NURS FPX 9000 Assessment 3 Topic Report With CITI Training

NURS FPX 9000 Assessment 3 Topic Report With CITI Training

Student Name

Capella University

NURS-FPX9000

Professor Name

Submission Date

Topic Report With CITI Training

This topic represents a PhD project aimed at decreasing infusion-related complications in adult patients under infusion therapy in an outpatient setting. The identified gap in current practice is that there are incomplete assessments and adherence to aseptic technique, and there is an inconsistency in IV site assessments. The preventative intervention(s) proposed are based on the Infusion Nurses Society (INS) Infusion Therapy Standards of Practice. The interventions consist of standardizing site assessment of IV sites, an aseptic technique compliance bundle, and structured, competency-based, patient staff training designed to enhance the safety of the patient and uniformity of nursing practice. The implementation of a structured, multicomponent infusion care protocol with trained nursing personnel decreased complications, improved accuracy in documentation, and helped with following infection control measures. All training in the ethics of research and/or quality improvement training has been accomplished with the institutional CITI program, and compliance with human subjects protection and ethical standards for the project has been documented on the training transcript in the appendix.

Project Problem and Relevant Evidence

The problem of infusion-related complications (IRC) continues to be an important patient safety issue in outpatient infusion therapy. The occurrence of related complications to the peripheral intravenous (PIV) line – such as phlebitis, infiltration, extravasation, occlusion, catheter-related bloodstream infection, and its consequences – can cause patient discomfort, interrupt treatment, force patients to repeat intravenous insertion, use more resources, and result in unnecessary costs. Two of the standards for prevention of adverse events in infusion therapy are part of the infusion therapy standards of practice (9th ed.) of the Infusion Nurses Society (INS): standardized assessment of the IV site and rigidly following the aseptic non-touch technique. While there are clear professional standards, there is significant variation in infusion practices, especially in the absence of effective structured competency validation and standardised processes of recording that infusions are carried out.

Located in a private outpatient infusion center, specializing in the treatment of adults via intravenous fluids with a focus on wellness-based IV treatments, hydration therapy, and vitamin packets. It has been found to operate in a suburban community and infuse about 25-35 adult clients per day, or a mean of 150-200 infusion encounters per week (Clinical Director, personal communication, January 15, 2026). All therapies involve having to insert an IV in a peripheral vein and monitoring it for each treatment session carried out. A review of the IV insertion site over a three-month period identified noticeable inconsistencies in the assessment of IV insertion sites and the use of aseptic technique in the site care practices. 14 percent were found during the last 8 weeks of infusion encounters, when baseline data were gathered, and had documented infusion-related complications. Complications reported were phlebitis (6 percent), infiltration (5 percent), and catheter occlusion as evidenced by a need to reinsert the catheter (3 percent). However, while there were no bloodstream infections detected, the time between IV re-evaluations was not standardized, nor were grading tools used.

A greater number of infusion encounters had documentation of a documented IV site reassessment at the recommended time intervals during the infusion, which was found in 48 percent of the patients’ electronic health record documentation. The grading of phlebitis wasn’t on a specific scale, but was described; therefore, comparison was limited to cases. During informal audits of disinfection of the hubs, the duration of disinfection in the hubs was not consistent, and hand hygiene sequencing was variable in terms of the order in which it was performed, and gloving was not being done consistently when accessing the catheter (Clinical Director, personal communication, January 15, 2026). Recent quasi-experimental and quality improvement trials have shown that the use of structured care bundles and standardized training can significantly decrease the number of peripheral catheter-related complications and increase the reliability of documentation. The gap between the site and the standards identified indicates there is a gap in quality that can be measured and, therefore, needs to be addressed. There are several groups of stakeholders that are impacted. When complications arise, adult patients receiving infusion therapy suffer from pain, anxiety, a loss of therapy, and decreased satisfaction. Multiple insertions of IVs can cause increased discomfort and, over time, may make it difficult to insert and maintain IVs. When complications occur, the nursing staff gets disrupted, has an overload on their cognitive process, and might be subject to liability. In terms of organization, the process of reinserting prolongs chair time, decreases scheduling efficiency, increases the use of supplies, and has the potential of putting a dent in a competitive outpatient wellness market reputation. The myriad outpatient infusion services and growing client numbers further compound the risk factors, and make it more important that changes in practice are made that are standardized and based on evidence and today’s current professional standards.

