Peripheral intravenous catheters: the road to quality improvement and safer patient care

Huge success has been noted internationally in reducing catheter-related bloodstream infection with 'care bundles' for central venous catheters in intensive care units. A multidisciplinary team from the Infectious Diseases Unit at Ninewells Hospital, Dundee designed a 'bundle' for peripheral venous catheters (PVCs) based on drafts developed by Health Protection Scotland (details available online). A senior medical student collected weekly data, carried out monthly 'plan, do, study, act' (PDSA) cycles and displayed the results on the ward in real time. Data consisted of measures to assess objectively clinical performance for insertion (recording date, indication and location) and maintenance (daily review of necessity, clinical appearance of site, duration less than 72 h and timely removal). Care bundle compliance was assessed for each patient and percentage compliance plotted weekly. The initial compliance of 54% improved by 1.11% per week to 82% (95% confidence interval: 0.6-1.6%; P=0.0001). This was attributed to multiple interventions including daily assessment of PVC necessity, weekly audit and feedback, monthly patient safety meetings to discuss issues with compliance, the introduction of new PVC dressings and the promotion of new PVC care plans. In conclusion, we demonstrated a significant improvement in PVC management on a single unit by using a care bundle approach. In order to improve compliance, further implementation of the PVC care bundle throughout the hospital has been necessary.