NURS FPX 9010 Assessment 3 Project Proposal

NURS FPX 9010 Assessment 3 Project Proposal

Student Name

University

NURS-FPX9010

Dr.

July, 2026

Project Proposal

Patient safety has continued to be a challenge due to infusion-related complications in outpatient settings. The baseline data for this project site, a private outpatient infusion center where the clinical director is responsible for patient care, showed as high as 14 percent of infusion encounters were not able to be documented (Clinical Director, personal communication, January 15, 2026). Nickel et al. (2024) identified a few factors that could have contributed to this, such as inconsistent assessment of IV sites, deviations from aseptic technique, and inadequate documentation of procedures. IV peripheral complications (phlebitis, infiltration, catheter occlusion) add to the discomfort for patients and interruption of treatment (Marsh et al., 2024). There is a need to standardize best practices of care for which there is evidence, to address the gaps in patient safety and quality of care. Does adherence to the Infusion Nurses Society infusion therapy standards that include structured IV site assessment and aseptic technique training (I) when caring for adult patients receiving infusion therapy as outpatients, compared to current practice (C), impact the incidence of infusion-related complications (O) within 8 weeks (T)? There was a body of literature that supported a structured, comprehensive infusion care protocol that has been found to have a beneficial effect on the reduction in peripheral IV catheters and the accuracy of the written documentation of the care of the peripheral IV catheters (Demiroğlu & Tosun, 2025). When the competency-based training is used to develop evidence-based guidelines for the assessment of nursing practice and the prevention of infection associated with the use of peripheral IV catheters, the rate of adherence to the assessment and infection prevention guidelines increases for the nurse (Lewis et al., 2022). Evidence-based practice quality improvement efforts have shown that there are measurable reductions in adverse patient events that could have been prevented with infusion-related procedures in the ambulatory care environment. 

Practice Problem

A review of infusion records from the previous eight weeks revealed that there were complications in 14% of infusion encounters over that time (Clinical Director, personal communication, January 15, 2026). Again, the most common type of complication was phlebitis at 6%, infiltration at 5%, and the catheter had to be reinserted due to occlusion at 3% (Clinical Director, personal communication, January 15, 2026). The use of complications with medicine administration devices and the lack of follow-up care with the patients were ongoing problems for outpatient parenteral antimicrobial therapy (OPAT) programs in the world (Wolie et al., 2024). The evidence gathered indicates that a major deficiency in the quality of service being delivered to the patients at the location needs to be addressed immediately, in accordance with the best scientific evidence. The lack of standardization and clinical processes in outpatient environments has been documented as a significant driver towards avoidable complications. In the outpatient setting, the prospective study carried out by Beaudart et al. (2023) showed a significantly high patient-to-nurse ratio, a lack of interprofessional relations, and frequent rotation of the nursing staff, which led to the occurrence of high medication errors. Patients undergoing infusion therapy had similar issues about peripheral IV catheter insertion and maintenance with variable and suboptimal practice. Among 470 patients receiving peripheral IV, Costa et al. (2022) reported that 26% of them encountered issues directly attributed to poor IV aseptic non-touch technique. Marsh et al. (2024) found that the relationship between inconsistent catheter care across the globe and high rates of preventable peripheral IV failure and infection was shown in the results from the systematic review and meta-analysis. The project team noted that there were data from the previous efforts (chart audits, EHR review, and direct assessments) that documented inconsistent and/or non-standardized practice within the clinic.

Flawed Processes Leading to the Practice Problem

There is a notable and well-documented gap at local, national, and global levels between current infusion practices and accepted and scientifically supported standards of practice. The problem of infusion safety in the outpatient setting is also common and has been ongoing; 35.6% of patients undergoing OPT say they had complications related to the infusion of antimicrobials, according to Staples et al. (2022). Young et al (2023) reiterated that, with outpatient procedures continuing to advance and become increasingly more complex, safe practice procedures should continue to be standardized to prevent harm to a wider range of medically vulnerable patients. Nickel et al (2024) proved that there is a need for regular assessment of the IV site, using valid grading scales and consistent aseptic technique for all IV accesses, as this is a necessary component of a valid standard of safety. The rate of complications was 14% at the site, which is well above the published site standard of <10% for institutions that have enacted the standardization of service delivery methodology, and this suggests a significant issue that requires attention. Evidence consistently and extensively reinforces the need for the use of a structure and protocol-driven approach to administering infusions in order to reduce the risk of preventable complications when performed in outpatient settings. When Demiroğlu and Tosun (2025) added a protocolised care bundle of evidence-based practices to the use of peripheral IV catheter care, the researchers were able to show statistically significant reductions in the incidence of phlebitis when compared to those of regular care (p < 0.05). Training aimed at ensuring competency boosts patient safety in the clinical setting, ensures staff have sufficient competency levels, and supports the maintenance of successful quality improvement interventions in the long-term (Lewis et al., 2022). By standardising the IV assessment protocols, there is a chance to improve the quality of IV insertions and to achieve statistically significant reductions in IV-related adverse events among nursing staff, as reported by Jacobs (2022). The assessment of IV sites and proper aseptic technique are recognized as essential components of safe IV infusion therapy in the outpatient setting (Infusion Nurses Society, 2025). The complications of infusion therapy that do not get addressed according to standardized protocols negatively affect patients’ quality of life and the continuity of treatment for multiple disease processes (Van Laar et al., 2023). The evidence all points to the urgent need for the implementation of a structured INS-aligned assessment protocol and an aseptic technique compliance bundle to address the gaps identified at the project site.

