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- Title
Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key.
- Authors
Schults, Jessica A.; Kleidon, Tricia M.; Gibson, Victoria; Ware, Robert S.; Monteagle, Emily; Paterson, Rebecca; Charles, Karina; Keys, Adam; McBride, Craig A.; McTaggart, Steven; Lawton, Benjamin; Macfarlane, Fiona; Sells, Chloe; Rickard, Claire M.; Ullman, Amanda J.
- Abstract
<bold>Objective: </bold>To develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>The DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.
- Subjects
AUSTRALIA; CATHETERS; CUSTOMER satisfaction; INTER-observer reliability; RISK assessment; SELF-evaluation; INTRAVENOUS catheterization; RESEARCH evaluation; INTRAVENOUS therapy; LONGITUDINAL method
- Publication
BMC Health Services Research, 2022, Vol 22, Issue 1, p1
- ISSN
1472-6963
- Publication type
journal article
- DOI
10.1186/s12913-022-07605-2