Managing peripheral venous catheters: an investigation on the efficacy of a strategy for the implementation of evidence-based guidelines.
OBJECTIVE
Until now, the evaluation of the effectiveness of guideline implementation in nursing and allied health professions has received relatively little attention. The aims of this study were (i) to describe the development process of guidelines concerning the management of peripheral venous catheters (PVCs) implemented in an Italian hospital; and (ii) to evaluate the effectiveness of guideline dissemination in terms of both clinical outcomes (signs of infection) and process outcomes (measures of appropriateness of PVC management).


METHODS
An observational study was conducted before and after the adoption of a new protocol in the CTO-CRF-Maria Adelaide Hospital. Data from 306 PVCs (153 before and 153 after) were collected. For each PVC, a wide range of outcome measures was collected, including: data on fixation system type of dressing; visibility of the insertion site; registration of the insertion date; duration of catheter insertion; presence of connectors, taps and needles; and signs of infection. The effect of guideline implementation was evaluated using a logistic regression model to adjust for the confounding variable represented by the nurses' average years of working experience.


RESULTS
The risk of using inappropriate dressing was significantly reduced [odds ratio (OR) 0.43; 95% confidence interval (CI) 0.27-0.70], while the use of transparent dressing increased (OR 2.39; 95% CI 1.46-3.89).


CONCLUSIONS
Our study shows significant improvement in practices relevant to the correct management of PVCs 2 months after guideline implementation. A second survey (after a minimum of 6 months) is necessary to assess persistence of improvement in clinical practices.
Quality Office, CTO-CRF-M. Adelaide Hospital, Torino, Italy.
Simona
S
Frigerio
Paola
P
Di Giulio
Dario
D
Gregori
Dario
D
Gavetti
Simonetta
S
Ballali
Silvia
S
Bagnato
Gabriella
G
Guidi
Francesca
F
Foltran
Giovanni
G
Renga
D000328:Adult; D001458:Bandages; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000451:nursing*; D002985:Clinical Protocols; D016001:Confidence Intervals; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D019370:Observation; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D010865:Pilot Projects; D017410:Practice Guidelines as Topic