Project Site

Outpatient infusion centers play a crucial role in providing ambulatory health care in numerous communities. The place that we will be studying is a privately owned outpatient wellness and infusion center in a suburban community within a metropolitan area. The site serves adults who are medically stable and are looking for elective and supportive intravenous therapies at the primary ambulatory level of care (Clinical Director, personal communication, January 15, 2026). There are multiple treatment chairs in the infusion suite, allowing multiple patients to receive IV treatments simultaneously (Clinical Director, personal communication, January 15, 2026). The center has a few clinical staff, registered nurses who are guided by an experienced clinical director who specializes in advanced infusion therapy. To implement quality improvement initiatives that are effective, it is important to understand the structural and operational features of the site on which the initiative is to be implemented. A good location is key to deciding if your innovation can be successful and if it can still work as a successful innovation. The Center in question is anticipated to have approximately 25-35 adult patients per day. Patients will be given an infusion once a week (150-200 infusion appointments total). Thus, the site will have sufficient opportunities for meaningful evaluation of infusion outcomes based on collected data (Clinical Director, personal communication, January 15, 2026). The clinical director has also provided full access to de-identified electronic health records (EHRs) of the patients who are being treated at the clinic, along with all de-identified electronic clinical procedures and templates used for a baseline assessment and observation (Clinical Director, personal communication, January 15, 2026). The clinic’s bi-weekly stakeholder involvement included registered nurses, operations coordinator, and clinic administrator, and ensured that the project received support from all of the organization’s stakeholders (Clinical Director, personal communication, January 15, 2026). Furthermore, the project has been directly inspired by the strategic initiatives of the organization to improve patient safety and reduce preventable complications, and to improve infusion care quality. A shared goal between project goals and center goals will significantly improve chances for the implementation and maintenance of practice change.

Current Practice Limitations and Previous Improvement Efforts

The process of finding gaps in the current way of doing things in the organization is an essential piece in forming evidence-based, specific quality improvement strategies. The current way that the facility practices is primarily reliant on the clinician’s knowledge of the practice and how the providers were orientated, and not structured through a competency validation framework (Clinical Director, personal communication, 1/15/2026). Phlebitis grading is not done using a standard grading scale but rather a descriptive format, which decreases the ability to use the complication data for objective comparisons and trends across the chart reviews (Clinical Director, personal communication, 1/15/2026). Peak volume scheduling blocks were noted by nursing staff to be a barrier to consistent documentation and suggested the addition of reassessment prompts in the electronic documentation template to help with the issue (Clinical Director, personal communication, 1/15/2026). No formal quality improvement projects have been instituted at the site that have focused specifically on the problem of infusion-related complications or on the use of aseptic technique. It is even more significant that there are no formalised improvement projects in place, highlighting the need for the evidence-based DNP project to be finished at the site.

Project Population

The first step is to identify the project’s target group for the design of a comprehensive and significant quality improvement endeavor. The project will include RN’s employed by an outpatient infusion center who give peripheral IV insertion and monitoring services. All nurses involved in IV infusion therapy will have the same position of direct patient care at the practice site. Tegegne and colleagues (2025) found that nurses’ knowledge and clinical practices will impact the rate of peripheral IV complications in an outpatient setting. By describing the common role, responsibilities, and clinical context for the population, the investigators will be sure that the interventions provided will be appropriately targeted and relevant.

Population Similarities and Clinical Context

Within a project, if there are common characteristics of the participants, the quality improvement interventions can be more internally consistent and generalizable. All nurses involved have been trained to perform basic clinical skills in common, including insertion of peripheral IV, keeping the IV insertion site covered, documenting patient history and clinical interventions, and using aseptic technique when inserting infusions. Additionally, the duties of the nursing staff in relation to workflow, documentation, and patient contact are similar throughout the outpatient infusion setting. Lewis et al. (2022 have shown that competency-based training programs are most effectively developed by relying on the commonly identified skills and practice settings of a clinical population. Identifying common professional characteristics of the participating clinical population will allow for a single standardized training and assessment tool to be developed and used by everyone in the participant population.

Inclusion and Exclusion Criteria

The clarity of inclusion/exclusion criteria will increase the integrity of the project and enhance the quality and reliability of the product from the project. Participants for the research project will meet the following criteria: They will be currently working as registered nurses and conducting peripheral intravenous (IV) insertion and infusion monitoring at the project site. Registered nurses on extended leave of absence, those hired after the initiation of the project, and those who do not have any involvement with peripheral intravenous (IV) care will be excluded from participation in the project. Fifteen registered nurses are registered at the project site. The inclusion criteria are met by all of the registered nurses (RNs) at the site, a sufficient and well-defined participant pool can be used to collect data. The 15 participants will adequately represent the registered nurse workforce and help to measure the competencies, compliance, and changes in practice over the duration of the research project.

