Does policy and practice for peripheral intravenous catheters match clinical standards? A point prevalence study.

BACKGROUND

Peripheral intravenous catheters (PIVCs) face complications from inadequate care, posing patient safety risks. The Australian 'Management of Peripheral Intravenous Catheters Clinical Care Standard' sets an expected level-of-care, but current adoption of the Standard into policy and practice is unknown.

METHODS

A multi-site point prevalence study was conducted in 134 acute hospital wards across 21 hospitals in 8 health services in one Australian state. Patients with ≥1 PIVC were included. Adherence to the Standard's 10 Quality Statements (QSs) was measured against the Standard's 13 structural and process indicators, and 6 additional study measures. Overall binary adherence for each QS was achieved when all indicators were met.

RESULTS

Adherence with Standard structural indicators ranged from 19 % to 43 %, while additional structural measures met 57.9 %-100 % adherence. For process indicators, 788 patients were included. Most had PIVCs used for a therapeutic purpose since insertion (91 %), and in the last 24-h (81 %), could identify the reason for their PIVC (86 %), and had clean, dry, secure PIVC dressings (81 %). Fewer had PIVCs inserted on the first attempt (70 %), had a documented insertion indication (80 %), or documented assessment of ongoing PIVC need (61 %). Notably, 53 % had PIVCs in an area-of-flexion and 42 % had documented PIVC inspections at least 8-hourly. Overall binary adherence was met for 2/10 (20 %) Standard QSs.

CONCLUSIONS

Despite a clear level of expected care for PIVCs, much unwarranted variation exists in policy and practice. Reform of local guidelines, policies, and processes to standardise PIVC care across hospitals and strategies to improve Standard adherence are needed.