PC1036: Utilization and Implication of the Modified DIVA Score and USGPIV in the Pediatric ED

Purpose/Objectives: The purpose of this study was to improve the timely identification and management of patients with difficult intravenous access in the pediatric emergency department. The SMART aim was to introduce an ultrasound-guided peripheral IV (USGPIV) training program in the pediatric emergency department (PED) with the goal to decrease the frequency of peripheral IVs requiring multiple attempts from 14% to 10% by December 2022.

Design/Methods: This study was conducted as a QI project with multiple PDSA cycles including all patients with an ESI score of 1-3 requiring PIV placement in the PED. A retrospective chart review was performed over a period of 3 months for collection of baseline data (PIV catheter size & side, location of catheter, adjuncts to aid in placement, number of attempts, time to IV placement, antibiotics, IV fluids, pain medication, lab results, and length of stay in the ED) and included 1755 individual patient encounters. Our first PDSA cycle implemented a modified Difficult Intravenous Access (DIVA) scoring tool (Yen, 1998) into the EHR (Electronic Health Record) documentation and DIVA scores are to be performed by clinicians prior to PIV placement (Image 1). Additional PDSA cycles provided education to end-users and visual reminders at the bedside. Ultrasound guidance is recommended for patients with scores of 4 or greater if trained clinicians are available. Implementation cycle will run over 12 months (currently ongoing) in the PED. During this cycle, simultaneous USGPIV training of additional clinicians will continue to increase the quantity of staff properly trained to perform USGPIVs in the PED. We are reviewing the same metrics collected before implementation of the modified DIVA scoring tool and USGPIV training program. These metrics are being analyzed using monthly run charts to monitor changes associated with our PDSA cycles.

Results: Following the first 3 months of the DIVA score and USGPIV training program, we saw a decrease in the percentage of PIVs requiring multiple attempts from 14% to 11%. Our rate of usage of ultrasound guidance went from 3.9% to 4.9%. Baseline metrics are currently being analyzed.

Conclusion/Discussion: From this study, we have shown that Initiation of USGPIV course is efficacious in terms of improving IV access and time to pertinent medications and decreasing LOS. Additionally, implanting USGPIV training helps to decrease the number of patients requiring multiple IV attempts. This study has shown that implementation of USGPIV program is an efficacious method of improving vascular access in the PED.