Implementing best practice for peripheral intravenous catheter use in Australian Emergency Departments: development and implementation of quality improvement interventions

This project will develop and implement quality improvement interventions which are embedded in an implementation science trial. The trial aims to reduce unnecessary peripheral intravenous catheter (PIVC) insertion and improve use of the devices on patients in emergency departments (EDs) in nine participating hospitals in Australia. The quality improvement interventions have been demonstrated to be effective locally and have been recommended by the Australian Commission on Safety and Quality in Health Care (ACSQHC) PIVC Clinical Care Standard. The hospital site-specific quality improvement intervention will be based upon our previous research and the ACSQHC clinical care standard. The interventions will be co-designed by clinicians and implementation scientists using validated implementation frameworks. They will be developed using Human Factors principles, such as equipment, environment and changing clinician heuristics, rather than determining the care of individual patients. We will use the Theoretical Domain Framework (TDF) and the Capability, Opportunity and Motivation for changing Behaviour (COM-B) system to co-design iterative adaptations to the intervention at each ED. This will provide insights into the key infrastructure components and relationship architecture of the implementation process and individual components to ensure intervention for successful scale up and sustainability. This phase will also ensure the incorporation of the new ACSQHC National Standards into the intervention. The co-design approach will involve stakeholder engagement at each site, supported by the appointment of a local clinical champion and researcher. Co-design is based in design thinking methodology that considers human factors discovered through design ethnography, observational interviews and in design workshops with clinicians, patients, and other stakeholders. Designers from the Design Health Collab at Monash University will work alongside ED clinicians and consumers to develop a deep empathy and understanding to inform any design thinking aspects of the intervention. We will interview and observe stakeholders (ED clinicians including nurses and doctors and patients) to understand needs and opportunities for a sustainable, national intervention. Both will play a pivotal role in ensuring wider clinician engagement and adaptation processes that include: Contextualisation of the guideline and education package; facilitation of the environmental modifications; establishment of the audit-feedback process; and modifications to posters and monitor/television screen-savers to local context. The audit and feedback element of the intervention will be informed by the Learning Health Systems (LHS) Framework. The data will both inform and drive health care improvement. In order to understand each new ED setting and the adaptations required to the intervention, the local champion and researcher will conduct mapping of local practices and undertake barriers and enablers analyses in each new setting. Each barrier and enabler analysis will be guided by the TDF. Mapping and contextualisation will ensure efficient opportunity for implementation learning about appropriate adaptation at each site and provide a set of context-sensitive strategies and processes required for future sites.