A Standardised Audit Tool - Phlebitis Grading Scal
Submitted by Carolyn Johnston, IVNNZ Inc. Educator. Orginally printed in March 2006 IVNNZ Inc. Newsletter
A Standardised Audit Tool - Phlebitis Grading Scale
Carolyn Johnston
The nurses' role in the management/care of intravenous access devices has changed notably over the years. With advances in technology, involvement in selection of the device and its insertion, maintenance and removal has become an integral part of the nurses role. With such advances in practice, it is a necessity that we have tools to assist us in evaluating practice and implementing change where required. Clinical effectiveness is used to assist us to determine if we are achieving quality care based on the best evidence. We can achieve this by conducting regular clinical audits, this helps us to compare actual practice to a standard of practice.
As Joanna Briggs (2003) states "A Clinical audit is a tool that addresses all the components of clinical effectiveness in the ongoing goal of improving the quality of health care"(p.5).
Let's take a common identified complication for Intravenous therapy.
Phlebitis is a common complication. According to Maki and Ringer (2001) "Phlebitis effects between 27% and 70% of all patients receiving intravenous therapy" (p.845) We know that phlebitis is caused by mechanical, chemical or bacterial interaction, and can cause permanent damage to the vein structure, patient pain, oedema and erythema. If what Maki and Ringer have stated is true then surely there must be a better way to manage infusion-related phlebitis? or do we just accept that phlebitis is a common complication.
The articles researched on phlebitis all state that the intravenous cannula should be routinely assessed for signs and symptoms of phlebitis. But what is this assessment based on? Do all nurses complete this assessment using the same thought process (that would be like saying all apples are the same when we know for a fact that there are several varieties).
A standardised phlebitis scale supports the clinical judgement of the nurses' assessment, thus providing clinical effectiveness - effective patient outcome.
As Schultz and Gallant 2005 state" valid assessment of IV sites is dependent on the use of a valid and reliable phlebitis scale". (p.1)
Various phlebitis-rating scales are available, two examples are provided below, or the organisation may choose to develop one of their own.
1. The Infusion Nursing Society
Macklin, D (2003) American Journal of Nursing p.58
2. This scale was developed at Chelsea and Westminster Healthcare NHS Trust It not only serves as a tool for grading the severity of phlebitis but also gives nurses guidance as to the appropriate action to take.
Since the peripheral cannula grading scale implementation at Chelsea and Westminster Healthcare Burke (2000) stated "There was a significant reduction in the incidence and severity of phlebitis following its introduction. This indicates that's it has been useful in raising nurses awareness of the potentially serious complication when carrying out this routine clinical procedure"(p.39).
When implemented into practice, for it to be effective the scale must be reviewed regularly. Data collected and measured " thus allowing the establishment of baseline practice against which change may be measured". (Ministry of Health Nursing Clinical Practice Guideline (p.1 2002).
The importance is to be consistent when using a selected scale to maintain an accurate assessment outcome for the patient.
Have your say:
Has your organisation implemented a phlebitis scale and if so, is the information obtained regularly to monitor best practice?
Reference:
Briggs, J. (200?) Clinical Auditing Manual - Acute Care
Burke, K (2000). Combating phlebitis: a peripheral cannula grading scale. Nursing Times, 96(29), p 38-39.
Intravenous Nursing Society. (2000). Infusion nursing standards of practice. Journal of Intravenous Nursing; 23(6S):S56-S69.
Maki, D.G., Ringer, M. (1991). Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial. Ann Intern Med, 114(10), 845-54
Macklin, D.(2003). Phlebitis: A painful complication of peripheral IV catheterization. American Journal of nursing, 103(2) p.55-60
Ministry of Health (2002). Toward Clinical Excellence: An introduction to clinical Audit, Peer Review and Other Clinical Practice Improvement Activities. Wellington: New Zealand.
Schultz, A., Gallant, P. (2005). Evidence-based quality improvement project for determining appropriate discontinuation of peripheral intravenous cannula Evidence Based Nursing Online: http://ebn.bmjjournals.com/cgi/content/full/8/1/1