Evaluation of Metrics and Areas for Improvement

The key will be to assess outcome and process indicators for metrics in order to gauge the effectiveness of the quality improvement intervention. A key outcome measure is the percentage of infusion encounters during an 8-week period that show there were documented complications related to the infusion. Secondary process measures are the percentage of encounters where the phlebitis was reassessed at recommended intervals, the percentage of encounters where a standardised phlebitis grading scale was used, and the percentage of all encounters where components of aseptic technique were observed, including the length of handwashing and hub disinfection.

Baseline data will be compared to benchmark data as well as results from implementation, to see if a reduction in complication rates and consistency of documentation can be achieved through practice standardization. Ongoing monitoring of the measures will help evolve workflow processes and help ensure infusion practice at the project site will be sustainable based on evidence.

The Project Site

The health care project site is located at an outpatient wellness environment/infusion center owned by a private company that administers intravenous hydration therapy and vitamin infusions, and offers other wellness therapies to its adult clientele. It is an ambulatory care clinic, and doesn’t treat patients in an inpatient or emergency setting. Care delivery emphasizes brief encounters for infusion that take place in a regulated clinical setting, typically care where the function of the RN is limited to the clinical setting. The focus of care delivery is on short-duration infusion encounters, where the RN delivers the infusion in a regulated clinical setting. The center is at a primary ambulatory level of care and provides infusion therapy for medically stable adults requiring elective or supportive infusion therapy. The clinic is in a suburban area of a metro area in the United States, and has a diverse middle-income population that has access to outpatient wellness services. The facility has a small clinical staff with a clinical director who provides clinical direction and standards and oversees the clinical practice at the facility. A number of treatment chairs are available in the infusion suite, enabling simultaneous treatments during the appointments. The average volume of adult clients seen per day is about 25, and the estimated volume of infusion encounters is about 150-200 per week. The quality improvement project will be rolled out to the entire outpatient infusion population, including all insertion and monitoring of peripheral intravenous (PIV) access.  

Project Support at the Project Site

There is an in-service training taking place at the Project Site for Project Support. Leadership and clinical team collaboration are a must to realize effective implementation and sustainability of successful QI efforts in an outpatient infusion. The wellness and infusion center has been well supported in the project, and the support has been organized to support the goals and mission of the project, which are to improve patient safety and service quality in the organization. The preceptor is an advanced infusion therapy practitioner/registered nurse with experience in working at the Clinical Director level and experience in registered nurse competency checking, validation, and ambulatory care operations. Ongoing weekly meetings with the preceptor have helped to refine and develop the infusion safety initiative, including reviewing baseline complication figures, creating IV site assessment tools, and informing routine practice of aseptic technique competency validation. Coordinated efforts like this make it possible to ensure the project is patient-centered, organizationally focused, and effective, and sustainable improvements for patient safety and nursing practice are being made.

The preceptor was given permission to review information from the chart audit, observe scheduling workflow, and review the documentation templates of the EHR to review practice patterns. Stakeholder engagement was done on a biweekly basis and involved registered nurses (RN) for the insertion and removal of peripheral IVs, the operations coordinator, and the clinic administrator. Discussions were planned from the perspective of the feasibility of workflow, efficiency of documentation, time spent at infusion events, and practical strategies to successfully incorporate standardized reassessment times without negatively impacting patient flow. Stakeholders spoke about the importance of short, focused training sessions without burdening clinic staff and helping to minimize disruption to the clinic workflow, and the need to incorporate reminders to reassess in the EHR to ensure compliance. Nursing staff feedback indicated that scheduling blocks for peak feeding time periods was problematic and may make it difficult for the nursing staff to document well. They were also asked for suggestions on visual reminders, such as alarms on infusion stations, to remind nursing staff of the appropriate hub disinfection time and ensure aseptic sequencing. VLE and stakeholder engagement led to improved adherence to standardized infusion practices and longer-term sustainability of infusion practices change, with evidence suggesting both were important. The clinic administrator agreed to make temporary scheduling changes in the process of implementing the changes to provide protected time for training staff in making the changes and for staff competency validation.

Areas for Preparation Enhancement

There are opportunities to develop skills, with further simulation exercises in using the non-touch technique for asepsis reinforcement and additional hands-on simulation practice to further develop phlebitis grading skills. Clear documentation requirements, along with defined time points of reinfusion that would also outline the intervals that patients need to be re-evaluated, would further assure implementation readiness. To support staff in their confidence and ensure consistent practice of INS-based standards in all infusion encounters, the use of competency check-off questions, as well as visual cue aids, may enhance practice.

