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‘How many audits do you really need?’: Learnings from 5-years of peripheral intravenous catheter audits

  • Nicole Marsh
    Correspondence
    Corresponding author. Royal Brisbane and Women's Hospital, Herston Road, QLD, 4029, Australia.
    Affiliations
    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, 4111, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, 4029, Australia

    School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia

    School of Nursing, Queensland University of Technology, Brisbane, 4059, Australia
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  • Emily Larsen
    Affiliations
    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, 4111, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, 4029, Australia

    School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia
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  • Barbara Hewer
    Affiliations
    Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, 4029, Australia
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  • Emily Monteagle
    Affiliations
    School of Medicine and Menzies Health Institute Queensland, Griffith University, Brisbane, 4111, Australia
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  • Robert S. Ware
    Affiliations
    School of Medicine and Menzies Health Institute Queensland, Griffith University, Brisbane, 4111, Australia
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  • Jessica Schults
    Affiliations
    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, 4111, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, 4029, Australia

    School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia

    Department of Anaesthesia, Queensland Children's Hospital, Brisbane, 4101, Australia
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  • Claire M. Rickard
    Affiliations
    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, 4111, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, 4029, Australia

    School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia

    Department of Anaesthesia, Queensland Children's Hospital, Brisbane, 4101, Australia
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Published:March 29, 2021DOI:https://doi.org/10.1016/j.idh.2021.03.001

      Highlights

      • Improving PIVC auditing practices will help identify early signs of infection.
      • PIVC audit should be between 100 and 250 PIVCs per audit round.
      • Auditing of PIVC care is an effective method to promote best practice and improve clinical care.

      Abstract

      Background

      Peripheral intravenous catheters (PIVCs) are medical devices used to administer intravenous therapy but can be complicated by soft tissue or bloodstream infection. Monitoring PIVC safety and quality through clinical auditing supports quality infection prevention however is labour intensive. We sought to determine the optimal patient ‘number’ for clinical audits to inform evidence-based surveillance.

      Methods

      We studied a dataset of cross-sectional PIVC clinical audits collected over five years (2015–2019) in a large Australian metropolitan hospital. Audits included adult medical, surgical, women's, cancer, emergency and critical care patients, with audit sizes of 69–220 PIVCs. The primary outcome was PIVC complications for one or more patient reported symptom/auditor observed sign of infection or other complications. Complication prevalence and 95% confidence interval (CI) were calculated. We modelled scenarios of low (10%), medium (20%) and high (50%) prevalence estimates against audit sizes of 20, 50, 100, 150, 200, 250, and 300. This was used to develop a decision-making tool to guide audit size.

      Results

      Of 2274 PIVCs evaluated, 475 (21%) had a complication. Complication prevalence per round varied from 7.8% (95% CI, 4.2–12.9) to 39% (95% CI, 32.0–46.4). Precision improved with larger audit size and lower complication rates. However, precision was not meaningfully improved by auditing >150 patients at a complication rate of 20% (95% CI 13.9%–27.3%), nor >200 patients at a complication rate of 50% (95% CI 42.9%–57.1%).

      Conclusion

      Audit sizes should be 100 to 250 PIVCs per audit round depending on complication prevalence.

      Keywords

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