Implementing standardized venous access assessment and validating competency for safe administration of vesicant chemotherapy agents according to practice standards reduces adverse venous events by nearly 80%, ONS members Melissa Arangoa Miller, MS, APRN, ACNS-BC, AOCNS®, Victoria Frazier-Warmack, DNP, MSN, RN, OCN®, and Kathrene Castelo, RN, MSN, OCN®, reported in study findings published in the Clinical Journal of Oncology Nursing.
Identifying the Need
After analyzing opportunities to align their practices with ONS and Infusion Nurses Society (INS) standards and better meet the needs of the patient population at their Magnet-designated academic medical center, the nurses developed and implemented a practice change. They formed a work group representing all internal stakeholders: frontline infusion nurses, the oncology clinical nurse specialist, departmental nursing leadership, and the oncology clinical nurse educator.
Building the Plan
Together, they updated their institutional policies and practices on safe administration of vesicants and irritants to include:
- Steps on how to administer vesicant agents via peripheral IV according to INS standards
- Best-practice recommendations for checking blood return prior to, during, and after peripheral IV vesicant infusion based on ONS and INS standards
- New positioning of the Modified Adult Difficult IV Access (A-DIVA) Scale assessment tool in the electronic health record to ensure consistent use
The team introduced the changes to nursing staff through a needs assessment and gamified educational teaching, with subsequent one-on-one sessions with staff who couldn’t attend the initial training. They also placed reminders about the Modified A-DIVA Scale assessment tool and peripheral IV best practices at each computer screen; discussed the practice change during rounds, huddles, and staff meetings; and shared weekly outcome results.
“These regular team discussions facilitated engagement between leaders and staff and provided an opportunity for routine outcome monitoring and reviewing,” the authors wrote.
Measuring the Results
During the implementation (August 2019–June 2021), nurses documented 521 venous assessments using the Modified A-DIVA Scale with an average score of 1.31 of 5. Postimplementation (July 2021 to September 2022), the number of assessments increased to 9,203 with an average score of 0.7 of 5.
Prior to the practice change, the average chemotherapy-related venous event (e.g., infiltration, extravasation) rate from February–July 2019 was 0.24 per 100 peripheral IVs placed for chemotherapy visits. No PIV vesicant venous events occurred postimplementation, and chemotherapy-related adverse events decreased to 0.05 per 100 peripheral IVs—a 79% reduction in venous events.
“Using the evidence-based practice process can assist oncology nurses with identifying best practice for safe administration of peripheral IV vesicant chemotherapy, proper venous access selection, and advocation for central line placement when necessary,” the authors concluded. “This quality improvement project illustrates how a multifaceted, collaborative approach can allow the infusion nurse to preserve patient safety, standardize care, enhance communication among oncology teams, and apply current evidence-based practices for safe peripheral IV administration of chemotherapy.”
Learn more about the quality improvement project by reading the full Clinical Journal of Oncology Nursing article.