The I-DECIDED® device assessment and decision tool: qualitative findings

Background: The I-DECIDED® device assessment and decision tool was created from clinical guidelines to facilitate decision-making, with prompts to continue, troubleshoot, or remove a device. In several studies, implementation of I-DECIDED® reduced the prevalence of idle peripheral intravenous catheters (PIVCs) and PIVC complications, and improved nursing documentation.

Aim: To explore nurses’ PIVC assessment and decision-making pre- and post-implementation of the I-DECIDED® tool.

Methods: Focus groups with nurses were undertaken during a study to implement the tool in 3 Australian hospitals 2017–2018. Participation was voluntary and informed written consent was obtained. Interviews were audio-recorded and transcribed. Two nurses independently conducted thematic analysis. Ethics approval was obtained.

Findings: Pre-implementation (9 focus groups, 54 nurses): Nurses reported assessing PIVC length of dwell and local complications. Post-implementation (14 focus groups, 60 nurses): Nurses reported assessing PIVC need; more regular PIVC flushes; more frequent assessment of complications; improved confidence in making decisions about whether to remove the PIVC or change the IV dressing; and improved accountability for documentation. Several nurses said the mnemonic was helpful, but they expressed frustration with the additional paperwork.

Conclusions: Implementation of the I-DECIDED® tool improved nurses’ assessment and flushing of PIVCs and increased accountability for PIVC documentation. Nurses reported increased confidence in making decisions to remove unnecessary PIVCs. Electronic records could improve documentation compliance.