Peripheral Intravenous (PIV) Electronic Medical Record Documentation: A Quality Improvement Project Courtney Wilson, BSN, RN, PCCN; Linda Breimon, RN; Deborah Cox, RN; Lisa Dymond, RN; Holly Emmer, BSN, RN; Evelyn Keehan, MS, BSN, RN; Angela Pereira, RN; Martin Mikell, BSN, RN, CEN; Elizabeth Schroeder, Nursing Student/VA Volunteer; Sherry Tennies, MSN, RN; Vicky Reith, MS, APRN, CNS-BC; Patti Blanchette, RN;

Nicole Komers, BSN, RN; Sharon Wolf, Manager; Shannon Haley, BSN, RN; Brianne Kulick, BSN, RN; Kristen O’Connor, BSN, RN; Tiffany Pilliow, BSN, RN; Megan Singer, BSN, RN; Rosemarie Vugrinec-Daleiden, BSN, RN; & Mary Hagle, PhD, RN, FAAN

Clement J. Zablocki VA Medical Center; Milwaukee, WI

Abstract

Background/Aim

Map / Measure

Change

Conclusion / Sustain

Disclaimer • This material is the result of work supported with resources

and facilities at the Clement J. Zablocki VA Medical Center. • The content is the responsibility of the authors alone and does

not necessarily reflect the views or policies of the Department of Veterans Affairs or the United States government, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

PIV audits were conducted to monitor phlebitis prevalence, adherence to new IV policy documentation, and dressing labeling. Electronic medical record (EMR) documentation of 5 required elements for PIV insertion demonstrated need for improvement; time to find PIV documentation exceeded 10 minutes for 13% of EMRs. PIV workgroups were formed to revise EMR templates, conduct pilots, and implement in specialty areas. Documentation improved for all required elements and retrieval did not exceed 10 minutes.

• Quality monitoring of infusion therapy is recommended to advance patient care quality & safety (INS, 2011)

• PIV audits conducted to assess for prevalence of phlebitis, adherence to new IV policy & needed labeling of dressings

• Improvement was needed • Framework: VA TAMMCS (Vision-Analysis-Team- Map-Measure-Change-Sustain) • Aims:

1. Improve EMR documentation of PIV insertion 2. Obtain “Voice of the RN Customer”

• PIV Insertion/Removal Note: –PIV workgroup developed note in EMR (CPRS) –Approved by Shared Governance

• Education on the units: – Flyer / Staff Reps / IV Team support / Councils – Informatics (CLIMET) staff met with each RN to enable

‘default note listing’ (easier to find note) • Evaluation methods:

–Audits of documentation – “Voice of the RN Customer”

• Implemented November 2014 • Increased documentation of PIV insertion elements • “Voice of RN Customer”: 100% of RNs on pilot unit:

template moderately to highly usable • Decreased time to find PIV documentation

• Standardized EMR templates, with free text options, improves documentation of best practice

• Continue PIV audits (unit-based PRN & hospital-wide) for phlebitis, dressing, documentation

• Report audit results • Validate EMR report with actual documentation • Goal for April 2015: 100% use of PIV

Insertion/Removal note for all PIVs

References

• Infusion Nurses Society. (2011). Infusion Nursing: Standards of Practice. J Infus Nurs, 34(Suppl.), S1-S110.

• New KA, Webster J, Marsh NM, Hewer B. (2014). Intravascular device use, management, documentation and complications: a point prevalence survey. Aust Health Rev, 38(3), 345-349.

• O’Grady NP, Alexander M, Burns LA, et al. (2011). Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control, 39(4)(suppl1), S1-34.

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PIV Insertion Documentation in EMR

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PIV Documentation found in <5 minutes