Implementación de un modelo de movilización del conocimiento para prevenir eventos adversos asociados al catéter venoso periférico

Abstract

BACKGROUND. Two billion peripheral intravenous catheters (PIVCs) are inserted each year in hospitalised patients worldwide. Nearly one in two PIVCs fails before the completion of intravenous therapy. Thus, we face the challenge of mitigating the health, economic, human, and social impact of PIVC failure, underestimated by healthcare professionals and managers due to its low impact on patient safety. OBJECTIVES. The main aim of this thesis is to evaluate the efficacy of the implementation and hospital cost of a multimodal intervention based on the i-PARIHS model to reduce PIVC failure (phlebitis, extravasation, obstruction, dislodgement, and infection) among hospitalised patients, improving adherence to the best available evidence regarding PIVC care. METHODS AND RESULTS. This doctoral thesis incorporates studies with different methodologies according to the requirements of the implementation process in response to the research hypothesis. The use of quantitative and qualitative research methodologies has been essential to conduct a thorough baseline analysis from an organisational aspect at the micro-level, exploring the impact of decision-making at the stakeholder level along with clinical indicators that determine the degree of adherence to recommendations. This thesis continues with the principles identified both in the systematic review and in the baseline studies of quantitative and qualitative methodology, which show that PIVC failure is a problem of great relevance and frequently during the hospitalisation of patients. In addition, it allows us to analyse adherence to the recommendations proposed by the CPGs and how they integrate decision-making regarding the care and management of PIVCs among nurses in the health system. Finally, behavioural and organisational 20 knowledge led to better decisions regarding the planning of the multimodal intervention. This methodological solution made it possible to adapt and modulate all the actions carried out by the internal facilitators within a larger strategy and ensure the success of the knowledge mobilisation model throughout the implementation process. These actions reduced PIVC failure rates and hospital costs associated with its most severe complications, improving adherence to recommendations from CPGs. CONCLUSIONS. The implementation of the multimodal intervention reduced PIVC failure, avoiding potentially infectious complications for hospitalised patients at 12 months and hospital costs for the National Health System. In addition, the findings of this thesis have allowed a deeper understanding of the integration of the best available evidence into the decision-making of PIVC care from different organisational aspects. The use of the facilitation model counteracted the impact of perceptions, attitudes, and beliefs about the determinants of decision-making of nurses for PIVC care, improving adherence to the best available evidence and, consequently, providing safe and quality care during health care.