Proposed Interventions

Two evidence-based interventions to reduce infusion-related complications (IRC) in adult patients getting outpatient infusion therapy will be implemented: (1) A standardized protocol to complete IV site assessment and documentation consistent with an approach to the INFUSION concept, and (2) Aseptic technique compliance bundle with structured competency validation. The interventions identified are the gap in which each item is a step-by-step, sequential process to guarantee consistency, safety, and follow best practices. An infusion therapy approach uses explicit strategies that are based on the Infusion Nurses Society (INS) Infusion Therapy Standards of Practice (9th ed.), which presents infusion therapy guidelines in light of the latest evidence. Interventions identified will directly address gaps in practice identified with baseline data that will support the PICOT question. The first intervention is to take an approach to assessing the IV site using a standardized protocol, using the Infusion Nurses Society (INS) Infusion Therapy Standards of Practice. The protocol will mandate the use of a validated phlebitis grading scale, calibration of the time frame for reassessment whilst infusion, and documentation fields within the EHR that will be structured. Implementation will include prompts to reassess and/or review abnormalities of the site in documentation templates, and will ensure that any abnormality that occurs at the site has been graded by consistent criteria. Standardized assessments have the supporting evidence needed to show that they help to reduce peripheral catheter complications. An evidence-based care bundle was shown to be effective in reducing the peripheral venous catheter-related phlebitis rates in the study by Demiroğlu and Tosun. There was an increase in adherence to venous catheter maintenance procedures and a decrease in complications after standardized procedures were introduced into the venous catheter maintenance clinic, said Yang. Structured competency validation resulted in an improvement in the quality of IV insertion and reduced adverse events, Jacobs found. Feng said there was a greater uniformity of rapid response in cases of infusion complications when it was trained via standardized training. The conclusion of all the studies is that “structured assessment protocols” are an effective strategy to enhance patient safety.

The second intervention will target a bundle of interventions to achieve compliance with the aseptic technique within the unit, and auditing and competency validation will be used. This kit covers standard hand hygiene, access to the hub with the disinfection solution for a specific period of time, wearing gloves, and maintaining aseptic non-touch technique when accessing the hub (when putting on and using a catheter). Implementation is done directly by observation of the infusion encounters in the selected weeks, and then, as the infusion encounters are quarterly competency assessments. Aseptic technique is emphasised as a key aspect in preventing catheter-related complications, among the goals for the INS standards. The study by Demiroğlu and Tosun (2015) found that if care bundles were to be developed that included aseptic practices, the incidence of phlebitis could be reduced. When the procedures for maintaining and keeping the infection prevented were standardized, Yang) proved better outcomes in terms of infection prevention. There is strong evidence that establishing injection practices based on a standardised practice bundle and then validating competency with reliable checks are effective in enhancing the reliability of injection practices and mitigating the risk of complications.

Evidence-Based Interventions

The intervention could be used for either of two primary interventions, but it is not the primary practice change. The major part will consist of a competency-based training program with all registered nurses who insert and monitor peripheral IVs. Training will involve obtaining the knowledge of the standards of INS, the grading of phlebitis, the intervals between reassessment, and hands-on using aseptic non-touch technique. A skills validation checklist will be used for competency check-offs. For training, cards with pictures that contain visual cues will be used at infusion stations, and a standard for documentation will be in the electronic guide. Evidence suggested that competency-based training has the potential to enhance the reliability of clinical practices and nurses’ confidence, which in turn helps to minimise the adverse outcomes and sustain quality improvement efforts over time. Together, the standardized assessment protocol, aseptic compliance bundle, and additional training create a standardized evidence-based approach to minimize infusion-related complications, optimize patient care, and increase uptake of best practice throughout the 8 weeks.

Comparisons

The comparison process for the DNP project will measure the current standard of care against the desired standard of care and the changes after the proposed interventions have been implemented. The current practice in the outpatient infusion center appears to be standard IV insertion and maintenance practice without a standardized assessment protocol and practicing a structured aseptic technique bundle. The findings of baseline observations show that there is variation in the monitoring of IV sites, different IV phlebitis grading, incomplete documentation in the EHR, and nursing staff do not have consistent adherence to aseptic non-touch techniques. The inconsistencies increase a vulnerable patient population, the likelihood of complications associated with infusion, such as phlebitis, infiltration, and infection, and compromise overall safety and quality of care. The desired state of care includes 100% compliance with an IV site assessment protocol that is aligned with the INS best practices, and an aseptic technique compliance bundle, with competency-based staff training. This will allow for the evaluation periods, documentation, and infection control measures to be standardized, which will ensure more consistent and evidence-based nursing practice. The comparison draws attention to the differences between the current (unsystematic) practice and the more systematic and consistent processes that are recommended by evidence-based guidelines. Assessing the effectiveness of the interventions and whether the desired state of care is met will be indicated by measuring changes in complication rates, how well the information is documented, and whether or not the protocols are followed for aseptic practice.

