Adaptation and validation of pediatric peripheral intravenous catheter insertion and care practices audit tools

Objectives:This study aimed to describe the translation process and establish the validity of the three instruments in Indonesian to assess pediatric peripheral intravenous catheter(PIVC)insertion and care practices.Methods:The six-step forward and backward translation method was used to translate the adapted questionnaires.The English version questionnaires included the point prevalence audit checklist,the nurse survey consisting of the nurse PIVC knowledge questionnaire and the nurse PIVC confidence questionnaire,plus a Patient/parent Experience Survey.Data collection was conducted in Indonesia between October 2019 and February 2020.In total,there were six translators(two for each instrument),nine-panel vascular access experts(three for each instrument),and 30 participants(ten for each in-strument)of the target population involved in the translation and validation of the three instruments.Three-panel experts rated the content relevance of each instrument using a four-point rating scale.Item level and scale level content validity index and kappa index were calculated.Ten-panel members of the target population evaluated each questionnaire regarding feasibility,clarity,logical sequence,and formatting.Qualitative comments from the panel were also reviewed.Results:The translation process indicated relatively low discrepancies between translators except for semantic equivalence.There were nine,eight,and one semantic discrepancies found in the forward translation of the point prevalence audit checklist,nurse survey,and patient/parent experience survey.The semantic discrepancies were less prevalent in the backward translation,with only one,three,and two items reported during the process.The item validity index for all of the three instruments showed relatively high agreement between experts(I-CVI>0.78,S-CVI/Ave>0.90,S-CVI/UA>0.70,and kappa index>0.74).The face validity was established with the panel reporting that the three instruments were easy to understand and presented logically.However,some re-formatting of the nurse survey and pa-tient/parent experience survey were needed to avoid ambiguity and confusion for the participants.Conclusions:The results indicate that the translated three survey instruments that had been widely used in other developed countries show good content validity in the Indonesian context.They can be used as a reference for further testing in different countries and contribute to understanding the pediatric PIVC audit tools used in future clinical research.

带量采购前后不同静脉留置针的临床使用情况及费用比较

目的通过对比带量采购前后不同静脉留置针的临床使用情况及整体费用,为优化临床决策、完善医用耗材带量采购提供参考。方法通过关键知情人访谈收集带量采购前后不同静脉留置针产品的临床使用情况,基于文献回顾及关键知情人访谈等构建模型对静脉留置针的整体费用进行分析。结果对来自南京和临沂的16家医院的27位临床护士进行了访谈。与带量采购前使用X品牌留置针相比,带量采购后使用中标品牌留置针的平均留置时间由3.7 d降为2.1 d,单个患者留置针平均用量由2.0个上升为3.5个。穿刺平均耗时增加,首次穿刺成功率降低,导管堵塞、脱管、发红、皮下血肿、液体渗漏、静脉炎等并发症发生率上升,留置针穿刺及耗材费用、并发症治疗、产品破损及护士人工费等上升。以100例使用静脉留置针的住院患者为1个研究单位,总费用从7765.4元上升到9338.7元,增加了1573.3元。结论带量采购后,静脉留置针的质量及临床使用出现一定的问题。尽管中标产品单价下降,但整体费用控制效果不如预期,甚至不降反增。建议逐步建立针对医疗耗材带量采购的质量和整体费用评价标准,加强对医用耗材带量采购事前、事中、事后的质量评估与临床使用监测,更全面地分析费用并进行决策。