Evidence-Based Interventions

In order to preventable complications, to ensure consistency in the way that clinicians administer Infusions to patients when they are outside hospital environments, and to help clinicians draw on evidence as one way to inform their clinical decision making, there must be a recognition that an evidence-based approach is safe. To keep patients safe, the IV site should be routinely assessed, using a validated grading scale, and the standard for use of Aseptic Technique must also be met. Nickel et al. (2024) have identified that using “Established Professional Standards” identified through research, and supported by the use of validated tools, is substantiated to positively impact the safety outcomes of the patients. On the other hand, Thompson et al. (2026) showed that the national PIVC Failure and Complication Rate ranges from 35-50%. Thompson’s results indicate that there is a spectrum of non-compliance with the standards on clinician competence and systematic clinical practice of the evidence-based standards and competency. Thompson et al.’s (2026) study focused primarily on the gap between the established guidelines and the standard of practice. The clinician uses the professional standards as a foundation for the selection of interventions and obtains a direct and logical relationship between the problem he/she is attempting to facilitate the change in evidence-based practice and expected outcomes for the chosen intervention.

Intervention One: Standardized INS-Aligned IV Site Assessment Protocol

The use of consistent assessment protocols is one of the most universally validated interventions to decrease complications of peripheral IVs in a variety of clinical settings. Nickel et al. (2024) suggested three components of a safe infusion protocol: validated scales for phlebitis, validated intervals to review phlebitis, and a structured electronic documentation field. But Paterson et al. (2022) demonstrated that using consistent evidence-based guidelines and clinical practice escalation pathways, along with the use of individual assessment tools, resulted in significantly greater first-attempt insertion success and patient outcomes. Whilst the study reported by Nickel et al. (2024) is more broadly applicable to all infusion settings, the sample population included in the study was not specifically identified as those with a more complex IV access – hence, the conclusion by Paterson et al. (2022) that there is a need for standardised protocols to support patients with different levels of complexity in the IV access. This was corroborated by Demiroğlu and Tosun (2025), who found that the structured peripheral IV care bundle, which involved standardized assessments of phlebitis, was associated with a statistically significant reduction in phlebitis compared to the care bundle in the routine care group (p < 0.05).

Intervention Two: Aseptic Technique Compliance Bundle

Systems of aseptic technique compliance have been proven to be effective and evidence-based in the reduction of intravenous therapy-related complications and vascular access infections for a long time. Kent et al. (2025) completed a comprehensive scoping review and found that the use of aseptic technique by nurses across different nurses and clinical contexts was inconsistent, highlighting the importance of establishing guidelines at the facility level. However, Malhi et al. (2025) went beyond mere identification of variability, as the authors demonstrated that using a standardized aseptic non-touch technique resulted in reduced training time (63%) and no catheter-related bloodstream infections during the study period for patients performing home self-administration of parenteral support. Malhi et al (2025) investigated home patients, whilst Kent et al (2025) generally discussed the range of clinical nursing practice settings, implying that the value of standardized aseptic technique applies to all patients, irrespective of the setting in which they receive care. There was a lack of research examining the correlation between structured, standardized aseptic practice and decreased risk of infection, but solid rationale for adopting an aseptic technique compliance bundle at the project site.

Comparison and Contrast of Interventions Within Literature

The evidence that can be found from various studies helps to support the rationale for the chosen interventions and assists in the determination of the goals of the project. While Malhi et al. (2025) demonstrated that there are benefits from using bundled strategies to prevent catheter-related bloodstream infections (CRBSI) using the aseptic non-touch technique, Demiroğlu and Tosun (2025) noted that there are benefits of using a bundled approach to preventing peripheral IV insertion complications. There are areas where the bundled approaches address overlapping but different aspects of infusion safety. Nickel et al. (2024) presented the most comprehensive clinical framework that combined site assessment and aseptic technique as inter-dependent aspects of a safe infusion practice and Paterson et al. (2022) concentrated more specifically on how to standardize assessment instruments and escalation pathways for patients with difficult access. Thompson et al. (2026) synthesized system-level perspectives and argued that the national failure to implement a standard of care for peripheral IV access (PIVC) has a major negative impact on many people, thereby further supporting the recommendation to implement intervention strategies simultaneously rather than individually. Collectively, all of the studies provide consistent and conclusive evidence for a combined multicomponent intervention model as the better option for addressing either assessing or aseptic methods of infusion practice.

