NR 714 Week 2 Outcome Measure Write-Up Example

Defining Premature Peripheral IV Catheter Failure as a Reproducible Outcome on an Adult Medicine Unit, With a Six-Month Baseline

Student Name

College of Nursing, Chamberlain University

NR 714: Application of Analytic Methods II

Instructor Name

Month Day, Year

Defining Premature Peripheral IV Catheter Failure as a Reproducible Outcome on an Adult Medicine Unit, With a Six-Month Baseline

The Outcome, Stated as an Event

The outcome is premature failure of a peripheral intravenous catheter: removal of the catheter before the end of the intravenous therapy it was placed for, with a removal reason of infiltration or extravasation, occlusion, dislodgement, phlebitis or leakage. A catheter removed because therapy ended, because the patient was discharged or because of a routine site change is not a failure. Each catheter can fail once. The measure is reported two ways: as a rate against catheter-days on the unit, per 1,000, which is the primary form, and as the percentage of catheters that fail, which is easier for staff to picture. Defining failure by the reason for removal rather than by dwell time follows the way the major cohort studies have counted it (Marsh et al., 2018), which also lets the unit compare its figure, cautiously, with theirs. A removal for any other reason is recorded but not counted, so a change in discharge timing cannot move the figure.

Who Is In and Who Is Out

The population is every peripheral catheter in an adult patient while that patient is on 4 North, a 36-bed general medicine unit. A catheter enters the count when the patient arrives on the unit with it or when it is inserted on the unit, and it leaves the count at removal, at the patient's transfer off the unit or at discharge, whichever comes first.

Four exclusions are written down because each changes the figure. Catheters removed within one hour of arrival are excluded, since they were almost always placed for a single dose of contrast in imaging and taken out on the patient's return. Midline catheters and central lines are excluded, because they are different devices with different failure patterns. Catheters in patients receiving comfort care only are excluded, because sites are often left in place without therapy. Catheters that fail after a patient transfers off the unit are not counted; their catheter-days stop at transfer, so the unit is not charged for time it did not manage.

Source, Field and Extraction

Each catheter appears in the electronic health record as a device entry under lines, drains and airways. The fields used are insertion date and time, arrival on unit date and time from the bed management record, removal date and time and removal reason from a fixed picklist of nine options. Five options map to failure; four, therapy complete, discharge, routine change and other, do not. Entries marked "other" are read against the free-text comment by the project lead, and if the comment describes swelling, pain on flushing, a dislodged catheter or a red cord, the entry is counted as the matching failure.

The unit's data analyst runs a saved report early each month, on its third working day, covering the month before. The report returns one row per catheter. Catheter-days are computed from the later of insertion and arrival to the earliest of removal, transfer and discharge, in hours divided by 24. A catheter with no removal entry is closed at discharge or transfer time. The same report, the same mapping and the same person produce every month, so a change in the figure is not a change in who counted.

A Baseline With Its Ordinary Swing

The baseline covers January to June 2026, before any part of the bundle was introduced.

Table 1

Premature Peripheral Catheter Failure on 4 North, January to June 2026

Note. Note. Failures are removals for infiltration, occlusion, dislodgement, phlebitis or leakage. Six-month figures are totals, not averages of months.

Over six months, 437 of 1,412 catheters failed, 30.9%, at a rate of 103.2 per 1,000 catheter-days. With nothing being done to it, the monthly rate moved between 96.0 and 111.6, a range of more than 15 points. A single month lower than 96 after the bundle starts would therefore mean very little. Six monthly points are also too few to set control limits with confidence, so the baseline will be extended with July and August 2026 before the bundle begins in September, giving eight points (Provost & Murray, 2022).

Failures split by reason as follows: infiltration 172, occlusion 118, dislodgement 96, phlebitis 31 and leakage 20. The two largest groups are the ones the bundle is most likely to touch, through securement and through a once-a-shift site check.

Who Records It, and How Consistently

The removal reason is chosen by whichever nurse removes the catheter, often at the end of a busy shift. To check consistency, two nurses independently assessed 40 sites in May 2026 using the unit's phlebitis and infiltration scales, and agreed on whether a failure was present in 36 of the 40, but on the specific reason in only 29. Total failure is therefore a firmer measure than the split by reason, and the project's primary comparison uses total failure for that reason. The agreement check will be repeated in the third month after the bundle starts, on another 40 sites, because nurses who have been taught a site scale may grade differently from nurses who have not. If agreement on the presence of failure drops below 33 of 40, the project lead will review the month's reason entries against the notes before the figure is reported. A shift in recording would otherwise look exactly like a shift in practice.

Where Measure and Meaning Part

The measure counts removals, not harm. An infiltration of saline in a forearm and an extravasation of a vesicant in the hand count the same, though they are not the same event for the patient. The measure also cannot see the effect of a failure, such as the second and third insertion attempts, the delayed antibiotic dose or the patient's distress, though these are the reasons the problem matters (Helm et al., 2015). And because the reason is chosen by the nurse, a bundle that makes nurses look more closely at sites might raise the recorded rate of phlebitis even if it lowers the real one. The unit will report what the measure is, a count of premature removals by recorded reason, and will not describe a falling rate as fewer injured patients.

References

Helm, R. E., Klausner, J. D., Klemperer, J. D., Flint, L. M., & Huang, E. (2015). Accepted but unacceptable: Peripheral IV catheter failure. Journal of Infusion Nursing, 38(3), 189-203. https://doi.org/10.1097/NAN.0000000000000100

Marsh, N., Webster, J., Larsen, E., Cooke, M., Mihala, G., & Rickard, C. M. (2018). Observational study of peripheral intravenous catheter outcomes in adult hospitalized patients: A multivariable analysis of peripheral intravenous catheter failure. Journal of Hospital Medicine, 13(2), 83-89. https://doi.org/10.12788/jhm.2867

Provost, L. P., & Murray, S. K. (2022). The health care data guide: Learning from data for improvement (2nd ed.). Jossey-Bass.