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. 2020 Jul/Sep;35(3):E41-E46.
doi: 10.1097/NCQ.0000000000000448.

Intravenous Access in Gastrointestinal Hemorrhage: A Multidisciplinary Quality Improvement Initiative Led by Emergency Department Nurses and Internal Medicine Physicians

Andree H Koop  1 , Jed Cowdell, Neej Patel, Alex Kesler, Edson Mwakyanjala, Alexander Heckman, Divya Padmanabhan Menon, Neil Patel, Patricia Narciso, Ashley Reid, Nicholl Decicco, Leigh Speicher
Affiliations

Intravenous Access in Gastrointestinal Hemorrhage: A Multidisciplinary Quality Improvement Initiative Led by Emergency Department Nurses and Internal Medicine Physicians

Andree H Koop et al. J Nurs Care Qual. 2020 Jul/Sep.

Abstract

Background: The management of acute gastrointestinal hemorrhage (GIH) is focused on early resuscitation through 2 large-bore intravenous (2LBIV) catheters, although adherence to this recommendation is low.

Local problem: Of 100 patients hospitalized with GIH in 2017, only 14 received 2LBIV access. The goal of this study was to improve this measure.

Methods: A multidisciplinary team used the DMAIC (define, measure, analyze, improve, and control) framework to perform a quality improvement initiative.

Interventions: The team used quality tools including a stakeholder survey, swimlane diagram, and fishbone diagram. The first intervention involved education of the hospitalists directing admissions, and the second intervention involved education of emergency department (ED) physicians and nurses regarding the importance of 2LBIV placement.

Results: Following the second intervention, there was a substantial increase in 2LBIV placement to 37 of 86 (43%).

Conclusions: Carefully directed education of ED physicians and nurses with monthly feedback was effective in improving appropriate intravenous placement in patients with GIH.

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References

    1. Kim BS, Li BT, Engel A, et al. Diagnosis of gastrointestinal bleeding: a practical guide for clinicians. World J Gastrointest Pathophysiol. 2014;5(4):467–478.
    1. Baradarian R, Ramdhaney S, Chapalamadugu R, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol. 2004;99(4):619–622.
    1. Chen ZJ, Freeman ML. Management of upper gastrointestinal bleeding emergencies: evidence-based medicine and practical considerations. World J Emerg Med. 2011;2(1):5–12.
    1. Hegade VS, Sood R, Mohammed N, Moreea S. Modern management of acute non-variceal upper gastrointestinal bleeding. Postgrad Med J. 2013;89(1056):591–598.
    1. Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345–360; quiz 361.

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