Desirable Outcomes

The main goal of the DNP project is to reduce the cases of infusion-related complications (IRC) in outpatients with adult DMTTs. Specifically, the project’s goals are to reduce by 30% or more the occurrence of peripheral IV complications (phlebitis, infiltration, and local infection) within 8 weeks of initial implementation of the project as compared to the baseline periods. Secondary outcomes consist of better adherence to standard IV site assessment practices, better aseptic technique, and better and more complete Electronic Health Record documentation. This will result in clear outcomes that will be measurable and will give evidence of improvement in practice.

There will be a number of quantitative indicators that will be used for outcomes. Documented events of phlebitis, infiltration, and infection will be charted each week, and this will be reviewed to monitor the incidence of IV complications. IV site assessments will be carried out in accordance with the standardized procedure, and monitoring will be done with a checklist that identifies and monitors the different grades of phlebitis and reassessment times. Structured observation audits will be used to assess the adherence to aseptic technique and will be carried out during random infusion encounters – at least 90% of the nursing staff should achieve this. Documentation accuracy and completeness will be assessed using an audit tool, which will be compared to a standardised template. Adopting standardized assessment and aseptic techniques will likely minimize preventable complications, improve patient satisfaction, and help to ensure sustainability of evidence-based infusion care practices. The benefits of a successful project are: increased patient safety, better quality of care to patients, and regaining confidence for nurses to conduct infusion therapy procedures.

Learner’s Role for the Project

During this project, the learner’s role is to be the leader and manager in putting evidence-based interventions into practice to decrease infusion-related complications. As the project lead, I will oversee the training of staff, competency assessment, and validation of skills, and put INS-aligned IV site assessment and aseptic technique protocols into practice as routine. There is collaboration with the preceptor (infusion specialist board-certified) for policy and evidence-based practice. Continued monitoring of compliance with protocol, regular audits, and current feedback will help identify issues with the protocol processes and ways to enhance them.

Project Question

How does the Infusion Nurses Society (INS) Infusion Therapy Standards of Practice with structured training on IV site assessment and aseptic technique (I) sound when compared to current practice (C) affect the infusion-related complications (O) of nursing staff caring for adult patients who are receiving outpatient infusion therapy (P) over an 8-week period of time (T)?

The PICOT question for the current project is related to outpatient infusion therapy (intravenous antibiotic therapy, intravenous (IV) fluids, or any other IV medication) for adult patients who are at risk of developing complications (P) from the therapy, like phlebitis, infiltration, or local infection. The proposed intervention (I) is the standardisation of the IV site assessment process (inspecting routine, protocol, and documentation) and aseptic technique (inspecting routine, protocol, and documentation), which are part of the INS Infusion Therapy Standards of Practice, complemented by structured, competency-based professional training. Current standard of care (C) has the current standard of care in mind, where IV insertion and maintenance occur as part of routine care; however, not each one is assessed at fixed intervals, as there are no fixed competencies to validate, and there are no established bundles of aseptic technique. The intended outcome(s) (O) for this intervention are: To decrease infusion-related complications, to increase the level of adherence to routine assessment and aseptic technique, and to improve the documentation of the assessment and aseptic technique. The time frame (T) for the QI project is an eight-week period to implement the main interventions, with monitoring of adherence, competency, and complication rates for eight weeks to assess effectiveness and sustainability. The PICOT method helps to organize the planning, implementation, and evaluation of the QI project and helps ensure measurable and evidence-based outcomes.

Conclusion

The goal of the DNP project is to help decrease complications associated with the use of IVs in adult outpatient patients by promoting a standardized IV protocol for assessing IV sites and aseptic technique protocols. Evidence-based interventions, directed by the INS Infusion Therapy Standards of Practice, help to increase patient safety and result in better infusion therapy practice. Staff training is planned and structured to make sure staff are competent, and this helps to keep them in line with best practice. This will be measurable after 8 weeks of implementation, when complications, documentation, and compliance with the protocol will be assessed. The project aims to encourage better, long-term quality improvement, improved patient outcomes, and boost nurse confidence in infusion therapy procedures.

Related Assessment for this class: NURS FPX 9000 Assessment 2, NURS FPX 9000 Assessment 4 and NURS FPX 9000 Assessment 6