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 implementation Factors 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 condition PVC in situ and in use select “yes” & go to question 3 If 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 situ PVC in situ PVC in Use No Inflammation/ Extra-vasiation Dressing intact PVC < 72 hrs Hand hygiene Yes PVC in situ PVC in Use No Inflammation/ Extra-vasiation Dressing intact PVC < 72 hrs Hand hygiene Yes No Remove 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 PVC in situ PVC in Use No Inflammation/ Extra-vasiation Dressing intact PVC < 72 hrs Hand hygiene Yes No Remove PVC -

Pictures with permission from IV team Rotherham Trust 3. PVC dressing intact Pictures with permission from IV team Rotherham Trust

3. Dressing Intact PVC 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 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 hours PVC in situ PVC in Use No Inflammation/ Extra-vasiation Dressing intact PVC < 72 hrs or as per local decision Hand hygiene Yes yes PVC in situ PVC in Use No Inflammation/ Extra-vasiation Dressing intact PVC < 72 hrs Hand hygiene 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 PVC in situ PVC in Use No Inflammation/ Extra-vasiation Dressing intact PVC < 72 hrs Hand hygiene 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