Evidence Based Practice Evaluation Plan Sample Paper
Assessing knowledge and skills of intravenous line use among nurses and its impact
Intravenous line is an easy procedure which nurses encounter daily in practice. This occurs either during administration of medications or during fixing of intravenous lines. However, nurses are vulnerable to inappropriately preparing and pushing medications. This can be due to lack of knowledge and skills of IV drug preparation and safe use of IV lines. Also, lack of standards of IV-line insertion and usage and miscommunication between health care professionals is a contributing factor. This can lead to harm of the patients which is against the ethics of practice (Pezeshkmehr, 2021). As identified by Boström et al. (2020), some of the complications of IV lines include thrombophlebitis, limb ischemia due to a retained tourniquet in the arm of the patient and misconnection due to poor communication and documentation. Despite the presence of multiple guidelines on IV lines insertion and maintenance, nurses and other health care professionals still experience IV-line related complication which can bring in the individual factor in rates of IV-line related complications. Peripheral venous line complications account for up to 69% of premature access failure in hospitals (Ray-Barruel et al., 2019).
Expected Outcomes
The proposal will aim to first identify how confident the nurses are that they have the required knowledge and skills to safely fix and use IV lines without causing adverse complications to the patient. The skills, according to Osti et al. (2018), include site identification, cleaning of the site, proper insertion technique, management of the line after insertion and possible complications of poor line insertion. In addition, it will identify the percentage of nurses who at one point in practice have experienced an infection at the site of line insertion and how they managed it. It will also assess the possible misconnections which they have experienced in their lifetime during practice. In addition, it will evaluate the importance of having a care plan in each hospital for IV lines.
The care plan includes assessing the patient which involves looking at the patient clinical status and educating the patient on care for IV line. The second part of the care plan is choosing correct IV line and site for insertion. Large IV lines have a possibility of rupturing small veins hence causing irritation while small IV lines are not best to give fast infusion or even blood due to the possibility of breakdown of blood products termed as hemolysis (Morgaonkar et al., 2017). Next is the intervention which involves cleaning IV lines before use, ensuring they are patent, and assessing them daily for signs of infections. The last part is evaluating whether the patient has understood the instructions and whether the site is developing infections.
Even though most nurses have knowledge of IV-line use and complications, some lack the necessary skills to insert and maintain an IV line without complications. Also, patient consent is sometimes neglected. In addition, nurses have at one time or another experienced insertion site infection and thrombophlebitis which can be avoided. It is an expectation that nurses should have the necessary knowledge and skills to fix IV lines and take care of them as it is central to evidence based nursing practice. In case some lack the required skills, measures can be made to help train them to better nurses who are competent.
Data Collection Tools
The most appropriate data collection tool for this proposal will be interviews and checklist. Other tools which may be appropriate during the study will be questionnaires and reports and existing data. Interviews with a checklist is appropriate because it is simple and able to get the relevant information from the participants. Also, it is cheap and less time is required. From the data collected in the checklist during interviews, analysis can be done to come up with a conclusion hence leading a better and well-informed evidence-based practice. Interviews are reliable because you get the information directly from participant hence no second party information.
Statistical Test for the Project
The statistical test of choice is multiple regression test. This is especially essential for quantitative data helping to know the effect of lack of enough knowledge and skills on the number of IV-line related complications amongst the nurses. This will help in coming into conclusion whether there is need for more training on IV lines protocols and the need for development of a standardized guidelines for IV-line use in all health care facilities (Feinsmith, et al., 2018). A chi square test can also be used to compare rates of IV-line related complications amongst those who feel they have enough knowledge and skills on IV lines and those who do not.
Methods Applied to Data Collection Tool
Using the checklist as the data collection tool, the methods which are planned to be used include using open or closed ended questions in interviews, observation by volunteer groups, following up patients on IV lines for possible complications and using online methods to reach clients. This will help reach a high number of nurses hence increasing the success rate and quality of the results collected. In addition, consent will be taken from the nurses so as to participate in the project with confidentiality maintained.
Strategies if the Project fails to Provide Expected Outcome
One will be the evaluation for the cause of the unexpected outcome including conflict of interests. This will then be reported early and possible plan for correcting it made. Also, it will involve evaluating the whole process taken in the project to identify reasons for the lack of expected outcomes hence mitigation measures to avoid it. Overall in case of lack of expected outcome, a recommendation for further research on the field to be done to help come up with better guidelines which are evidence based.
Plans to Maintain, Extend, Revise and Discontinue a Proposed Solution
The proposed solutions to fixing the problem including developing a training schedule for nurses about IV lines and this include both during trainings in nursing training institutions and during practice. In addition, a proposed protocol for improving IV access include evaluation of the patient, intervention and reevaluation. When this process is used, less complications of IV lines will be experienced and if they happen, they will be recognized early. The plans will involve making policies in consultation with hospital managers to develop a standard guideline for IV drug use. This will help build a better plan which will last for future generations.
Additionaly, further research and evidence will help revise the guidelines and incase the recommendation needs to be stopped, it will be based on the evidence provided. The proposed solution can be discontinued in case a better proposal guiding IV-line insertion and usage is developed. To help extend the proposed solutions, changes can be made based on research to make it more applicable, affordable and easy to implement hence better patient outcome.
References
- Boström, E., Ali, L., Fors, A., Ekman, I., & Andersson, A. E. (2020). Registered nurses’ experiences of communication with patients when practicing person–centered care over the phone: a qualitative interview study. BMC Nursing, 19(1), 1-8. https://doi.org/10.1186/s12912-020-00448-4
- Feinsmith, S., Huebinger, R., Pitts, M., Baran, E., & Haas, S. (2018). Outcomes of a simplified ultrasound-guided intravenous training course for emergency nurses. Journal of Emergency Nursing, 44(2), 169-175. https://doi.org/10.1016/j.jen.2017.10.001
- Morgaonkar, V. A., Shah, B. V., Nimbalkar, S. M., Phatak, A. G., Patel, D. V., & Nimbalkar, A. S. (2017). Educational intervention to improve intravenous cannulation skills in pediatric nurses using low-fidelity simulation: Indian experience. BMJ Paediatrics Open, 1(1). https://dx.doi.org/10.1136%2Fbmjpo-2017-000148
- Osti, C., Khadka, M., Wosti, D., Gurung, G., & Zhao, Q. (2019). Knowledge and practice towards care and maintenance of peripheral intravenous cannula among nurses in Chitwan Medical College Teaching Hospital, Nepal. Nursing Open, 6(3), 1006-1012. https://doi.org/10.1002/nop2.288
- Pezeshkmehr, A. (2021). Principles of Vascular Access and Complications. In Vascular Complications of Surgery and Intervention (pp. 127-148). Springer, Cham. DOI: 10.1007/978-3-030-86713-3_8
- Ray-Barruel, G., Xu, H., Marsh, N., Cooke, M., & Rickard, C. M. (2019). Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: a systematic review. Infection, Disease & Health, 24(3), 152-168. https://doi.org/10.1016/j.idh.2019.03.001