The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation

Abstract

ObjectiveTo describe the clinimetric validation of the I-DECIDED tool for peripheral intravenous catheter assessment and decision-making.Design and settingI-DECIDED is an eight-step tool derived from international vascular access guidelines into a structured mnemonic for device assessment and decision-making. The clinimetric evaluation process was conducted in three distinct phases.MethodsInitial face validity was confirmed with a vascular access working group. Next, content validity testing was conducted via online survey with vascular access experts and clinicians from Australia, the UK, the USA and Canada. Finally, inter-rater reliability was conducted between 34 pairs of assessors for a total of 68 peripheral intravenous catheter (PIVC) assessments. Assessments were timed to ensure feasibility, and the second rater was blinded to the first’s findings. Content validity index (CVI), mean item-level CVI (I-CVI), internal consistency, mean proportion of agreement, observed and expected inter-rater agreements, and prevalence-adjusted bias-adjusted kappas (PABAK) were calculated. Ethics approvals were obtained from university and hospital ethics committees.ResultsThe I-DECIDED tool demonstrated strong content validity among international vascular access experts (n=7; mean I-CVI=0.91; mean proportion of agreement=0.91) and clinicians (n=11; mean I-CVI=0.93; mean proportion of agreement=0.94), and high inter-rater reliability in seven adult medical-surgical wards of three Australian hospitals. Overall, inter-rater reliability was 87.13%, with PABAK for each principle ranging from 0.5882 (‘patient education’) to 1.0000 (‘document the decision’). Time to complete assessments averaged 2 min, and nurse-reported acceptability was high.ConclusionThis is the first comprehensive, evidence-based, valid and reliable PIVC assessment and decision tool. We recommend studies to evaluate the outcome of implementing this tool in clinical practice.Trial registration number12617000067370

Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial

“…Research within vascular access has focused on the reduction of infection; however, the scale and implications of PIVC failure have only recently been acknowledged. This trial is one of the few recently published studies addressing the maintenance phase of the PIVC [ 20 , 29 , 30 ]. It has provided important information on the effectiveness of post-insertion PIVC maintenance, specifically, optimising patency through flushing.…”

‘How many audits do you really need?’: Learnings from 5-years of peripheral intravenous catheter audits

“…One is the early detection of potential complications and in particular early signs of infection, which can lead to appropriate intervention (e.g. PIVC removal), therefore avoiding staff time and treatment costs associated with the negative sequalae of caring for a PIVC complication [28]. Auditing staff are at the bedside and may be able to give "just-in-time" education to patients and nursing staff.…”

An Implementation Framework for the Clinically Indicated Removal Policy for Peripheral Intravenous Catheters

“…[30] Adoption of clinically indicated removal therefore needs new, simple algorithms such as the I-DECIDED tool which prompts care and removal decisions by aggregating clinical guidelines into a simple mnemonic. [31] Nursing commentary has recommended education of patients, family members, and clinicians on how to assess for complications and decide on PIVC removal, plus the need to regularly audit local outcomes. [32] Accessible material for busy clinicians might include electronic or paperbased support tools at the bedside and as e-learning packages that allow flexible delivery.…”

“…[15] This is particularly true for changing to a patient-centered decision, whereby clinicians, generally nurses, must enact more autonomy in decision making than under the previous time-driven criteria. [21,31] Heightened autonomy requires individuals to cognitively understand the new policy and their role in it. This requires knowledge of how to decide which PIVCs to remove, and the confidence to make this decision and communicate it with the care team.…”