ABSTRACT
INTRODUCTION: Peripherally-inserted venous catheters (PIVC) are essential for cancer patients to receive treatment. Phlebitis is a major complication of PIVC. Currently, nurses' assessment of phlebitis mainly involves visual inspection. However, the latest literature suggests palpation for tenderness to promote the early detection of phlebitis. OBJECTIVES: This project evaluated the effectiveness of a bundle approach to increase nurses' compliance with PIVC site assessment to promote early detection of phlebitis (grade 2 and above). METHODS: The JBI Evidence Implementation Framework was used to conduct this project in a 28-bed hematology-oncology ward in a Singapore hospital. The bundle approach used in this project consisted of a training presentation, medical mannequin, and phlebitis scale card. The rate of nurses' compliance with best practice for PIVC site assessment was measured at 1 month and 6 months post-implementation. The incidence of phlebitis was monitored up until 12 months post-implementation. RESULTS: Baseline data indicated that only 18.75% (3 out of 16) nurses palpated for tenderness when assessing for phlebitis. Data at 1 month and 6 months post-implementation reported sustained high compliance rates of 85.71% (24 out of 28) and 89.29% (25 out of 28), respectively. Late detection of phlebitis was reduced by 66% (from three cases to one case) at 6 months post-implementation, and no patients required invasive interventions. CONCLUSIONS: The bundle approach used in this project facilitated early detection of phlebitis following the inclusion of palpation into nurses' assessment for phlebitis. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A204.
ABSTRACT
AIM: The aim of this project was to educate staff nurses and enrolled nurses on the correct placement of blood pressure cuff and monitor the compliance of best practice to audit criteria. METHODS: This project adopted a pre- and post-implementation audit approach. It utilised the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The project utilised three audit criteria that are considered the best practice standards. The audit took place in a 10-bed oncology high-dependency unit that involved 24 nurses. RESULT: The post-implementation audit findings revealed an improvement in all the three criteria. The first criterion scored 100% consistent documentation of blood pressure measurement in the clinical charts by the nurses. The second criterion showed a 50% improvement in the correct placement of blood pressure cuff on the arm circumference. The third criterion achieved a 12% improvement in compliance with maintaining the patient's arm at the heart level. CONCLUSION: This project highlighted some essential strategies that are required to implement evidence in clinical practice. These strategies include planning a systematic process, using Joanna Briggs Institute best practice sheet, involving relevant stakeholders and using multifaceted strategies. Having a committed and enthusiastic team contributed to the positive outcomes. The challenge now is to develop strategies in sustaining the momentum of compliance and embed the new evidence into routine clinical practice.
