1. Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key
- Author
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Jessica A. Schults, Tricia M. Kleidon, Victoria Gibson, Robert S. Ware, Emily Monteagle, Rebecca Paterson, Karina Charles, Adam Keys, Craig A. McBride, Steven McTaggart, Benjamin Lawton, Fiona Macfarlane, Chloe Sells, Claire M. Rickard, and Amanda J. Ullman
- Subjects
Pediatrics ,Catheterization, peripheral ,Difficult intravenous cannula insertion ,Clinical decision-making ,Decision support techniques ,Quality improvement ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objective To develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics. Methods Mixed methods underpinned by literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia. Results Interview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February–April 2020) involving 21 stakeholders culminating in the co-production of the “DIVA Key”. The DIVA Key was evaluated between May–December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63–0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2–27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 [8–10]; 8 [8–10 respectively). Conclusion The DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.
- Published
- 2022
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