Defense Date
7-17-2025
Graduation Date
Summer 8-21-2025
Submission Type
Dissertation/Thesis
Degree Name
Doctor of Nurse Anesthesia Practice
Department
Doctor of Nurse Anesthesia Practice (DNAP) Program
School
School of Nursing
Faculty Mentor
Catherine Johnson
Keywords
Adult-Difficult Intravenous Access, Modified A-DIVA Scale, Difficult Intravenous Access, Intravenous, Peripheral Intravenous, Peripheral Intravenous Catheter, Ultrasound Guided Peripheral Intravenous Catheter
Abstract
Peripheral intravenous cannulation (PIVC) is one of the most performed invasive procedures in hospital settings, yet it is frequently associated with multiple attempts in patients with difficult intravenous access (DIVA). In obstetric (OB) triage settings, where time-sensitive care is critical, failed PIVC attempts can delay treatment and negatively affect patient experience. The Modified Adult Difficult Intravenous Access (A-DIVA) scale is a validated tool designed to identify patients at risk for DIVA and guide early use of advanced techniques such as ultrasound (US) guidance.
A QI initiative was implemented in the OB triage unit of a large academic hospital. The tool was introduced as a standardized screening tool to be used by staff prior to all PIVC attempts. Educational sessions and on-site reinforcement were employed to support adoption. Process measures included rate of first-attempt success, number of PIVC attempts per patient, and documentation compliance. Qualitative feedback from staff regarding barriers to implementation was also collected.
Following implementation, 35% of patients screened were identified as high risk for DIVA. Staff reported increased awareness of DIVA risk; however, challenges such as perceived additional workload and a lack of electronic medical record (EMR) integration impacted sustained practice change.
The Modified A-DIVA scale is a practical, evidence-based tool for improving PIVC outcomes in OB triage patients. Its implementation was associated with improved DIVA recognition. Integration into the EMR and continued staff engagement are essential for sustaining its use and maximizing patient benefit.
Language
English
Recommended Citation
Weaver, Dakota S. and O'Sullivan, Ryan, "Optimizing Workflow and Patient Outcomes: The Impact of the Modified Adult Difficult Intravenous Access (A-DIVA) Scale on Peripheral IV Access: A Quality Improvement Project" (2025). Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts. 10.
https://dsc.duq.edu/dnap/10