Keywords: Intravenous/Infection
Nursing Practice
prevention prevention and control/Education
Innovation Infection control
This article has been double-blind peer reviewed
●
An education campaign used a simple acronym to reduce the risk of healthcare-associated infection infection posed by intravenous intravenous procedures
Campaign for bes best practice in intravenous therapy In this article... The risks associated with infusion therapy How the campaign helped health professionals reduce infection Feedback and advice for future practice Authors Wayne Baldwin is practice
development nurse; Jayne Murphy is practice education facilitator; David Shakespeare is head of infection control; Chris Kelly is professional development unit manager; Louise Fox is lead infection prevention and control nurse; Matthew Kelly is practice development nurse; all at Walsall Healthcare Trust. Abstract Baldwin W et al (2013) Campaign for best practice p ractice in intravenous therapy. Nursing Times; 109: 33/34, 22-23. Intravenous therapy is an integral part of nursing care but is associated with a high risk of infection. This article outlines a campaign that aimed to increase awareness of best practice for IV therapy and reduce the risks of healthcare-associated IV infections in hospital and community settings.
Due to this identified risk and the widespread use of IV therapy, the professional development unit and infection prevention and control team at Walsall Healthcare Trust devised and implemented a trust wide educationeducation-based based focus focus campaig campaign n to: Increase awareness of best practice in hospital and community settings; and Implement strategies to minimise the risk of cannula-related cannula-related bacteraemia and other IV-associated infections. »
»
About the campaign
The campaign used a simple acronym – CLEAN IT – to describe and raise awareness of best practice. Each letter relates to a particular stage in the IV therapy journey (Fig 1). Key messages are attached to each letter and cover key considerations, such as: How long the cannula should be in situ; Assessment of the cannula site using a visual infusion infusion phlebitis (VIP) score; Accurate labelling labelling of the IV line, among other relevant issues. The overall focus was on raising awareness, providing information and educating staff about the importance of aseptically delivered IV care that is correctly evaluated, recorded and observed for complications. The campaign was underpinned by best practice principles from a number of sources, including the Department of Health (2007; 2003), Pratt et al (2007) and the RCN (2010). The campaign was launched in December 2011 in a staged approach across the trust’s acute and community services. It was planned to last six months, completing in July 2012 after the priority issues were chosen in January 2012. The project group chose a flexible approach offering more than one option for disseminating » »
I
nfusion therapy is very much part of the nurse’s role and is referred to as an “integral part of professional practice” (Royal College of Nursing, 2010). Intra venous venous cannulati cannulation on and administration administration of IV therapy are also seen as common practice (Lavery, 2010), with Curran (2011) referring to the preparation of IV drugs as a “common nursing procedure”. However, these therapies carry a high risk of infection: “Bloodstream infections are serious infections that increase patient morbidity. They are frequently associated with the use of intravenous devices.” (RCN, 2010)
y m a l A
Higginson (2011) highlights a link between IV care delivered in the community and a rise in infection risk. Healthcare-associated infections can adversely affect patients’ experience of health ser vices, increase increase morbidity and prolong stay. stay.
»
22 Nursing Times 21.08.13 / Vol Vol 109 No 33/34 33/34 / www www.nu .nursi rsingt ngtime imes.n s.net et
5 key points
1
Intravenous therapy is widely practised in many healthcare settings It carries an inherent risk of healthcareassociated infections A relevant acronym is useful to help staff recall and retain key education messages Flexibility is key to delivering effective clinical teaching in a range of settings, from community health services to busy ward areas It is important to get key messages of education campaigns to staff quickly and in as many different ways as possible
2 3
4
5
Cannulation carries a high risk of infection, adherence to best practice is vital
“Take every opportunity for more education” June Girvin
FIG 1. THE
p28
“CLEAN IT” KEY MESSAGES
CLEAN IT Increasing awareness of best practice or intravenous therapy
C
L
E
A
N
CANNULA
1. Cannula site cleaned for a minimum of 30 seconds and allowed to dry before device is inserted 2. Cannula site cleaned with a chlorhexidine-based product 3. Cannula port cleaned before use and instillation of any medication 4. Cannula insertion and management using an aseptic non-touch technique 5. Cannula removed within 72 hours of insertion or record reason for prolonged dwell time
LINE
1. Line labelled on use 2. Line labelled with date and time 3. Line changed according to best practice guidance 4. Lines disposed of after disconnection and not left ha nging between infusions 5. Line disposed of when infusion complete 6. Line managed with an aseptic non-touch technique
EVALUATE
1. Evaluate effectiveness of treatment daily; discontinue when no longer required 2. Evaluate patency of the cannula on use 3. Evaluate vascular access device in use – would any other device be preferable?
