Right resource,right place: Utilizing pediatric difficult intravenous access escalation pathway to decrease peripheral intravenous insertion delays and improve staff allocation

Abstract

Right resource, right place

Utilizing pediatric difficult intravenous access (DIVA) escalation pathway to decrease peripheral intravenous (PIV) insertion delays and improve staff allocation.

Background

This children's hospital aimed to decrease delays in PIV catheter insertions in general care (GC) units by 15% within 3 years. We hypothesized that improving GC nursing skills would decrease the need for vascular access team (VAT) and emergency department (ED) PIV insertions on GC units, allowing staff to focus on critical patient care, and decreasing delays for both GC and ED.

Methods

Using the model for improvement, a DIVA escalation pathway (DIVA EP) and standardized education program were tested to improve and sustain GC skill levels and allocate resources appropriately. The DIVA EP assisted in identifying the required expertise level and when to escalate.

Results

A total of 10.6% of GC PIV insertions were delayed, showing no decrease. Average hours from GC PIV removal to insertion by GC staff decreased by 21 h (p = 0.08). GC nurses with a skill level of novice/advanced beginner decreased by 26.6% while proficient and expert skill levels increased by 267.1% and 177.4%, respectively. The percentage of GC PIVs inserted by GC nurses increased by 69.6% (p < 0.001). VAT and ED insertions decreased by 6.4% and 18.6%, respectively. Surveys from 2019 and 2022 indicated that 68.4% and 23.2% fewer GC nurses reported a lack of education and lack of confidence, respectively, as a barrier to inserting PIVs.

Conclusion

The implementation of a standardized education program and DIVA EP decreased the GC PIV insertion time, aiding non-GC staff in prioritizing higher acuity patients in their respective areas while giving GC staff the opportunity to improve PIV insertion skill levels.