Supporting Evidence for Competency-Based Training

Competency-based training that has been organized in a structured manner is an important strategy in supporting and sustaining primary interventions throughout implementation. Ray et al. (2022) found a significant statistical increase in the total score in the knowledge about IV infusion therapy and self-confidence in IV infusion therapy for the nurse participants in the study (p<0.001) following the completion of the structured, interactive education modules. On the other hand, Hawker et al. (2022) noted that teaching Aseptic Technique in nursing schools is not always consistent, and the students’ level of confidence reported is not necessarily representative of their actual competency. Although Ray et al. (2022) have shown some short-term success with the use of interactive infusion education modules, the authors also mentioned methodologic weaknesses amongst other studies addressed (Hawker et al., 2022) which suggested that any gain in knowledge must be done through a continual validation of competency rather than a one-off education session. However, Lewis et al. (2022) integrated both views by showing that in competency-based education, the staff need to show the knowledge and skills necessary to undertake clinical activities. Therefore, the skill validation checklists, visual cue cards and hands-on simulation will be used as part of the design strategy so that all 15 RN participants will meet and maintain the competency standards at each of the 4 project implementation phases.

Consistency of Practice Recommendations With Project Problem and Desired Outcomes

Recommendations with the Project Problem and Desired Outcomes are discussed. Quality improvement projects need to have a logical and evidence-based connection between the literature, practice guidelines, and suggested interventions to ensure the project is credible. Early detection of complications of vascular access and adherence to clinical practice guidelines (CPGs) has led to significant improvement in patient outcomes (Paterson et al., 2022). In an extension of this analysis, Yang et al. 2025 also showed that standardized maintenance procedures for catheters led to measurable decreases in the number of catheter-related adverse events, similar to the expected outcomes for the project, when analyzing the use of the devices in outpatient community clinics. Furthermore, the authors found the validity of the assessment tools and clinical escalation pathways to be key. In contrast, Yang et al. (2025) more generally confirm the need for standardisation of clinical practice in an attempt to optimise the process of practice improvement, and they include all aspects of standardisation to ensure success. The findings from Jacobs (2022) indicate that competency-based validation is an effective means of enhancing the quality of vascular access and the rate of adverse vascular access-related events, and the combination of competency and standardization is indeed two key factors in implementing successful training and protocols. The evidence combination therefore strengthens the logical, evidence, and operational consistency of the interventions identified with the project issue, the population that will be included, and the measurable outcomes that will be achieved in the project area.

Implementation Plan for Interventions

Step-by-Step Implementation Protocol

An implementation plan should be clearly outlined and easy to replicate for successful and sustained quality improvement initiatives. During week one, the Lead for the project will finalize all the standardized tools that will be shared with the nursing staff; these will include the INS phlebitis grading scale, IV reassessment checklist, and aseptic technique observation audit tool. Competency-based training (CBT) via structured training, education in INS Standards, Phlebitis grading scale, reassessment intervals, and Hands-on Aseptic Non-Touch Technique (HAST) will be provided to the 15 RNs in weeks two and three. Lewis et al. (2022) concluded that using a competency-based framework had the benefit of staff being able to demonstrate competency-based skills before conducting independent procedures and thus supporting the sustainability of the practice change. The implementation of the Standardized IV Site Assessment Protocol and Aseptic Technique Compliance Bundle will be implemented in weeks 4 through 8, and will involve implementation of the protocols for all IV placement events, as well as weekly chart audits and structured observation audits to assess compliance and barriers to compliance. Defining each role within the team sets everyone’s expectations and ensures that the application is the same throughout the project; fosters a culture of collaboration and ensures that everyone is on the same page. The Project Lead will be responsible for the development of all standardized tools, complete weekly audits, trainings for nursing staff, and real-time feedback to nursing staff on the implementation of the tools. The Clinical Director will serve as preceptor and site champion, overseeing the operational aspects of the training and making staff adjustments as necessary during the training process, and reviewing the outcomes of audits in weekly meetings with staff. Furthermore, Nickel et al. (2024) reported that organizations with a structured implementation plan in which the infusion procedures are consistent with the INS and in which there is organizational leadership support have significantly greater adherence to consistent infusion care procedures in an outpatient setting. All RN’s are expected to ensure the IV site assessment protocol and the aseptic technique compliance bundle are adhered to, using at every interaction with peripheral IVs (during the 8-week implementation period).

Scholarly Leadership and Project Oversight

Clarifying the role of the scholarly leader to ensure fidelity to the project, connection with stakeholders, and rigorous oversight throughout the project’s implementation. The scholar project lead will be responsible for coordinating all aspects of implementation, including developing tools, providing staff training, scheduling audits, collecting data, and performing ongoing formative analysis of outcome measures. The preceptor will be involved in weekly check-ins with the project leader to review audit results, barriers that can occur, workflows, and to make sure the project is on schedule and in line with the organization’s objectives. When structured leadership and active engagement of stakeholders were present, nurse-led quality improvement efforts had a positive effect on compliance with standardized IV care protocols in clinical practice (Jacobs, 2022). Clear communication with all stakeholders and team members will help ensure transparency throughout the phases of the project implementation, keeping it on track and ensuring that outcome data is gathered in a systematic manner and that it is full and accurate.

