Running head: LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis-Quality Improvement Process

Jessica DeRuiter, Kelli Koop, Jordan Lentz,
Mollie Morrissey, Elyse Sincler, & Katie VanderVelde
Ferris State University

LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis-Quality Improvement Process

Identify Clinical Need

Intravenous catheters (IVs) are continuously started in a wide-variety of patients, from
individuals who need chemotherapy to those who need a saline lock IV access. Approximately
200 million IVs are used in the United States each year and up to 70% of these patients needed
an IV in the acute care setting alone (Rickard et al., 2012). It is pertinent that nurses know how to
start an IV, thoroughly assess the sight often, use them properly, and know what the hospitals
policies are. Currently the policies require nurses to change the IVs every 72-96 hours to prevent
phlebitis, infiltration, and infection. This standard of practice is being challenged from routine to
clinically necessary replacement or removal (Ho & Cheung, 2012).
There have been several research studies on this subject that suggested clinically
indicated removal over routine replacement, because there was no clinical evidence that 72-96
hour replacement was more beneficial or needed. One study presented evidence supporting an as
needed replacement of intravenous catheters. The study showed that clinically indicated
replacement does not increase the risk of harm to the patient and the quality of care is not
hindered (Rickard et al., 2012). Another study found there was no significant increased risk of
phlebitis or bacteremia with IV indwelling times longer than 96 hours (Gallant & Schultz, 2006).
In pediatric units, nurses use an as needed replacement policy to decrease anxiety and increase
comfort in their patients (Rickard et al., 2012). If this is best practice for pediatric patients, it
should be considered whether it could be best practice for adults as well.
Interdisciplinary Team

LEADERSHIP STRATEGY ANALYSIS

In order to determine the need for having to change the IV catheters based on the patient
rather than using the 72-96 hour rule, an interdisciplinary team is essential to determine the best
quality of care for the patient. A team must work together to achieve cost-effective care while
achieving the highest quality of care in the health care setting (Yoder-Wise, 2013, p. 62).
Members of this team would include, nurses, physicians, case managers, and quality
improvement. Nurses, physicians and the case managers are involved because of the direct care
that they have with the patient. Nurses being the most important because based on this change,
they will need to be using their best nursing judgment and knowledge to attain quality and safety
for the patient. Quality improvement is involved due to the involvement they have with the
changes that would be made in the policies and procedures. These team members will need to
trust each other and work together to be able to make the decision based on the individual patient
so that we can avoid any phlebitis, infiltration, and infection, but also be able to reduce any
anxiety and increase comfort if the IV doesnt have to be changed within the 72-96 hours.
Data Collection Method
After the clinical need has been identified research is used to support and make change
on the clinical problem. As defined in Yoder-Wise (2013) Research utilization is used to
synthesize, disseminate, and use research-generated knowledge to influence or change existing
practices (p. 413). As a leadership strategy, the CINAHL database was used as a method of data
collection to retrieve nursing research articles in order to support research-generated knowledge
on IVs. The database showed three articles that supported clinically indicated removal over
routine replacement: intravenous catheter removal, intravenous catheter guidelines, and
discontinuing intravenous catheters.

LEADERSHIP STRATEGY ANALYSIS

Nurse leaders may not necessarily be the ones actually conducting research, evaluating
research evidence, or developing evidence-based guidelines, but they will be facilitating the
application of research findings in practice (Yoder-Wise, 2013, p. 413). The chosen articles met
a certain criteria that are required to be considered nursing research. First, the articles that did not
come from nursing journals and/or contain nursing authors would be eliminated from the
selection. Articles that have nursing authors or come from nursing journals give a perspective
that generally relates to a nursing point-of-view. Next, the articles needed to involve an
experimental research study about the IV practices; literature reviews or articles presenting no
clinical data were excluded from the selection process. Finally, the selected articles were chosen
based on their good literature review, large population selection, and representation of their
studys methods and results. Without the development of evidence-based guidelines the method
of data collection, as using research findings to gather data, would have not been accomplished.

Establishes Outcomes
If nurses could provide thorough and detailed IV assessments habitually rather than
maintaining routine IV changes, clinically indicated IV replacement could be attainable. Overall,
this change has the possibility to prevent unnecessary IV changes, which would increase patient
comfort, decrease time-consuming interventions, and decrease hospital costs (Gallant & Schultz,
2006). Therefore, our goal is for hospitals to implement IV changes based on thorough
assessments by the year of 2015.

LEADERSHIP STRATEGY ANALYSIS

References
Gallant, P., & Schultz, A. (2006). Evaluation of a visual infusion phlebitis scale for determining
appropriate discontinuation of peripheral intravenous catheters. Journal Of Infusion
Nursing, 29(6), 338-345. doi: http://0-ovidsp.tx.ovid.com.libcat.ferris.edu/sp3.11.0a/ovidweb
Ho, K., & Cheung, D. (2012). Guidelines on timing in replacing peripheral intravenous catheters.
Journal Of Clinical Nursing, 21(11/12), 1499-1506. doi:10.1111/j.13652702.2011.03974.x

LEADERSHIP STRATEGY ANALYSIS

Rickard, C., Webster, J., Wallis, M., Marsh, N., McGrail, M., French, V., & ... Whitby, M.
(2012). Routine versus clinically indicated replacement of peripheral intravenous
catheters: a randomised controlled equivalence trial. Lancet, 380(9847), 1066-1074.
doi:10.1016/S0140-6736(12)61082-4
Yoder-Wise, P. S. (2013). Leading and Managing in Nursing (5th ed.). Elsevier Health Sciences