Just Say No to the Just in Case Cannula: An Implementation Science Trial

The site-specific quality improvement intervention will be based upon our previous research and the Australian Commission on Safety and Quality in Health Care (ACSQHC) standard but co-designed by Emergency Department (ED) managers, clinicians and implementation scientists using validated implementation frameworks. It will be developed using human factors principles, such as equipment, environment and changing clinician heuristics rather than determining the care of individual patients. Each ED site will co-design locally tailored intervention over a two-to-six-month period. Focus groups and working group meetings will occur until consensus regarding site specific interventions has been reached. Elements of the interventions will include: 1. Clinical guidelines review on the best practice for peripheral intravenous cannula (PIVC): based on ACSQHC PIVC quality indicators and locally approved guidelines. 2. Education for healthcare workers, including • Revision of PIVC education at each site • Monthly education sessions at each site • Work with ED medical directors and nurse unit managers to encourage the best practice of PIVC • Reminders at daily clinical staff briefing • Provision of instructions to clinical staff on how to document PIVC in the Electric Medical Record (EMR) • Information to assist clinical staff to make informed decisions 3. Audit and feedback program, such as • Spot audits • Provision of PIVC documentation statistics to ED medical directors and nurse unit managers • Creation of a PIVC dashboard at each site 4. Clinical and leadership champions: to support, advocate for, and spearhead the implementation initiative at each site. 5. Environment and equipment change, such as • Audit of the intravenous (IV) trolley • Equipment changes of IV trolley Outputs of the co-design intervention will be determined by the principal site investigator and the site working group at each site. Trial design The trial duration is three years and consists of three steps: Step 1, Step 2 and Step 3. Routinely collected clinical and health services data will be collected from participating EDs for the duration of the trial. The nine participating ED sites are divided across three clusters, with three sites in each cluster. Each cluster will be allocated to receive the intervention at one of three study steps. This means that one cluster will receive the intervention at Step 1, another cluster will receive the intervention at Step 2, and the final cluster will receive the intervention at Step 3. The nine participating ED hospitals are 1. Monash Medical Centre (Monash Health) 2. Casey Hospital (Monash Health) 3. Dandenong Hospital (Monash Health) 4. Alfred Hospital (Alfred Health) 5. Sandringham Hospital (Alfred Health) 6. Box Hill Hospital (Eastern Health) 7. Gold Coast University Hospital (Queensland Health) 8. Robina Hospital (Queensland Health) 9. Royal Hobart Hospital (Tasmania Health)