Preceptor Partnership and Collaborative Oversight

The project leader’s relationship with the preceptor is key to the scholarly acceptance and practical success of the quality improvement program. During the implementation phase, the preceptor will provide weekly guidance on the initiative, give the necessary permissions for accessing audit data and electronic health record templates, and support communications about the project leader’s activities to nursing staff. Data from chart audits, observation audits, and competency check-offs will be analyzed in a biweekly fashion and preliminary patterns identified to correct any gaps. Demiroğlu and Tosun (2025) demonstrated that significant decreases in the occurrence of infusion-related complications have been consistently sustained over time by actively monitoring and giving structured feedback on adherence to the protocols developed in the course of the quality improvement initiatives. The evaluation of data gathered from the aforementioned formative analyses and the data compiled from the outcome data will give insight into deviations from plan that should be corrected to ensure the overall integrity of the project.

Internal and External Stakeholder Engagement

It is crucial to involve and identify stakeholders at various levels of your organisation if you want to build a solid base and sustainability of change in practice. Internal stakeholders are the clinical director, registered nurses, and the operations coordinator, who are all in direct contact with the day-to-day delivery of infusion care and workflow management at the project site. The clinical administrator is an internal stakeholder and/or administrative champion of the project who provides temporary change in staffing schedule during the training and who supports the project to the organization’s leadership. Jacobs (2022) found that stakeholder involvement and support through a clear mechanism, as well as evidence of leadership support, are predictors of greater adherence to infusion protocols and sustainability of infusion practice change in outpatient settings. External stakeholders are the patients who are receiving infusion therapy. The project will ultimately benefit patients receiving infusion therapy by decreasing the incidence of complications, improving the consistency of care, and increasing overall safety during the patient’s infusion therapy.

Interprofessional Team Composition and Functions

Interprofessional collaboration (ICC) has been associated with successful quality improvement initiatives in complex outpatient health care environments, which leads to positive outcomes when health care providers work together on quality improvement. The ICC team for the project includes the Doctorate of Nursing Practice (DNP) project leader, Preceptor (Clinical Director), Registered Nurses, the Operations Coordinator, and the Clinic Administrator. All of the members have unique but complementary roles that contribute to the project. The Operations Coordinator will play a key role in helping with this, providing logistical support to the programme, setting aside time for staff training, and arranging staff availability for observation audits during the project. Nickel et al. (2024) state that having a collaborative relationship between nursing leaders, clinical staff, and operational team members is very important when implementing and sustaining adherence to infusion therapy standards consistent with the INS standards in the outpatient clinical setting. There are specific roles that each member of the ICC team will play to support the project at the clinical, operational, and administrative level, and as a result, an integrated approach to implementation would be realized: all the programs would work together for a common goal.

Team Member Collaboration and Communication

The clear definitions of the role and function of each member of an interprofessional team, with the systematic and ongoing nature of the implementation of a project, can be realised, and teams are held accountable for the implementation of outcomes from the start until the end of the project. Registered nurses will be the first to implement the two types of interventions and will use the Standardized IV Site Assessment Protocol and the Aseptic Technique Compliance Bundle with every intravenous infusion encounter. The Clinical Director will act as the clinical expert for the project and liaison to the organization, mentor the Project Leader, review Formative Audit data, and ensure that the implementation of the project’s activities is accountable to the organization’s patient safety priorities. Jacobs (2022) has shown that engagement of interprofessional teams that are planned and organized, combined with clarified role expectations and leadership, support will result in increased quality and sustainability of implementing IV standardized care improvement initiatives. The efforts of all interprofessional team members will ensure that the project is implemented throughout the entire 8-week process in a clinical and operational precise manner with organizational alignment. Data collection, data analysis, and desired outcomes

Data Collection, Analysis, and Desirable Outcomes

Desirable Project Outcomes

Quality improvement efforts are measured by well-defined desired project outcomes, which are measurable metrics. The primary goal of the standardized protocol to be implemented over 8 weeks is to achieve a greater than or equal to 30% decrease in the complications associated with IV infusion in the outpatient setting (i.e., occlusion of the IV, infiltration, and phlebitis). The second desired outcome measure is for at least 90% of nurses to document the IV site evaluation protocol, follow the required aseptic technique adherence bundle consistently, and show accurate and complete documentation in the Electronic Health Record for all infusion encounters. Demiroğlu and Tosun (2025) reported statistically significant decreases in phlebitis after the application of a structured peripheral IV care bundle in an outpatient infusion setting, suggesting improvements in the outpatient infusion setting through the use of a multifactorial standardization process are clinically relevant, measurable, and consistent. The above-mentioned outcomes will together demonstrate that systems for implementing evidence-based practices will enhance patient safety, ensure consistent nursing practice, and support the sustainability of quality infusion care over time at the project site.

