Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The quality assurance and performance improvement (QAPI) project in the spotlight this month looked at reducing multiple IV attempts.

Based on quarterly patient safety reports, our center has seen a rise in incidents of multiple IV attempts. A patient safety report (PSR) is written when there are four or more IV attempts to produce a successful IV. Since the fourth quarter (Q4) of 2023, there has been an increase in multiple IV attempts with four or more attempts before we reached a successful IV start. The number of incidents during Q4 2023 was 18. Our average per quarter is seven.

This is important because repeated needle IV insertions negatively impact patients and staff. From a patient's perspective, these can cause psychological distress and anxiety, as well as pain, potential IV problems days or weeks after the day of service and poor patient experience correlating to low satisfaction scores. Staff perceive repeated IV attempts as poor clinical performance leading to low staff morale and reduced confidence. Unsuccessful IV insertions could raise costs by causing a delay in the procedure and increased utilization of resources. Because of the high negative impact on performance and satisfaction, a quality study was created to find ways to lessen these incidences that would lead to higher satisfaction among patients and workers and minimize costs.

MEASURE YOUR PROJECT

The goal is to reduce our quarterly incidents by 50 percent from the beginning of the study (18 incidents) by the first quarter of 2025 (nine or fewer incidents). We will collect data on the number of incidents that require four or more attempts before a successful IV start is reached. We will tally up the amount every month and provide a running report on the number of incidences regarding multiple IV attempts.

ANALYZE YOUR PROJECT

Data will be shared and posted on the huddle board to provide data to the staff to show trends. When analyzing our data and patient surveys, we have found a 67 percent increase in incidents from Q4 2023 to Q1 2024. The goal is to reduce our quarterly incidents by at least 50 percent by the first quarter of 2025 (nine or fewer incidents).

IMPROVE YOUR PERFORMANCE

Interventions used to reach our goal:

• Provide education and tips/tricks for successful IV attempts to the staff via email, showing videos and articles.
• Rounding with nurses regarding the obstacles or challenges they are experiencing.
• Provide mentors and pair them up with those who are experiencing challenges.
• Provide monthly data on the huddle board to show trends.
• Encourage staff to attend the "Back to Basics" training which will focus on perioperative care with a focus on IV skills.
• Provide recognition and positive reinforcement if monthly trends are pointing to a decrease in the number of incidents.
  

CONTROL SUMMARY

We are midway through the year, and so far, our incidents have dropped significantly from Q1 to Q2. Our total number of incidents for Q2 is 10, compared to 27 in Q1. This decrease in incidents is showing a significant impact from the interventions that we have implemented. If our incidences are down by 50 percent by 2025 from Q4 2023 data, we have met our goal. If not, we will assess the effectiveness of our corrective actions and adjust accordingly. Staff are utilizing the tools we have given them and providing support to each other. This is bringing the performance level and staff morale up.

We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content via an exclusive e-newsletter The Huddle, and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org.