Fragmentation of care threatens patient safety in peripheral vascular catheter management in acute care--a qualitative study.
BACKGROUND
The use of peripheral vascular catheters (PVCs) is an extremely common and necessary clinical intervention, but inappropriate PVC care poses a major patient safety risk in terms of infection. Quality improvement initiatives have been proposed to reduce the likelihood of adverse events, but a lack of understanding about factors that influence behaviours of healthcare professionals limits the efficacy of such interventions. We undertook qualitative interviews with clinical staff from a large group of hospitals in order to understand influences on PVC care behaviors and subsequent patient safety.


METHODS
Ten doctors, ten clinical pharmacists, 18 nurses and one midwife at a National Health Service hospital group in London (United Kingdom) were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework.


RESULTS
FOUR KEY THEMES EMERGED: 1) Fragmentation of management and care, demonstrated with a lack of general overview and insufficient knowledge about expected standards of care or responsibility of different professionals; 2) feelings of resentment and frustration as a result of tensions in the workplace, due to the ambiguity about professional responsibilities; 3) disregard for existing hospital policy due to perceptions of flaws in the evidence used to support it; and 4) low-risk perception for the impact of PVC use on patient safety.


CONCLUSIONS
Fragmentation of practice resulted in ill-defined responsibilities and interdisciplinary resentment, which coupled with a generally low perception of risk of catheter use, appeared to result in lack of maintaining policy PVC standards which could reduced patient safety. Resolution of these issues through clearly defining handover practice, teaching interdisciplinary duties and increasing awareness of PVC risks could result in preventing thousands of BSIs and other PVC-related infections annually.
Centre for Infection Prevention and Management, Imperial College London, London, United Kingdom.
Enrique
E
Castro-Sánchez
Centre for Infection Prevention and Management, Imperial College London, London, United Kingdom.
Esmita
E
Charani
Centre for Infection Prevention and Management, Imperial College London, London, United Kingdom.
Lydia N
LN
Drumright
Department of Surgery and Cancer and Imperial Centre for Patient Safety and Service Quality, Imperial College London, London, United Kingdom.
Nick
N
Sevdalis
Centre for Infection Prevention and Management, Imperial College London, London, United Kingdom.
Nisha
N
Shah
Centre for Infection Prevention and Management, Imperial College London, London, United Kingdom.
Alison H
AH
Holmes
D001291:Attitude of Health Personnel; D003422:Critical Care / Q000379:methods*; D005639:Frustration; D019983:Guideline Adherence; D006282:Health Personnel / Q000523:psychology; D006761:Hospitals; D006801:Humans; D061214:Patient Safety; D018570:Risk Assessment; D062666:Vascular Access Devices