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Quality Improvement: IV TubingToledo Hospital Urology, Nephrology, & Vascular Erin Bedell, Katelynn Butler, Sarah Dinger, Jacquelyn Gawle, Thomas Meridieth, Cait Zimmel

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Research OutlinePopulation: 39 beds out of 40Compliance: Low Problem: Noncompliance & Lack of SuppliesConsequences: Financial Burden & Infection Risk

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Pre-Data Collection QuestionnaireIV Tubing Change Primary66% - 96 hours22% - 96 hours and 24 hours intermittent11% - 24-72 hours

Secondary 55% - 24 hours33% - 96 continuous/24 intermittent11% - after infusion complete Swab Caps to Each Port100% - YesChanging Swab Caps 44% - every time used22% - as needed34% - every 24 hours Primary Solution100% - change every 24 hoursPrimary Solution Label 100% - said blue label22% - admitted to forgetting to label every time67% - answered yes that they use them every time and a blue label 11% - blue label if it is stocked

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Began our project by asking the staff to answer a questionnaire about IV tubing protocols and any recommendations they may have.

How often (per protocol) should you change your tubing?Do you use a swab cap on each port?How often do you change your swab caps?How long can a bag of primary solution hang before you have to change it?Do you label on your primary solution every time? What color do you use?

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Pre-Data Collection QuestionnairePrimary Tubing Label34% - admitted to forgetting; knew white for 96 hrs. and pink for 24 hrs. 22% - white for 96 hrs. & pink for 24 hrs.44% - white Secondary Tubing Label22% - admitted to forgetting; answered pink 22% - admitted to forgetting; use pink for 24 hour intermittent and white for 96 hour continuous56% - pink and change every 24 hours Labeling Improvement44% - none11% - none, but needs stocked11% - check daily33% - needs to be stocked Suggestions44% - N/A or none56% - stock labels

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Do you place a label on your tubing every time? What color label for primary? What color for secondary?What part of labeling or hanging IV solution/medications do you think could use improvement?Do you have any suggestions about how to improve labeling or swab cap usage? 4

IV Tubing Data: 6 North TTH

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The North Wing on the 6th Floor at Promedica Toledo Hospital had 9 IV Catheter Dressings on the wing. Of the 9 dressings, only 1 was in compliance with the proper date, time, and initial of the RN. That leaves the wing in 11% compliance for their IV Dressings.5

IV Tubing Data: 6 North TTH

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The North Wing on the 6th Floor at Promedica Toledo Hospital had 8 IV Primary Administration sets on the wing. Of the 8 Primary sets, only 3 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 37% compliance for their Primary IV sets. However, the Primary Tubing sets on the wing were in 100% compliance with orange caps on the ports.

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IV Tubing Data: 6 North TTH

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The North Wing on the 6th Floor at Promedica Toledo Hospital had 6 IV Secondary Administration sets on the wing. Of the 6 Secondary sets, only 1 was in compliance with the proper date, time, and initial of the RN. That leaves the wing in 17% compliance for their Secondary IV sets. 7

IV Tubing Data: 6 North TTH

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The North Wing on the 6th Floor at Promedica Toledo Hospital had 9 IV Fluid Bags on the wing. Of the 9 IV Fluid Bags, only 5 were in compliance with the proper date, time, identification of the fluid, and initial of the RN. That leaves the wing in 56% compliance for their IV Fluid Bags. However, one of the bags that was labeled properly, happened to be expired.

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IV Tubing Data: 6 Northeast TTH

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The Northeast Wing on the 6th Floor at Promedica Toledo Hospital had 8 IV Catheter Dressings on the wing. Of the 8 dressings, only 1 was in compliance with the proper date, time, and initial of the RN. That leaves the wing in 12% compliance for their IV Dressings.

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IV Tubing Data: 6 Northeast TTH

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The Northeast Wing on the 6th Floor at Promedica Toledo Hospital had 8 IV Primary Administration sets on the wing. Of the 8 Primary sets, only 7 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 87% compliance for their Primary IV sets. However, the Primary Tubing sets on the wing were in 75% compliance with orange caps on the ports.

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IV Tubing Data: 6 Northeast TTH

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The Northeast Wing on the 6th Floor at Promedica Toledo Hospital had 2 IV Secondary Administration sets on the wing. Of the 2 Secondary sets, all 2 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 100% compliance for their Secondary IV sets.

