Reducing pokes in pediatrics through nurse-driven interventions
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Ashley Servi, DNP, RN, PCNS, CPN; Ashley Bequest-Roeder, BSN, RN; Lia C. Bradley, MSN, RN, FNP-BC, CNL-BC
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Poster presentation
Session I presented Wednesday, October 2, 10:00-11:00 am
Purpose: Nurses start 700-900 peripheral intravenous catheters (PIVs) every month in the ED. The challenges of dehydration, critical illness and/or chronic medical conditions may increase the number of ‘pokes’ to a patient. Standardizing care for kids with diabetes was needed. By utilizing advanced equipment, and initiating protocols, we aimed to reduce pokes to our patients and improve time to treatment. This quality improvement initiative had two aims: reduce unnecessary PIVs in diabetics and reduce time to treatment with nurse protocol, and to reduce PIV pokes, through use of advanced equipment.
Design: The strategy for quality improvement included utilizing evidence from literature in adults and pediatrics, collaborating with providers and identifying support measures allowed us to successfully implement the new interventions. Part of the implementation included development of standardized procedures and discussion at local ED multidisciplinary clinical practice committee. The three new interventions implemented include: using advanced vein viewing device, using ultrasound for guiding IV placement, and using a nursing point-of-care (POC) protocol for diabetic patients. It was determined to trial the POC protocol with triage nurses for more than six months. Training for these nurse-based interventions include pre-course videos, literature review, hands-on instruction, quizzes and competency demonstration. Chart audits, feedback and outcome data was provided on a monthly basis.
Setting: The interventions took place at a pediatric emergency department and Level 1 trauma center with annual volume of ~70,000 patients.
Participants/Subjects: Subjects were patients 18 years and younger, seen in the ER from January 2015 through November 2018.
Methods: Statistical process control charts were utilized to measure the impact of our interventions. Pre-implementation data of diabetes patients were collected from January 2015 through November 2015, and the post-implementation data were collected from December 2015 through October 2018. Chi square analysis was used to determine if the proportion of PIVs placed and pre- and post- initial POC tests were statistically significant (a= 0.05). Retrospective analysis of patients with PIVs were evaluated for equipment used and successfulness from 2015 to November 30, 2018.
Results/Outcomes: Outcomes show a 49% reduction in unnecessary PIVs for diabetic patients due to utilization of the nursing POC protocol. In 18 months, there has been 62% reduction in time to DKA treatment, with 40 minute reduction in ED length of stay in patients without DKA. The cost savings for these unnecessary PIVs is estimated around $20,000. In 2017, the vein viewer was used 1,411 times (9.8% of PIV starts), and ultrasound was used 16 times. By 2018, the use of vein viewer has increased to over 3,500 times (28.4% of PIV starts) and ultrasound use to 68 times. Overall number of IV pokes has been reduced with over 1,000 pokes saved to kids.
Implications: Nurses have the power to enact innovation and improve care. These nurse-based interventions speak to the incredible abilities of nurses to identify an EBP change to reduce inconsistencies in practice and positively impact the care experience. The continued support of innovative quality improvement, nurse-based initiatives are essential to the pediatric population, as there limitations to literature available in pediatric ED setting.
Type | Poster |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Quality Improvement; Pediatrics; PIV Pokes |
Name | Emergency Nursing 2019 |
Host | Emergency Nurses Association |
Location | Austin, Texas, USA |
Date | 2019 |
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