ASSESS
1. Assess cannula site twice a day and record findings on the appropriate chart 2. Assess VIP score twice a day and act appropriately, remove if indicated 3. Assess sites of previous cannulations for any complications post removal
NOTES
1. Note the date and time of insertion of cannula on the record chart 2. Note the VIP score twice a day on recommended record sheet 3. Note any untoward occurrence in the patient’s record 4. Note any indication of infection or other complications and act accordingly
observation was made on the increased awareness and discussion the campaign generated and this was seen as beneficial for raising the profile of IV therapy. Recommendations
Clean It is flexible and can be used in other healthcare environments. However, some changes could be considered for future use: Ensure key messages meet specific circumstances; Undertake clinical audits relevant to the clinical situation to help finalise the campaign messages; Be clear from the start how the scheme will be evaluated, specifically how clinical colleagues perceive the support; Involve in-house communications professionals early and seek their support to promote the campaign. »
»
»
»
Conclusion
The Clean It poster was a winning entry at the trust’s 2012 conference and praised for 1. Intravenous therapy given using an aseptic non-touch technique the impact of its clear, strong messages. 2. Intravenous therapy flushed pre and post administration The acronym and associated messages will IV 3. Intravenous therapy prescribed in line with best practice IT continue to be used in the trust’s IV thera4. Intravenous therapy given and managed according to best practice THERAPY 5. Remember “Clean It” when dealing with intravenous therapy pies training programme and update, clinical update and other appropriate educakey information as the most effective created for use in these sessions to facilitate tional sessions. We will also encourage all course of action. It was seen as vital to use further discussion and exploration of key clinical areas to use the audit criteria on a straightforward and clear messages. issues. This was also used to update staff regular basis to monitor practice standOnce the key areas for action had been working in critical care. ards and ensure they meet requirements. Key campaign messages and materials We are considering the production of a highlighted, the infection prevention and control team devised an updated bedside were included in all relevant clinical Clean It DVD and other materials, such as chart for recording cannula insertion teaching sessions throughout the cam- stickers, to keep the campaign’s messages paign, and added to the trust’s mandatory at the forefront of people’s minds. We also details that incorporated the VIP score. An integrated IV therapy protocol was clinical update to reach a wider audience plan to explore further the use of acronyms also developed in May 2012 to support evi- across the organisation. The campaign was or slogans to promote key messages for dence-based clinical practice across the included in the trust’s 2012 annual confer- other trust-wide education campaigns. NT organisation and standardise clinical prac- ence and details of its implementation and tice of IV cannula care and IV line manage- progress were shared with all departments. ● This initiative was a finalist ment. This was supported by an audit tool in the Nursing Times Awards that was developed with the infection con- Feedback 2012 Infection Prevention trol team to enable clinical teams to mon- Clean It was well received by clinical staff. and Control category itor their own practice in the future. One main strength was the flexible References The essential aim of the campaign was to approach used to deliver key messages; Curran E (2011) Intravenous drug preparation: the deliver the key messages to frontline clin- these could be presented swiftly when nec- infection risks. British Journal of Nursing; 20: 14, S4-S8. ical staff as often, and in as many different essary – such as in the clinical area – with Department of Health (2007) High impact Intervention No 2. Peripheral intravenous cannula ways, as possible. It launched with a poster minimum disruption to clinical duties, or care bundle. In: Saving Lives: Reducing Infection, campaign in all clinical areas. Awareness discussed in more detail in a classroom or Delivering Clean and Safe Care. London: DH. Department of Health (2003) Winning Ways: sessions of 10-15 minutes were delivered in lecture theatre. Working Together to Reduce Associated clinical areas on a one-to-one basis or in a Senior staff in critical care said: Healthcare Infection in England. London: DH. small group. These had the greatest impact “It is very useful as a refresher to existing Higginson R (2011) IV therapy and infection control in patients in the community. British Journal of when it was possible to observe profesknowledge.” Nursing; 20: 3, 152-155. sionals in practice, such as when com“The training materials and audit tool is a Lavery I (2010) Infection control in IV therapy: a pleting an IV cannula assessment or great reminder for the ongoing delivery of review of the chain of infection. British Journal of Nursing; 19: 19, S6-S14. changing an IV line. Participants made posbest practice and safe care.” Pratt RJ et al (2007) Epic 2: national evidenceitive comments about these sessions. based guidelines for preventing healthcareAn awareness session was also added to The acronym provided a versatile focus associated infections in NHS hospitals in England. the administration of IV therapy and annual for the campaign and staff said they found Journal of Hospital Infection; 655, S1-S64 (III). Royal College of Nursing (2010) Standards for refresher courses that were already avail- it relevant and memorable, enabling them Infusion Therapy. London: RCN. tinyurl.com/ able to staff. A PowerPoint presentation was to recall the key messages quickly. A general RCN-infusion-standards www.nursingtimes.net / Vol 109 No 33/34 / Nursing Times 21.08.13 23
