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Title: Human factor-designed multimodal intervention reduces the rate of unused peripheral intravenous cannula insertion.
Austin Authors: Egerton-Warburton, Diana;McAllan, Fern;Ramanan, Radha;Lim, Zheng Jie;Nagle, Daniel;Dendle, Claire;Stuart, Rhonda
Affiliation: Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
Emergency Department, Monash Health, Melbourne, Victoria, Australia
School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Haematology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 12-Sep-2018
Date: 2018-09-12
Publication information: Emergency Medicine Australasia : EMA 2019; 31(3): 372-377
Abstract: Our objective was to examine the impact of a human factor-designed multimodal intervention on the proportion of unused peripheral i.v. cannula (PIVC) insertion in our ED. A pre- and post-multimodal intervention retrospective cohort study was conducted using a structured electronic medical record review within a single adult tertiary ED in Australia. Pre-intervention data was collected 30 days prior to the multimodal intervention, with 30 day post-intervention data collected 3 months after the intervention commenced. The rates of PIVC inserted, the unused rate and the unused but appropriately inserted cannulas were the main outcome measures. Intravenous cannula insertion rates decreased by 12.9% (95% confidence interval [CI] 12.19-13.61) between the pre-intervention (1413/4167 [33.9%]; 95% CI 32.5-35.4) and post-intervention cohort (928/4421 [21.0%]; 95% CI 19.8-22.2). An analysis of 754 cases (376 pre-intervention and 378 post-intervention) showed that 139 of 376 (37.0%; 95% CI 32.1-42.1) i.v. cannulas were unused pre-intervention, while 73 of 378 (19.3%; 95% CI 15.4-23.7) was unused post-intervention; an absolute reduction of 17.7% (95% CI 14.98-20.42). The relative risk of an unused i.v. cannula was 0.52 (95% CI 0.41-0.67). The proportion of unused but appropriately inserted i.v. cannulas remained unchanged in both cohorts, with a relative risk of 0.91 (95% CI 0.58-1.42). Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.
DOI: 10.1111/1742-6723.13165
ORCID: 0000-0003-0262-1305
Journal: Emergency Medicine Australasia : EMA
PubMed URL: 30208510
Type: Journal Article
Subjects: human factor
multimodal intervention
peripheral intravenous cannula
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