Background:
The overall aim of this implementation science trial is to improve peripheral intravenous catheter
(PIVC) insertion and reduce unnecessary cannulation in adult Emergency Department (ED) patients.
Documentation of PIVC insertion is, however, a challenge across all nine prospective ED trial sites,
with baseline insertion documentation below 50 percent. The implementation study, as initially
proposed cannot commence until documentation is >80 percent, thus our first implementation aim
was to optimise documentation.
Methods:
The first project aim was to increase rates of documentation of PIVC in Electronic Medical Records
(EMR) prior to commencing the first phase of the stepped-wedge trial. We used Theoretical Domains
Framework (TDF) and the COM-B Model to develop interventions to improve documentation.
Interventions included EMR changes, twice weekly audits at each site with feedback using
representative sampling, enlisting organisational support, policy changes, focus groups and huddle
messages, computer and PIVC trolley reminders, and dissemination of lanyard cards to explain how
to document PIVC insertion. Data were collected through direct observation of patients, followed by
EMR review. These are compared to EMR data for patients that indirectly infer patients received
PIVCs including intravenous therapy and medications.
Results:
Documentation of PIVC insertion continues to vary across trial sites (45.4 +/- 19.4%), but rates of
PIVC captured in EMR by indirect record review have reached approximately 80%.
Conclusion:
Co-design of interventions with clinical staff, consumers and implementation scientists using a range
of theory-informed processes are complete. We have learned that it takes a suite of interventions and
an abundance of patience and perseverance to improve documentation of PIVC in ED.