implementation of care bundles at ward level
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Implementation of Care Bundles at ward level. Content. Why implement the PVC care bundle? Implementation Monitoring Implementation. Why?. Implementing guidelines All acute hospitals have guidelines on PVC management and care - PowerPoint PPT PresentationTRANSCRIPT
Implementation of Care Bundles at ward level
Content• Why implement the PVC care bundle?
• Implementation
• Monitoring Implementation
Why?• Implementing guidelines – All acute hospitals have guidelines on PVC
management and care– Allows wards/units to demonstrate that PVC care
is their ward is best practice- ensures that these guidelines are implemented in
all wards consistently or if necessary targets education to those areas with greatest need
Why?• Rate of bacteraemia associated with PVC is
increasing year on year • HIQA Infection Control Standards 2008
Standard 8 Device related infections are reduced or prevented• Criteria 8.1
“the implementation of a structured set of processes that have been proven to improve outcomes, (e.g. bundles) for the prevention of invasive medical devices related infections”
Implementation• Each site should decide how best to approach
local implementationFactors to take into account
• Target consultants/ward managers in a small number of wards initially
• Weekly care bundle - Medical and nursing staff should complete bundle together (e.g. at ward rounds)
• Agree that IPCT are informed when on going non compliance is identified
• Use of excel document to tract results & avoid paper work
5 Interventions Check if PVC in situ – Ask patient or check for PVC – If no – Decontaminate hands and move to next patient
PVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs
Hand hygiene
No - - - - -
PVC in situ
2. Is PVC in use? • Current IV therapy (medication or infusion) ?• PVC required for planned clinical procedure
(radiology, transfusion etc)• Vascular access required due to unstable conditionPVC in situ and in use select “yes” & go to question 3If PVC in situ but not in use and not required, remove
PVC and select “no” to this question Decontaminate hands and move to next patient
PVC in situPVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs Hand hygiene
Yes Yes
PVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs Hand hygiene
Yes NoRemove PVC
- - - -
2. Absence of inflammation/extra-vasiation
Sample phlebitis scale
Absence of inflammation/extra-vasiation
PVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs Hand hygiene
Yes Yes Yes
PVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs Hand hygiene
Yes Yes NoRemove PVC
- - -
3. PVC dressing intact
Pictures with permission from IV team Rotherham Trust
3. Dressing IntactPVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs Hand hygiene
Yes Yes Yes yes
PVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs Hand hygiene
Yes Yes Yes No – replace dressing or remove PVC
- -
4. PVC in place < 72hours
• Not applicable in paediatrics• 72 hours is not an absolute cut off – local
clinical decision based on expected duration of PVC, condition of PVC entry site, vascular access
• > duration of PVC > greater risk of infection• Determining exact date of insertion from
medical notes/nursing notes
4. PVC in situ < 72 hoursPVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs or as per local decision
Hand hygiene
Yes Yes Yes yes yes
PVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs Hand hygiene
Yes Yes Yes Yes No – remove catheter
-
5. Hand Hygiene
• Hand hygiene before and after contact with PVC
• Observe HCWs during administrating of IV medication/adjusting infusions during nursing shift that hand hygiene occured
5. Hand Hygiene PVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs or as per local decision
Hand hygiene
Yes Yes Yes yes yes yes
PVC in situ
PVC in Use
No Inflammation/Extra-vasiation
Dressing intact
PVC < 72 hrs Hand hygiene
Yes Yes Yes Yes No – remove catheter
no
Results • Target 100% for all PVC’s in all patients• All 5 elements must be Yes to score• Example 10 PVC’s in situ – 5 = 5 yes answers – 3 = 4 yes answers – 2 = 3 yes answers
• 50% compliance is the ward score
Implementation monitoring • CEO/senior area manager will report to LIT the
% of wards in each site using PVC care Bundle from January 2010
• January 2010 – report all bacteraemia associated with PVC to risk management
• HPSC monitoring national data using enhanced bacteraemia from participant laboratories