P065 - Development of a Real-time Vascular Access Dashboard: A Quality Improvement Initiative to Understand Use of Vein Visualization Technology and Enhance Patient Care
Elizabeth Weathers, PhD, BSc, PGCertTLHE, RGN, FAAN - Director of Medical and Clinical Affairs, AccuVein Inc. Leticia Caraveo, BSN, RN, LIC-P - Trauma PI Coordinator, Cook Children’s Medical Center Julie Thompson, PhD - Consulting Associate (Statistical Analysis), AccuVein Inc. Mary Cazzell, PhD, RN - Director, Nursing Research and Evidence-Based Practice, Cook Children’s Medical Center
Nurse Manager, Vascular Access Team Cook Children's Medical Center Fort Worth, Texas
Purpose - What was the goal of the study?: The primary goals were twofold: (i) to identify usage of vein visualization technology by the vascular access team; and (ii) to develop and implement a vascular access dashboard that enables the Vascular Access Team to track outcomes in real-time, and ultimately improve care.
Background - What was the problem? Why was it important?: Over 300 million peripheral intravenous catheters (PIVCs) are placed annually in the United States, making it the most frequently performed medical procedure. [1-2] An average of 2.18-2.35 attempts are required to place a single PIVC. First-attempt success rates are low in children, who are considered one of the most challenging populations due to factors such as vein depth and inability to immobilize the access site in younger children.  Vein visualization technology (e.g., near-infrared) is recommended for pre-insertion assessment by the INS and the AVA, especially in children predicted to be difficult to cannulate, and when clinicians lack experience. [4-8] Use of vein visualization technology can decrease time to cannulation and costs, improve care and satisfaction of patients.  This quality improvement initiative sought to: (i) evaluate current practice and utilization of vein visualization technology for PIVC placement via collection of retrospective data; and (ii) develop and implement a real-time dashboard to track PIVC outcomes. The initiative is now in phase 2, which will evaluate the impact of vein visualization technologies on first attempt success.
Results - What were the findings?: Retrospective data were extracted and analyzed to establish current PIVC practices and technology utilization rate. Data analysis revealed that several important data points were not tracked routinely or were missing (e.g., incomplete information on reason for removal of PIVCs, number of PIVC placement attempts prior to escalating to the vascular access team was not reported). However, an exploratory cluster analysis revealed valuable clinical findings regarding clinician preference for specific types of vein visualization technology, depending on patient characteristics. This analysis provided a preliminary understanding of how the team assesses patients and determines the best method or technology to use for PIVC placement to ensure success. A follow-up prospective study is underway to capture the missing datapoints. The second deliverable from this initiative was a vascular access dashboard that is now used by the team to track real-time data on PIVC insertions, escalations, dwell time etc. The dashboard allows the nurse manager and PIVC team to gather clinically relevant insights that can inform further inquiry and improvements in practice.
Conclusions - What do the final outcomes mean?: This quality improvement initiative provided a deeper understanding of current practice regarding PIVC placement and usage of vein visualization technology for PIVC placement in children. It also allowed the team to identify important datapoints, not routinely collected. Phase two seeks to prospectively collect more data, including the missing datapoints, to evaluate the impact of vein visualization technologies on first attempt success and determine if these data should be collected routinely. This initiative also resulted in the implementation of a dashboard to track real-time PIVC outcomes. The team can monitor the data, identify trends and be proactive in improving PIVC care.