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IV Tubing Data: 6 Northeast TTH

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The Northeast Wing on the 6th Floor at Promedica Toledo Hospital had 8 IV Fluid Bags on the wing. Of the 8 IV Fluid Bags, only 6 were in compliance with the proper date, time, identification of the fluid, and initial of the RN. That leaves the wing in 75% compliance for their IV Fluid Bags. 12

IV Tubing Data: 6 South TTH

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The South Wing on the 6th Floor at Promedica Toledo Hospital had 16 IV Catheter Dressings on the wing. Of the 16 dressings, only 7 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 44% compliance for their IV Dressings.

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IV Tubing Data: 6 South TTH

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The South Wing on the 6th Floor at Promedica Toledo Hospital had 14 IV Primary Administration sets on the wing. Of the 14 Primary sets, only 5 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 36% compliance for their Primary IV sets. However, the Primary Tubing sets on the wing were in 71% compliance with orange caps on the ports.

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IV Tubing Data: 6 South TTH

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The South Wing on the 6th Floor at Promedica Toledo Hospital had 7 IV Secondary Administration sets on the wing. Of the 7 Secondary sets, only 5 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 71% compliance for their Secondary IV sets.

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IV Tubing Data: 6 South TTH

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The South Wing on the 6th Floor at Promedica Toledo Hospital had 16 IV Fluid Bags on the wing. Of the 16 IV Fluid Bags, only 3 were in compliance with the proper date, time, identification of the fluid, and initial of the RN. That leaves the wing in 19% compliance for their IV Fluid Bags.

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Dressing Label Compliance

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The average Dressing Label Compliance for the entire 6th Floor at Promedica Toledo Hospital was 27%. While the North wing (11%) and Northeast wing (12%) fell below the average for the floor, the South wing at 44% had the highest compliance rate on their IV dressing labels.17

Primary Tubing Label Compliance

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The average Primary Tubing Label Compliance for the entire 6th Floor at Promedica Toledo Hospital was 50%. The North wing (37%) and South wing (44%) fell below the floor average, while the Northeast wing was above average at 87%.18

Secondary Tubing Label Compliance

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The average Secondary Tubing Label Compliance for the entire 6th Floor at Promedica Toledo Hospital was 53%. The North wing (17%) was the only wing below the entire floor average. While the Northeast wing (100%) and the South wing (71%) were both above the entire floor average.19

IV Fluid Bag Compliance

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The average IV Bag Label Compliance for the entire 6th Floor at Promedica Toledo Hospital was 42%. The South wing (19%) was the only wing below the floor average. While the Northeast wing (75%) and North wing (56%) were both above the average for the floor.

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Follow-Up Questionnaire Question 1: What would help you to remember to label your IV solution bag?

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This graph represents how the nursing staff on the 6th floor of Toledo Hospital, on 4/13/2016, answered the question What would help you to remember to label your IV solution bag. The majority of staff, 34%, chose the answer Having central supply tape a label to the solution bags upon stocking. The second most frequent response (33%) was Having labels right next to the bags-on the same shelf. The remaining total were equally distributed at 11%; a reminder sign, labels at station, and other. Other was having labels period .21

Follow-Up QuestionnaireQuestion 2: What would help you to remember to label your IV tubing?

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This graph represents how the nursing staff on the 6th floor of Toledo Hospital, on 4/13/2016, answered the question What would help you to remember to label your IV tubing?. The majority of the staff, 45%, chose the answer A sticker taped to the IV tubing. The Second most frequent response was a tie between Having a sign on the shelf to remind you to grab a sticker near the tubing supply (22%) and Having a sign that reminds you what sticker to use for 96hr vs. 24hr (22%). The remaining 11% hand wrote in Having the labels available.

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Follow-Up QuestionnaireQuestion 3: What would help you to remember to place swab caps on each port?

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This graph represents how the nursing staff on the 6th floor of Toledo Hospital, on 4/13/2016, answered the question What would help you to remember to place swab caps on each port?. The majority of staff, (67%) chose Keeping swab caps in a closed top container on each WOW. The second most frequent repose was Creating and using an IV bundle kit- including swab caps and tubing (22%). The third most frequent response was Only using the flushes with the swab caps attached (11%).

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