Evaluation Criteria and Measurement Approach

It will be necessary to have clear and measurable indicators and criteria of success throughout the process of implementing the change in practice. Primary outcome measures for examining rates of infusion-related complications will be weekly electronic health record audits of randomly selected charts, with any documented cases of phlebitis, infiltration, or catheter occlusion captured from all infusion encounters. A standardized checklist will be used to evaluate adherence to the IV site assessment protocol, the accuracy of the phlebitis grading, the time of the physician’s re-assessment of IV sites per standard practice, and to ensure that all required fields were completed in each IV site assessment documentation record. The INS Phlebitis Scale is a valid and standardized phlebitis assessment scale widely adopted for research involving infusion therapy that can be used to objectively evaluate the severity of phlebitis, based on clinical signs such as erythema, pain, edema, and palpable venous cord (Nickel et al. 2024). Consistency and validated measurements for all measurements will make outcome data collected reflect the actual outcomes of the interventions, and will help to facilitate the dissemination of project findings in a reputable manner.

Measurement Tools, Validity, and Reliability

Measurement tools are selected appropriately and reliably to yield valid, accurate outcomes for quality improvement measurements. Therefore, the INS Phlebitis Scale will be used as the primary framework to measure complications of peripheral IVs to establish an objective and standardized approach to documenting and assessing the severity of complications of all infusion-related care episodes. The clinical reliability of the INS Phlebitis Scale has been confirmed by its consistent use in many research studies, clinical quality improvement projects, and clinical trials of infusion therapy conducted worldwide (Nickel et al. 2024). The INS is publicly available as a professional resource, eliminating the need for additional permissions to use the tools in the respective sections of the project, and will enable transparent, replicable, and accessible measurement processes all over the project.

Data Analysis Plan

A project’s outcome(s) must be interpreted, and results for quality improvement must be meaningfully disseminated, which requires a well-defined and appropriate data analysis plan. Descriptive statistics will be the only type of analysis used to assess the data because the sample size for the project is 15 nurses and the data has been collected at the weekly encounter level throughout an 8-week period. Baseline complication rates will be calculated and reported as percentages of all weekly infusion experiences to be directly comparable to post-implementation complication rates at each measurement time point. Marsh et al. (2024) found that descriptive measures using percentage to assess the number of peripheral IV complications tracked are a simple, clinically meaningful, and easily communicated measure for evaluating the effectiveness of standardized infusion care interventions. Outcome information is presented in simple terms, either percentages or frequencies, for all stakeholders, from nursing staff to clinical directors to organizational leaders, to understand the results of the project.

Weekly Data Tracking and Outcome Reporting

As the implementation moves forward, careful and sustained data monitoring is crucial to look for trends, to ensure progress in implementation, and for timely feedback to inform decisions that have an impact on the likelihood of reaching the targets. There will be weekly audits conducted throughout the eight weeks to document complication rates, adherence to the protocol, and ensure documentation is complete in a running data tracker. Observational audit scores will be calculated as percentages of total audits, and the number of samples collected from each week will be used to generate trend data that will be provided to the nursing staff for targeted feedback as needed, based on the percent of observations that were conducted in accordance with all of the bundle elements. As Jacobs 2022 demonstrated in the literature review, the implementation of an ongoing data tracking system with regular feedback to clinical staff can improve adherence to the standardized care protocols and ultimately achieve continuous improvement of IV care outcomes over time. The ability to summarize all of the descriptive data collected into weekly percentage comparisons and a final pre/post implementation summary table will make project outcomes easy to organize, will allow for the clear reporting of project outcomes, and will make project outcomes easily accessible for dissemination to stakeholders and the nursing practice community.

Conceptual Model

Plan-Do-Study-Act Model Overview

A sound reference system can be a useful tool to help systems structure and implement QI (quality improvement) programs within health care systems. The PDSA (plan, do, study, act) model relies on structured phases following each other in a cyclic iterative process to create an environment for testing and implement quality improvements. The PDSA is a systematic approach to improving a process by continuously and gradually adjusting it, and quickly adopting innovative processes with a clear procedure of evaluation and revision, as well as a systematic examination of new evidence that could affect the existing process; hence, the methodology is very suitable for complex healthcare settings (Abuzed et al., 2023). Elhihi et al. (2025) confirmed that in several contexts the PDSA method enhances the effectiveness, sustainability, and overall quality of QI programs by integrating PDSA methodologies with EBP (evidence-based practice) methodology, creating successful QI outcomes. The PDSA model is an excellent method to develop, monitor, and improve the use of standardized infusion therapy protocols at the clinical improvement project implementation site because of its flexibility and iterative process.

Connection of PDSA to Project Goals and PICOT

Conceptual framework of the project stays in alignment with the PICOT question and the goals; therefore, all phases of implementation will have a clear purpose, an ability to provide measurable results, and be based on evidence. The standardized, INS-aligned IV site assessment protocol, along with the aseptic technique compliance bundle, competency training materials, and all tools for data collection, will be completed in the Plan phase of the project before implementation. During the Do phase, each registered nurse who enters the study (15 nurses) will receive structured competency training, and interventions will be delivered to all patients for peripheral IV insertion over the course of the 8-week project period. In the 8 weeks of implementation, Pathan et al. (2024) reported that the clinical unit efficiency increased from 60% to 75%, with 15% improvement in the bed utilization by building healthcare improvement project strategies following the PDSA phases, process mapping, and root cause analysis. Each step of the PDSA cycle is associated with the components of the PICOT, which helps the project to be systematic and move toward a measurable change in infusion-related complications in the 8-week implementation period.

