title: Peripheral venous catheter care in the emergency department: education and feedback lead to marked improvements.
abstract: BACKGROUND
  Peripheral venous catheters (PVCs) can be associated with serious complications. We evaluated the effect of education and feedback on processes related to PVC placement.
  
  
  METHODS
  We implemented an educational intervention in a 72-bed Emergency Department (ED) over 12 months (4 periods, each a quarter). During preimplementation period, we evaluated PVC placement, condition, accurate documentation, and demonstration of aseptic steps for medication infusion. With implementation, ED nurses had formal education, with direct observations and feedback. For postimplementation periods 1 and 2, we continued direct observations and feedback, reducing the number of audits per week.
  
  
  RESULTS
  Of 2,568 PVCs evaluated in the ED, accurate documentation on dressing improved from 83 of 803 (10.3%) preimplementation to 300 of 476 (63%) at the end of the study (P < .0001). Correct documentation in ED records improved from 498 of 803 (62%) preimplementation to 409 of 476 (85.9%) at the end of study (P < .0001). We observed 273 attempts to place PVC; of them, 220 (80.6%) were completed. The overall compliance with the procedure steps was very poor preimplementation (n = 3/63, 4.8%) and improved in implementation (n = 17/55, 30.9%) and postimplementation periods 1 (n = 19/60, 31.7%) and 2 (n = 14/42, 33.3%, P < .0001). ED health care workers showed significant improvement in knowledge with education.
  
  
  CONCLUSIONS
  Education and real-time feedback to ED health care workers are associated with an increased and sustained compliance with processes to reduce the risk of infection from PVCs.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center and Wayne State University School of Medicine, Detroit, MI, USA. Mohamad.Fakih@stjohn.org
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
authors.forename: Karen
authors.initials: K
authors.lastname: Jones
authors.forename: Janice E
authors.initials: JE
authors.lastname: Rey
authors.forename: Robert
authors.initials: R
authors.lastname: Takla
authors.forename: Susanna
authors.initials: S
authors.lastname: Szpunar
authors.forename: Karrie
authors.initials: K
authors.lastname: Brown
authors.forename: Arlene
authors.initials: A
authors.lastname: Boelstler
authors.forename: Louis
authors.initials: L
authors.lastname: Saravolatz
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002406:Catheterization, Peripheral / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D004282:Documentation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement