and even more seriously phlebitis related to a poor IV insertions. IV therapy is needed for procedures, medication administration, fluid resuscitation, and body nutrition. IV therapy is a necessary component of the medical management of many illnesses, but before that we need to have competent staff initiating IV therapies to ensure patient safety.

Variables are often too many to count when it comes to intravenous therapy and as new variables arise, new quality improvement measures need to be taken. When evaluating data based standards the issues that arise are clinical judgement, assessment skills, IV start skills or confidence, placement, and purpose. Many of the nurses that I come into contact with are very new and have limited confidence at this point in their career and the take any instruction as negative criticism. These nurses have not yet had the opportunity to build their clinical judgement foundation, assessment skills, or confidence. These nurses use skills taught to them at school and during clinical rotations to start IVs and many go by appearance rather than feel. Another issue that comes to mind is the placement of the IV, these newer nurses going by appearance rather than feel often start IVs in the hand. Hand IVs are typically more unstable related to the movement in the client’s hands and the brushing it up against objects. Purpose is closely related to plan of care, what procedures will this patient require and where is the proper place based on those procedures for an IV?

Implementing a quality improvement plan can be both time consuming and costly to an organization, there is an art to performing a plan and implementing an outcome. My action plan would

This could be overcome by having the nurse finish orientation first and then have these shift completed by their 90 day evaluation. This would also make it so the shifts could be worked around patient census as well. The paging team could be busy at the time of notification and feel over worked by having to start other people’s IVs. The IV start team could be financially compensated for caring the pager and make an extra dollar per hour when they needed to be on call during their shift. The email system could be overlooked when going through email notifications and could be offered as subscribe only setting to ensure the people getting the emails were looking for them. Procedure books are costly and could be misplaced by other staff members and not be noticed for a period of time. Health unit clerk duties which already include a shift check list could have the verification of the procedure book added to their shift duties. Phlebitis scales would add to the charting requirements but a reduction in phlebitis and infiltrations could be shown to motivate the nursing staff into accepting the new charting