How the PDSA Model Will Guide the Project

The PDSA Framework helps in establishing an operational and systematic plan for implementing, monitoring, and refining quality improvement throughout the project. Data collection during the Study phase will be reviewed by weekly chart audits, observation audits, and competency check-off completion rates to ensure that the interventions produce the desired outcomes and to recognize the emergence of new barriers. The Study phase of the PDSA Cycle is the most important part of the analysis process and outcome data to identify opportunities for process change based on comparisons to pre-established benchmarks at each interval (Abuzed et al., 2023). Information gathered from formative analyses will also be used during the Act phase to redesign workflow challenges, reduce discrepancies in documentation, improve adherence to aseptic technique, and support all nursing staff adherence to the nursing staff Protocol through the rest of the implementation phase. As the PDSA cycle continues, real-time data will constantly update the project response, and interventions will be continually refined to improve patient safety and sustainable practices.

PDSA Model in Similar Healthcare Improvement Circumstances

The PDSA model is widely used and has been proven to be effective with regard to the implementation of healthcare quality improvement projects. Elhihi et al. (2025) were able to show that the use of PDSA methodology in implementing evidence-based practice (EBP) was able to reduce central line infections in an ICU from 1.37 to 0.62 infections per 1000 patient days. Multimodal intervention can be achieved, which yields measurable and significant outcomes in the domain of infection prevention, through PDSA-guided processes. Likewise, Pathan et al. (2024) used the PDSA cycle in a chemotherapy day care center to improve the utilization of beds using the same process improvement methods as described above: structured process mapping, root cause analysis, and iterative improvement of intervention steps over a series of PDSA cycles. In addition, Abuzied et al. (2023) underscore the application of PDSA methodology as a pathway to creating guidelines or protocols, involving multidisciplinary stakeholders, and to facilitating ongoing quality improvement in complex and multifaceted healthcare processes. The outpatient infusion quality improvement project was guided by PDSA, and the consistent and documented success of PDSA in comparable clinical situations to reduce the number of infection-related complications and improve the standardization of care provides strong evidence for the selection of PDSA. A scientific method is required to be used, and a budget should be prepared, as well as ethical issues to be considered.

Methodology, Budget, and Ethical Considerations

Project Methodology and Design

The project methodology has been created in order to give a clearly defined path to follow in conducting the quality improvement project with integrity, transparency, and rigorousness throughout the project. The project has been designed as a quality improvement project with an infusion-related complication pre-post measurement framework to identify infusion-related complication deficiencies identified by the project during the 8 weeks of implementation, as compared to the pre-project infusion-related complication baseline deficiency rates for each of the infusion-related complications. The project assumes that 15 registered nurses (RNs) participate fully in the project, organisational support from the Clinical Director, and that the diagnostic indicators for infusion encounters will not change during the project implementation phase. When evaluating peripheral intravenous line care from before to after a project is implemented, the pre-post concept and standardized data collection methods yield meaningful and reliable clinical outcome data for quality improvement efforts, as suggested by Marsh et al. (2024). The project will be based on data from infusion encounters and professional competency development that remains anonymous and is not related to individual patients, and therefore does not require formal institutional review board (IRB) approval; however, the principles of human subjects protection will be followed throughout the project.

Project Limitations and Mitigation Strategies

It is important to be open about project constraints, as they affect the credibility and integrity of the quality improvement findings and the wider implications. The biggest limitation of the project is the limitation to other infusion care sites and to much larger nurse populations, with only 15 nurses at one outpatient location. Other restrictions are bias in observation arising from the process of audit on aseptic technique, inconsistencies in documentation of the EHR, and potential for interruptions in staff scheduling during the eight-week implementation period. Demiroğlu and Tosun (2025) recognized that quasi-experimental, quality improvement studies with one site have limitations due to contextual constraints; however, they also noted that uniform guidelines need to be implemented in auditing and formal monitoring processes to minimize bias and improve the dependability of the data. To overcome these limitations, strategies will be implemented, such as ensuring all audits are carried out using the same audit tool; learning through observations with different scheduling blocks; staff to be continually fed back about the audit; and open communication between the preceptor and staff to enable them to respond quickly to the obstacles they face during implementation.

