Peripheral intravenous catheter clinical care standard adherence in emergency departments: A qualitative study underpinned by the behaviour change wheel

Abstract

Aim: To explore the barriers and facilitators influencing emergency department clinicians' adherence to the Australian Peripheral Intravenous Catheter (PIVC) Clinical Care Standard, using the Behaviour Change Wheel (BCW).

Background: Suboptimal PIVC practices are frequently linked to a range of patient-important adverse outcomes. The first Australian Peripheral Intravenous Catheter Clinical Care Standard was introduced in 2021, aiming to standardize practice. However, a recent national survey revealed a lack of adherence to the Standard among emergency department clinicians.

Design: A qualitative descriptive study.

Method: The study was conducted across two Australian emergency departments in 2023. Utilizing purposive sampling, semi-structured interviews were conducted. The analysis incorporated both deductive and inductive approaches, mapping the findings to the BCW.

Findings: Interviews with 25 nurses and doctors revealed nine key subthemes. The main barriers were the stressful environment, insufficient education and training, and the absence of a feedback mechanism. The main facilitators were recognition of suboptimal practice, belief in the importance of patient engagement, and the desire to improve practice.

Conclusion: Multiple complex factors have an impact on clinicians' adherence to the Standard. The identified interventions will serve as a guide for future implementation of the Standard.

Implications for the profession and patient care: The findings inform healthcare organizations of the significance of implementing strategies to enhance clinicians' acceptance of the Standard. Clinicians should consider incorporating the multifaceted interventions developed in accordance with the BCW for future implementation projects.

Impact: Promoting adherence to standards opens avenues to challenge suboptimal practice and has the potential to instigate a culture shift in the fundamental skills of frontline clinicians.

Reporting method: The study is designed and reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

Patient or public contribution: No patient or public contribution.

Keywords: barriers; emergency department; facilitators; guideline adherence; peripheral intravenous catheter; qualitative study; vascular access.