ED adherence to Australia’s PIVC Clinical Care Standard: what really gets in the way?

Study Overview

Design: Qualitative descriptive study using the Behaviour Change Wheel (BCW/COM-B)
Setting: Two metropolitan EDs in Queensland, interviews in 2023
Participants: 25 clinicians (RNs, CNs, SMOs, JMOs)
Aim: Identify barriers and facilitators to adhering to the 2021 PIVC Clinical Care Standard in EDs.

What clinicians said (themes mapped to COM-B)

Capability (knowledge/skills):

Barriers: Low awareness of the Standard, limited structured PIVC education, few clinicians trained in ultrasound-guided cannulation, complex/long guidance documents, junior skill mix.

Facilitators: Willingness to learn ultrasound; recognition that adherence benefits patients.

Opportunity (environment/resources):

Barriers: Busy triage, time/space constraints, frequent staff rotation, variable equipment and credentialing, reliance on “gut feel,” limited access to senior ultrasound inserters.

Facilitators: Phlebotomy services; pre-packed cannulation trolleys/packs; desire to standardise.

Motivation (regulation/beliefs/feedback):

Barriers: “Not feasible” perceptions (documentation, 8-hourly review), fear of being judged for escalating, no feedback loop on ED-inserted PIVC complications.

Facilitators: Recognition of suboptimal practice, patient-engagement mindset, “make the first go the best go,” anticipated regret from failed attempts.

Practical implications (BCW-aligned interventions)

• Education & training: Short, visual, interactive modules on the 10 QSs; regular competency checks; onboarding refreshers; teach DIVA tools (e.g., DIVA key) and insertion decision rules (e.g., 80% sure rule).
• Ultrasound capability: Train nurses in US-guided PIVC for DIVA to reduce delays and repeated attempts.
• Standardisation: One ED “way” for kits, documentation fields, attempt limits, escalation triggers; align credentialing across services.
• Environment tweaks: Stock cannulation packs and mobile trolleys; protect quick set-up time even when busy; consider dedicated phlebotomy/vascular access support at peaks.
• Feedback & culture: Close the loop with individual and team feedback (e.g., add PIVC cases to M&M), celebrate “first-attempt success” champions, and use storytelling of adverse scenarios to shift norms.
• Patient partnership: Script brief shared-decision prompts for when not to cannulate “just in case.”

Why it matters

Simply publishing a Standard isn’t enough. Targeted, theory-informed implementation (COM-B/BCW) can make ED practice safer, faster, and more consistent—especially around idle PIVCs, site choice, first-attempt success, and documentation.

Read More:https://onlinelibrary.wiley.com/doi/10.1111/jan.16409

Authors: Hui Xu (Grace), Julie Bowdery, Yeng To, Jed Duff, Bronwyn Griffin, Amanda J. Ullman, Claire M. Rickard, Karin Plummer