Project Budget

To develop a successful and complete project, determine all the necessary resources needed before, during, and after the project. Staff costs are the biggest portion of the project budget and include the time nursing staff will spend on competency training sessions that will span 2 weeks, weekly audits, and biweekly meetings with stakeholders that will last a total of 8 weeks. The other part of the budget will cover the costs of supplies such as printed IV site assessment checklists, competency check-off forms handed to every nurse parked at an IV station, and visual cues for aseptic technique training at IV stations. By budgeting staff time as part of the project, Jacobs (2022) noted that it aids in determining the amount of actual operating costs involved in implementing competency-based quality improvement programs in clinical practice. The clinical director and operations coordinator will coordinate with modifications to the electronic health records (EHR) system to properly add new fields for standardized reassessment prompts and structured documentation templates in order to implement efficiently and effectively, for the purpose of supporting the implementation process on time and within budget constraints. Health Insurance Portability and Accountability Act (HIPAA) Compliance and Data Security.Health Insurance Portability and Accountability Act (HIPAA) Compliance and Data Security. Whenever a quality improvement project is planned that includes clinical data, full compliant to HIPAA regulations and proper secure data protocols should always be followed. During the entire improvement process, audit data gathered from chart audits/clinical records will be only de-identified, aggregate encounter data, and will not contain access, store, or report individually identifiable information (patient data) of any patient involved. Additionally, all project documents, such as weekly audit results, competency check-off sheets, and observation audits, will be maintained on an encrypted (password-protected) project lead-only laptop from start to finish of the project. Elhihi et al. (2025) recommend the creation of a system utilizing carefully anonymized, secure storage of all data at every stage of quality improvement initiatives, to ensure privacy and adherence to institutional and federal data security guidelines. All physical data records (printed audit forms, competency checklists, etc.) will be securely stored in locked cabinets on site, and access will be restricted to the project lead/preceptor, with continued measures put in place to ensure data confidentiality and security at all times during the project.

Health Insurance Portability and Accountability Act (HIPAA) Compliance and Data Security

A project timeline offers structure and expectations for implementation, productivity, and helps to guarantee that all project activities are finished on time. The project time is 12 weeks, divided into three (3) phases: Preparation phase for (2) weeks, implementation phase for (8) weeks, and data analysis and dissemination phase for (2) weeks. As indicated by the application of a PDSA framework to guide a quality improvement project into clearly defined and sequential phases increases productivity, brings in more stakeholders, and makes it easier to achieve measurable outcomes in set timeframes (Pathan et al., 2024). The establishment of weekly milestones for each of the following project steps: Tool finalization, training of staff, protocol implementation, chart audit, observation Audit, Formative Analysis, and Final Outcome Reporting (all of which will take place once/week for a total of 12 weeks), provides a clear and concise week-by-week timeline. The use of timelines will help ensure that project components are implemented in a systematic way and will help to early identify any barriers to implementation integrity.

Project Timeline

Implementation Timeline and Work Plan

To ensure all project activities are completed within a set amount of time, a project timeline provides a structure and expectations for implementation productivity. The project timeline for the project consists of 12 weeks and includes three (3) phases: preparation phase for (2) weeks, implementation phase for (8) weeks, and data analysis and dissemination phase for (2) weeks. According to Pathan et al. (2024), the use of a PDSA framework to structure quality improvement projects into well-defined and sequential phases, as evidenced by, enhances productivity, increases stakeholder involvement, and allows for greater measurable outcomes to be achieved within targeted time frames. The establishment of weekly milestones for each of the following project steps: Tool finalization, training of staff, protocol implementation, chart audit, observation Audit, Formative Analysis, and Final Outcome Reporting (all of which will take place once/week for a total of 12 weeks), provides a clear and concise week-by-week timeline. Timelines will be used to ensure that project components proceed systematically and identify any arising barriers to implementation integrity promptly.

Figure 1

Project Implementation Timeline

Practicum Hours Plan of Action

To demonstrate advanced clinical scholarship and professional competence as part of the DNP program, students must accumulate 1,000 practicum hours working on the course assignments from 4 different courses (NURS-FPX9000, NURS-FPX9020, NURS-FPX9030, & NURS-FPX9040). The 1,000 hours will be broken down into the core courses, tied to individual course-based projects tied to the Infusion Safety Quality Improvement Initiative. Lewis et al. (2022) validated that the structure of competency increases your clinical leadership and gives you an evidence-based practice and quality improvement project management to advanced nursing roles through your practicum experience. Some of the activities that will take place throughout the DNP program are: a literature review, site assessment, stakeholders’ involvement, protocol development, staff education/training, data collection, audit monitoring, formative assessment, and outcome dissemination. The practicum hour plan details the way in which all projects will be documented during the entire DNP program, as well as the number of hours available for each contribution (class) to the total 1,000 hours.

Table 1

DNP 1,000-Hour Practicum Plan of Action

Conclusion

The two major interventions of the quality improvement project are: 1) a standardized IV site assessment and documentation procedure that is aligned with the INS, and 2) an aseptic competence compliance bundle with competency-based training, which will be implemented to reduce the complications associated with infusion therapy for adult patients receiving outpatient infusion therapy. The interventions will take place for 12 weeks at a private outpatient infusion center. Data will be collected using weekly chart audits and structured observation audits throughout the implementation, and analyzed and shared with stakeholders using descriptive statistics. Overall, the plan is to improve patient safety, enhance the competency of the nursing staff, enhance documentation accuracy, and to replicate a model of evidence-based standardizing infusion care through the use of a PDSA conceptual framework and empirical literature to support clinical significance and measurable patient care gaps identified through baseline chart audits of 15 registered nurses whose complication rate is fourteen percent, in an outpatient setting.

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