I have read with interest the research that has examined the measurement quality of phlebitis scores Ray-Barrel et al (2014). A theme that appears to have undergone some discussion in the literature is the level of reliability, validity and responsiveness of tools that monitor peripheral IV sites. In addition, the practical application of the tool should be considered. It is with this final point that I have decided to publish this short insight into the history and the practical use of the VIP score.
In 1995 I was fortunate to obtain a specialist nursing post in intravenous therapy. Back in the day (the mid to late nineties), infusion phlebitis was common place and ownership of preventative methodologies was at best absent. For those who know me well they will recognise that I was consumed with a need to improve patient care. As infusion phlebitis was a) a problem affecting many patients and b) was a clinical issue that lacked any professional proprietorship, I decided to develop a tool that would have the following qualities:
- Visual and thought provoking.
- Easy to integrate into current systems e.g. care plans.
- Deliver a consistent clinical message associated with IV site monitoring.
- Identified early signs of phlebitis.
- Empower professional groups to act on the earliest signs of phlebitis and remove the device.
- Provide a system for grading more severe episodes of phlebitis.
- Ensure clinicians are consistent with the documentation (clinical signs such as ‘slightly red’ could now be translated into a number).
- When documentation is reviewed, the reviewer has a tool that defines what the clinician has documented about the condition of the peripheral IV site.
To conclude this section, the VIP score is a tool that encourages site observation, identifies the earliest signs of phlebitis and ensures device removal. In addition, the VIP score raises the profile of IV care and adds to the language of vascular access, in turn ensuring standard documentation.
Future research associated with phlebitis scores should consider the impact of the introduction of the score. The impact it has on increasing the frequency and type of checks made to peripheral IV sites. How they have increased professional proprietorship following introduction. The impact of the introduction on associated issues such as device associated bacteraemia. Finally, the whole purpose of the VIP score was to identify the early signs of phlebitis and facilitate early device removal. During any future research design I recommend that this defining role of the VIP score score is acknowledged. I’m not sure if any of the research I have read to date has effectively reviewed the main reason why the VIP score has been so successful and effective.
Conflict of interest: Andrew designed the VIP score.
Ray‐Barruel, G., Polit, D. F., Murfield,, J. E. and Rickard, C.M. (2014) Infusion phlebitis assessment measures: a systematic review. Journal of Evaluation in Clinical Practice. .20(2), p.191-202.