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CUH IV Services for Nursing conference May 2016 1 INTRODUCTION, IMPLEMENTATION AND AUDIT OF PERIPHERAL VENOUS CANNULA CARE BUNDLES IN CUH What is a Care bundle? 2 A Care Bundle" is a group of evidence -based care components for

  1. CUH IV Services for Nursing conference May 2016 1 INTRODUCTION, IMPLEMENTATION AND AUDIT OF PERIPHERAL VENOUS CANNULA CARE BUNDLES IN CUH

  2. What is a Care bundle? 2  A “Care Bundle" is a group of evidence -based care components for a given disease/intervention that, when executed together, may result in better outcomes than if implemented individually.  It is a means to ensure that the application of all interventions is consistent for all patients at all times. CUH IV Services for Nursing conference May 2016

  3. Why introduce a Peripheral venous Cannula (PVC) care Bundle? 3  Incidence of blood stream infections associated with use of IV lines 42% (Quality and Safety Directorate 2013).  Quality and Safety Directorate – Suggests that up to 70% of line associated infection is preventable.  Care bundles based on best practice have been proven to reduce risk of Health Care Associated Infections.  Ensures that best practice is implemented in all wards consistently and if necessary, targets education to those areas with greatest need.  Allows units to demonstrate that PVC care on their ward is in line with best practice. CUH IV Services for Nursing conference May 2016

  4. Why introduce a PVC care Bundle? 4  HIQA Infection Control Standards 2008 Standard 8 Device related infections are reduced or prevented  Criteria 8.1 “the implementation of a structured set of processes that have been proven to improve outcomes, (e.g. bundles) for the prevention of invasive medical devices related infections”. In 2015 HIQA focused on implementation of Care Bundles in their unannounced inspections . CUH IV Services for Nursing conference May 2016

  5. CUHG PVC care bundle 5 1. All PVCs in situ must be required and in use. 2. Any PVC with signs of phlebitis/infiltration should not be in use. 3. All dressings must be clean dry and intact. 4. All PVCs in use should be in situ no longer than 96 hours. 5. Documentation should be in line with hospital policy. 6. Hand Hygiene must preformed be before and after all procedures with the PVC. CUH IV Services for Nursing conference May 2016

  6. Implementation on a ward 6  Link nurses who wish to get involved in the care bundle process are identified.  Link nurse and CNM2 IV Services conduct baseline audit of current standard of care.  Results of audit presented by link nurses to CNM and all clinical staff on the ward.  Link nurse then informs all clinical staff involved in IV therapy of elements of care that are considered essential to deliver optimum care.  When all staff informed re-audit.  Audits preformed monthly, results and recommendations for improvement are fed back to staff through notice boards and ward meetings etc. CUH IV Services for Nursing conference May 2016

  7. Audit of compliance with the PVC care bundle 7  All patients on the ward with a PVC in situ are assessed for compliance with the 6 elements of the care bundle using adapted HPSC care bundle audit tool.  The PVC care bundle summary sheet is then completed and displayed on staff notice board. Results are discussed with CNM and ward staff. Following assessment;  The PVC will be removed if ;  It is not required.  Phlebitis/infiltration is present.  It is in situ longer than 96 hours (it may remain in-situ if patient has poor access and there is no signs of phlebitis/infiltration ). CUH IV Services for Nursing conference May 2016

  8. PVC in situ 8 PVC PVC Phlebitis Dressing PVC Docume Hand in situ in Use score intact < 96hrs ntation hygiene <2 hrs complet 1 e? Yes Yes Yes Yes Yes Yes PVC PVC in Phlebitis Dressing PVC Docume Hand in situ Use score intact <96 hrs ntation hygiene <2 complete 2 ? No - - - - Remove PVC CUH IV Services for Nursing conference May 2016

  9. Phlebitis Score 9 PVC PVC Phlebitis Dressing PVC Docume Hand in situ in Use Score intact < 96 hrs ntation hygiene <2 complet 3 e? Yes yes Yes Yes Yes Yes PVC PVC in Phlebitis Dressing PVC Docume Hand in situ Use Score intact <96hrs ntation hygiene <2 hrs complete 4 ? Yes No - - - Remove PVC CUH IV Services for Nursing conference May 2016

  10. 10 Phlebitis Score Chart  Insertion sites should be checked at least daily for signs of inflammation and document using VIP score CUH IV Services for Nursing conference May 2016

  11. PVC dressing clean, dry and 11 intact? Pictures with permission from IV team Rotherham Trust CUH IV Services for Nursing conference May 2016

  12. 12 Hand Hygiene Moment 2--before an aseptic procedure  Hand hygiene before and after contact with PVC.  Hand Hygiene before drawing up IV medications.  Practice observed during preparation and administrating of IV medication/infusions to assess if hand hygiene preformed. CUH IV Services for Nursing conference May 2016

  13. CUH Standard 13  Target 100% for all PVC’s in all patients  All 6 elements must be Yes to pass the bundle.  Example 10 PVC’s in situ  5 PVCs all yes  1 PVC not in use.  1 PVC dressing dirty and loose  3 PVCs no documentation.  50% compliance is the ward score CUH Policy conduct monthly audits however if compliance<80% repeat audit in 2 weeks. CUH IV Services for Nursing conference May 2016

  14. Implementation in CUH 14  September 2011,PVC care bundle first introduced by CNM2 IV Services.  May 2013 following HIQA visit, Care Bundle working group set up.  January 2014 PVC monitoring chart updated to include the PVC care bundle, the Visual infusion Phlebitis score and extended dwell time.  December 2014,Policy on the introduction, implementation and monitoring of PVC Care Bundles in CUHG finalised and available on QPULSE . CUH IV Services for Nursing conference May 2016

  15. Results 2015 15 All clinical areas visited by IV Services.  13 Clincal areas achieved >80% compliance (of which 11 achieved 100%).  2 clinical area just started-baseline audit 7- 38%.  4 clinical areas audits not conducted monthly, results range from 57%-77%. Main issues, PVCs not in use, soiled/loose dressings and documentation. CUH IV Services for Nursing conference May 2016

  16. New Guidelines not yet implemented. 16  Routine removal not required- removal only when clinically indicated. HOWEVER  Twice daily assessment and documentation of PVC care required. Therefore  CUH policy and chart will have to be reviewed and updated. CUH IV Services for Nursing conference May 2016

  17. Conclusion 17  Audits have shown that the implementation of PVC care bundles has improved the management of PVCs in CUH and enhanced patient care.  Feedback from some clinical areas is very positive many see it a worthwhile quality initiative.  Feedback for other areas- difficult to get time to conduct audits.  Maintaining the standard requires ongoing commitment and surveillance with compliance.

  18. References 18  SARI (2009) Prevention of Intravascular catheter-related infection in Ireland. SARI Prevention of Intravascular catheter related infection sub-committee. Health Protection Surveillance Centre. Dublin. Updated September 2014.  Jackson A (1998).A battle in vein – Infusion Phlebitis. Nursing times. Vol. 94; No. 4.; Pg. 68-70.  Resar R, Griffin FA, Haraden C, Nolan TW. Using Care Bundles to Improve Health Care Quality . IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012. (Available on www.IHI.org)  Health protection Scotland (2009) updated 2012 www.HPS.scot.nhs.uk/haiic/ic/pvccarebundle.aspx  Royal College of Nursing (2010) Standards for infusion therapy. Available at www.rcn.org.uk

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