Effective IV cannulation training is essential for patient safety

Placing an intravenous (IV) cannula can be challenging for experienced doctors and intimidating for less experienced ones.¹ Cannulation errors occur for different reasons including insufficient training, user error, improper use of a cannula or inadequate maintenance.² Cannula use-related factors may lead to IV complications.³

Medical students must acquire a certain number of safety behaviours before graduating from medical school.⁴ When future doctors learn to master technical procedures, this may help them ensure patient safety by minimising the risk of making errors.⁵

Non-technical skills (NTSs) are also necessary to minimise human error.⁶ NTSs include:⁶

• Cognitive abilities
• Attitude
• Social skills

Once acquired, NTSs enable medical students to face challenging, constantly changing and unfamiliar settings.⁷

A range of formats are available for training medical students on how to cannulate a patient:

• Practice on other students⁸
• Mannequins⁹
• E-learning⁷
• Virtual reality⁹
• Augmented reality¹⁰
• Etc.

Evaluating hybrid IV cannulation training⁴

Carter et al. conducted a qualitative study at the University of Plymouth’s Peninsula Medical School on safety behaviours in medical students using video-reflexive ethnography (VRE), interviews and two simulation scenarios.

The study was organised in five steps:

1. First simulation
2. E-learning
3. Second simulation
4. VRE questionnaire
5. Interview

Researchers recruited five female and five male final-year medical students to participate in the simulations, the second one occurring two weeks after the first. Two actors played patients and a student nurse was recruited to play the part of the nurse. The actors wore a specialised cannulation sleeve to simulate real-world cannulation.

Before the simulations, actors were instructed to change their moods and get into awkward positions. Participants had to manage poor lighting and equipment layout. During each simulation, the medical students faced a certain number of human factor-related issues to handle. The second simulation was designed to be unpredictable compared with the first simulation.

Training with IV cannulation e-learning

After the first simulation, participants participated in e-learning training.⁴ They learned about theory, took quizzes and watched videos for a deeply engaging experience.⁷

The e-learning resource was primarily designed for:⁷

• Doctors
• Nurses
• Paramedics
• Other healthcare professionals

The e-learning resource was made up of a total of four modules:⁴

1. “Prepare”
2. “Procedure”
3. “Preserve”
4. “Communication skills and human factors”

The aim of these modules was to help reduce high IV complication and cannula failure rates.⁷ Participants were asked to complete the fourth module.⁴

The fourth module covered the following topics:⁴

• Why communicate?
• Communication skills
• Human factors and safety
• Best practices in communication

The fourth module included the Swiss cheese model,⁴ which is made up of four “slices” or barriers with potential “holes” or failures in them.¹¹ For cannulation, these barriers against patient harm include good communication, infection prevention, documentation and adequate staffing.⁴

Examples of human errors that may lead to patient harm during or after cannulation include: inadequate communication with the patient, poor hygiene, inadequate written documentation and staff shortages.⁴

Evaluating this hybrid cannulation training⁴

After the second simulation, study participants were asked to watch videos of themselves during the simulations and fill in a questionnaire to compare how they performed at each simulation. This method, called VRE, helped participants analyse and reflect on their performance. After completing the VRE questionnaire and within 10 days of the second stimulation, they also participated in 15–25 minute interviews. Researchers asked participants questions about the e-learning to find out why behaviours changed between each simulation.

More on this topic: How best practice vascular access can help you foster a culture of safety and infection prevention

Impact of IV cannulation training on safety behaviours

This hybrid IV cannulation training enabled participants to develop their NTSs and become more focused on the patient.⁷ One of the participants said, “I was able to use more of my brain power focusing on the actual interaction with the patient instead of worrying about what to pick up and how to put a cannula in.”⁷

Participants improved their ability to control, adapt and improvise during complex situations.⁷ According to Carter et al., “The simulations gave participants confidence that they could manage challenging [IV] cannulation in real-world practice.”⁷

They thought safety behaviours improved in participants thanks to the e-learning resource used between scenarios.⁴ The combination of demonstrative videos with interactive activities helped influence safety behaviours in the 10 medical students that participated in this qualitative study.⁴ Carter et al. feel that effective training is essential for maintaining high standards of patient safety in healthcare facilities.⁷

More on this topic: Make the safety switch: 4 potential everyday safety hazards

References