NR 714 Week 6 Data Analysis Results Example

Data Analysis Results: How Often Peripheral IV Catheters Failed Once 4 North Adopted a Securement Bundle, With Every Record Accounted For

Student Name

College of Nursing, Chamberlain University

NR 714: Application of Analytic Methods II

Instructor Name

Month Day, Year

Data Analysis Results: How Often Peripheral IV Catheters Failed Once 4 North Adopted a Securement Bundle, With Every Record Accounted For

Records Expected Against Records Obtained

The analysis plan anticipated roughly 1,400 catheters, over roughly 4,200 catheter-days, after the bundle began. The extraction returned 1,388 catheter records. Forty-six had neither an insertion time nor a time of arrival on the unit, so their catheter-days could not be computed, and they were excluded as the plan required. That leaves 1,342 catheters and 4,071 catheter-days in the analysis, 96% of the expected catheters, above the plan's floor of 1,260.

Fifty-four analyzed catheters had a blank removal reason. The project lead and a second nurse reviewed each against the nursing notes and agreed on 39: 22 described a failure and 17 did not. Fifteen remain unknown. As planned, those 15 are treated as intact catheters in the primary analysis and as failures in the sensitivity analysis.

Who Was Lost, and Were They Different

The 46 excluded catheters were 3.3% of the records, above the 3% at which the plan required a comparison. They differ in one way. Thirty-one of the 46, 67%, arrived from the emergency department between 23:00 and 07:00, against 38% of analyzed catheters. Their median patient age, 71, was close to the analyzed group's 68. Night arrivals from the emergency department are the catheters that receive the bundle latest, at their first dressing change, so excluding them is more likely to flatter the bundle slightly than to hide an effect. The subgroup comparison below shows the size of that difference.

A Departure From the Plan, Declared

The plan set the post period as 1 September 2026 to 28 February 2027. The tissue adhesive arrived on 13 September, two weeks late, because of a supplier backorder. The post period was therefore moved to 15 September 2026 to 14 March 2027, which keeps it at 181 days and starts it when all three parts of the bundle were in use. The decision was made on 14 September, before any post-period record was extracted, and recorded in the council minutes. No other departure was made.

Description Before Comparison

Table 1

Catheters and Dwell Before and After the Securement Bundle, 4 North

Note. Note. Dwell runs from when a catheter was both in place and on the unit until it was removed or the patient left.

Dwell time was strongly right-skewed in both periods, with a long tail of catheters kept for a week or more, so medians are reported. The median rose by eight hours after the bundle. That matters for the choice of comparison: with catheters lasting longer, a per-catheter percentage would understate any improvement per day of use, and the catheter-day rate planned as the primary measure is the right one. The two periods had similar shares of emergency department arrivals.

The Primary Comparison

Failures fell from 437 over 4,236 catheter-days, 103.2 per 1,000, to 318 over 4,071 catheter-days, 78.1 per 1,000. The rate ratio is 0.76, with a 95% confidence interval from 0.66 to 0.87. The upper limit is below 1.0, which meets the plan's definition of a reduction. Across its range, the interval is consistent with a fall of between 13% and 34% in the failure rate.

In the sensitivity analysis, with the 15 unknown removals counted as failures, the post rate is 333 over 4,071, 81.8 per 1,000, and the rate ratio is 0.79 (95% CI 0.69 to 0.91). The conclusion does not depend on how the unknown removals are treated. A p-value is not reported as the finding, because it would say only that the ratio is unlikely to be exactly 1.0; the interval says how large the change plausibly is, which is what the unit has to decide on (Sullivan & Feinn, 2012).

Secondary Comparisons

Per catheter, 318 of 1,342 failed after the bundle, 23.7%, against 30.9% before, a risk difference of 7.3 percentage points (95% CI 3.9 to 10.6). Dislodgement fell from 96 removals, 22.7 per 1,000 catheter-days, to 52, 12.8 per 1,000, a rate ratio of 0.56 (95% CI 0.40 to 0.79), the largest change of any reason and the one securement most directly targets.

On the u-chart, all six post-bundle months fell below the baseline center line, though none fell below the lower control limit of about 67 per 1,000. The chart's shift rule asks for eight consecutive points, so March and April 2027 will show whether the shift holds (Provost & Murray, 2022).

In the planned subgroup, catheters inserted on the unit fell from 100.8 to 69.4 per 1,000 catheter-days, a rate ratio of 0.69 (95% CI 0.57 to 0.84). Catheters arriving from the emergency department fell from 106.3 to 90.9, a rate ratio of 0.86 (95% CI 0.69 to 1.06), an interval that includes no change. The pattern fits the bundle working where it is applied at insertion, but the two intervals overlap, so the difference between subgroups is suggestive rather than shown.

Balancing Measures

Medical adhesive-related skin injuries rose from 2 in the baseline period to 7 after the bundle. The counts are small, but the direction is the one the unit was watching for, and all seven occurred in patients over 80. The added supply cost was $4,160 for the period, $3.10 for each of 1,342 catheters. At the baseline rate, the post period's 4,071 catheter-days would have produced about 420 failures, so roughly 102 were avoided, at about $41 each in supplies, before counting the nurse time and supplies each reinsertion uses.

What the Analysis Shows and What It Does Not

The analysis shows that premature failure of peripheral catheters on 4 North fell after the bundle began, by an amount the unit can describe with its interval, and that the fall was largest for dislodgement and for catheters inserted on the unit. It does not show that the bundle caused the fall. With one unit measured before and after, the design cannot rule out other changes in the same months, and the evaluation plan will name the ones the unit knows of. It also does not show that patients were harmed less, since the measure counts removals rather than injuries. A large randomized trial of dressing and securement products in adults found no clear advantage for any single product over standard care (Rickard et al., 2018), which is a reason to read this single-unit result with care and to credit the bundle's whole routine, including the shift check, rather than one product.

References

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

Rickard, C. M., Marsh, N., Webster, J., Runnegar, N., Larsen, E., McGrail, M. R., Fullerton, F., Bettington, E., Whitty, J. A., Choudhury, M. A., Tuffaha, H., Corley, A., McMillan, D. J., Fraser, J. F., Marshall, A. P., & Playford, E. G. (2018). Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): A pragmatic, randomised controlled, superiority trial. The Lancet, 392(10145), 419-430. https://doi.org/10.1016/S0140-6736(18)31380-1

Sullivan, G. M., & Feinn, R. (2012). Using effect size, or why the P value is not enough. Journal of Graduate Medical Education, 4(3), 279-282. https://doi.org/10.4300/JGME-D-12-00156.1