Implementing an Evidence-based, Standardized Care Bundle Targeting Register Nurses and Anaesthesiologists, to Enhance Patient Safety and Quality of Intravascular Access Devices Care Management - The Safe-IVADs Project. A Longitudinell Implementation Intervention With an Embedded Process Evaluation.

To evaluate changes in intravascular catheter care quality and healthcare professionals' knowledge over time, at the intervention and control hospital.

The protocol monitor intravascular catheters quality encompasses nominal variables (0 or 1) and points are summarized with an optimal score of zero indicating high intravascular catheter care quality . Thrombophlebitis is classified using a severity grading scale from 0 to 4 grades, where higher grades indicate greater symptom severity. Staff knowledge test consist of 26 question from the National Board of Health and Welfare catheter best practices. Linear mixed models will be used for longitudinal analysis of the repeated measurements of intravascular catheter quality and staff knowledge test. With additional comparisons between intervention and control hospital.

To translate and cross-culture adapt an adult difficult vein access scale (A-DIVA) to Swedish context.

The adult difficult vein access scale, Adult-DIVA scale will be translated into Swedish and culturally adapted following internationally recommended guidelines. The process will include forward-backward translation, expert panel review, and cognitive debriefing with healthcare professionals to ensure conceptual, semantic, and operational equivalence. To assess the validity and reliability among the Swedish registered nurse and anesthesiologists involved in difficult vein access management, a convenience sample (n=30) of general native Swedish speaking healthcare workers will be recruited from both intervention and control hospital. After completing the cross-cultural adaptation, reliability and validity will be assessed within a larger sample (n=100) of healthcare workers involved with A-DIVA management.

Process evaluation of the Safe IVADs implementation intervention, using Medical Research Council (MRC) guidance regarding feasibility, acceptability and fidelity.

The design integrates quantitative and qualitative process data, to evaluate the implementation process, and contextual factors influencing the prevention of IVAD-related complications across an intervention and a control hospital. Quantitative process data: Attendance rate in meetings, completed IVAD certificates and staff turnover. Qualitative process data: Implementation logbook (notebook on processes, meetings, and reflections). Semi-structured interviews, with a strategic selection of participants on micro- and meso-level within the organization (variation from the involved units, type of profession, age, working years, and gender)

To evaluate the cost-effectiveness of the intervention

Cost-effectiveness analysis will compare incremental costs from a health system perspective (implementation, intervention, and downstream) to the incremental health outcomes; the IVADs complications.