实施一项针对注册护士和麻醉医师的循证标准化护理捆绑包，以提升患者安全与血管内通路装置护理管理质量——Safe-IVADs项目。一项包含嵌入式过程评估的纵向实施干预。

干预

实施计划与干预医院的利益相关者共同设计。 作为共同设计学习活动的实施对象，针对的是干预医院的注册护士和麻醉师。

行为的：安全IVADs项目

该实施干预基于关于组织文化、领导力和对话的经典理论，旨在改变护士和麻醉医师的思维和行为方式，以提高血管内导管的质量。

实施将由六名引导者领导。大约650名注册护士和50名麻醉医师将参与该实施计划。实施对象是共同设计的学习活动，这些活动将在一年内实施。

对照医院

常规护理（有或无局部变化）

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.