ORIGINAL RESEARCH Human factor-designed multimodal intervention reduces the rate of unused peripheral intravenous cannula insertion Diana EGERTON-WARBURTON , 1,2 Fern MCALLAN, 3 Radha RAMANAN, 4 Zheng Jie LIM , 5 Daniel NAGLE, 5 Claire DENDLE 2 and Rhonda STUART 6 1 Emergency Department, Monash Health, Melbourne, Victoria, Australia, 2 School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia, 3 Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia, 4 Haematology Department, Austin Health, Melbourne, Victoria, Australia, 5 Faculty of Medicine, Monash University, Melbourne, Victoria, Australia, and 6 Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia Abstract Objective: Our objective was to examine the impact of a human factor-designed multimodal interven- tion on the proportion of unused peripheral i.v. cannula (PIVC) inser- tion in our ED. Methods:A pre- and post- multimodal intervention retrospec- tive cohort study was conducted using a structured electronic medical record review within a single adult tertiary ED in Australia. Pre- intervention data was collected 30 days prior to the multimodal intervention, with 30 day post- intervention data collected 3 months after the intervention commenced. The rates of PIVC inserted, the unused rate and the unused but appropriately inserted cannulas were the main outcome measures. Results: Intravenous cannula insertion rates decreased by 12.9% (95% confi- dence interval [CI] 12.19–13.61) between the pre-intervention (1413/4167 [33.9%]; 95% CI 32.5–35.4) and post-intervention cohort (928/4421 [21.0%]; 95% CI 19.8–22.2). An analysis of 754 cases (376 pre-intervention and 378 post- intervention) showed that 139 of 376 (37.0%; 95% CI 32.1–42.1) i.v. cannulas were unused pre-interven- tion, while 73 of 378 (19.3%; 95% CI 15.4–23.7) was unused post-interven- tion; an absolute reduction of 17.7% (95% CI 14.98–20.42). The relative risk of an unused i.v. cannula was 0.52 (95% CI 0.41–0.67). The proportion of unused but appropriately inserted i.v. cannulas remained unchanged in both cohorts, with a relative risk of 0.91 (95% CI 0.58–1.42). Conclusion: Our multimodal inter- vention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions. Key words: human factor, multi- modal intervention, peripheral intra- venous cannula. Introduction Peripheral i.v. cannulas (PIVCs) are commonly used in ED to gain vascu- lar access. PIVCs ensure that i.v. fluids and medications are effec- tively administered to patients where oral administration may be difficult or contraindicated. However, PIVCs are not without complications, with infective complications such as phle- bitis 1 and Staphylococcus aureus bac- teraemia (SAB). 2,3 Reports indicate that PIVCs contribute to nearly 25% of all healthcare-associated SAB cases, with 39.6% of these PIVC inserted in the ED. 4 Trinh et al. 2 dem- onstrated that among PIVC-related SAB, 67% of PIVC were inserted in the ED. Occupational risk to staff in the form of needle stick injuries have also been well documented. 5,6 Efforts to address the infective complications of PIVC have focused on insertion (aseptic or ‘no-touch’) technique, line maintenance and replacement. 7–9 Recently, research has suggested a primary approach to preventing these complications by reducing unused PIVC in the ED. Limm et al. 10 demonstrated in a single-centre study that up to 50% Correspondence: Associate Professor Diana Egerton-Warburton, Emergency Depart- ment, Monash Health, Monash Medical Centre, Locked Bag 29, Melbourne, VIC 3169, Australia. Email: diana.egerton-warburton@monash.edu Diana Egerton-Warburton, MBBS, FACEM, MClinEp, MPH, CCPU, Emergency Medicine Physician; Fern McAllan, MBBS, BMedSc, Emergency Medicine Registrar; Radha Ramanan, MBBS, Haematology Registrar; Zheng Jie Lim, Medical Student; Daniel Nagle, Medical Student; Claire Dendle, MBBS, FRACP, GCHPE, Infectious Diseases Physician; Rhonda Stuart, MBBS, FRACP, PhD, Infectious Diseases Physician. Accepted 26 July 2018 Key findings • Human factor-designed multi- modal intervention was effec- tive in reducing the rate of unused peripheral i.v. cannula insertions. • The intervention reduced the proportion of adults having a peripheral i.v. cannula inserted. • The appropriateness of unused peripheral i.v. cannula insertions did not change. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine Emergency Medicine Australasia (2018) doi: 10.1111/1742-6723.13165