The DIVA tool gave novice nurses a reliable indication of the probable difficulty of an IV insertion and resulted in a change in the IV policy standard at the institution, which now limits the number of peripheral IV insertion attempts to two per nurse and four per patient, bringing current policy into alignment with the 2016 Infusion Therapy Standards of Practice. Use of the revised and validated DIVA tool has the potential to enhance patient comfort and satisfaction and effect significant change in nursing practice.

Because of the longevity of children diagnosed with chronic illness, many adult institutions are now seeing an influx of adolescents with chronic illnesses. An urgent need exists to educate adult care nurses on adolescent development, childhood chronic illness, and techniques to guide young adult patients through illness and hospitalization.This article describes the development of an educational program for nurses who care for these chronically ill young adult patients who are transitioning to adult care.

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The University of Cincinnati Medical Center (UCMC) is a multibuilding hospital and health care campus that is part of an academic health center. Procedural sedation is performed in both inpatient and outpatient areas (Table 1 provides specific locations where sedation was performed). In 2008, through regulatory mock surveys, weaknesses were identified in our implementation of procedural sedation throughout the hospital campus. The organization was ready for a policy revision, standardization of documentation tools, implementation of the use of pharmacologic agents to induce a state of deep sedation outside of the operating room 1 and an update in our Quality/Performance Improvement Program. A multidisciplinary task force was created, as a part of performance improvement project to develop a standardized Procedural Sedation Program across the sedation continuum for all areas performing procedural sedation. The ultimate goal was to design a program that ensured safe care of patients, during invasive (diagnostic and therapeutic) and manipulative (eg, orthopedic) procedures by nonanesthesiologists on nonintubated patients. 2 It quickly became apparent that the standardization of procedural sedation practices over such a large number and diverse practice settings would be a complex, resource-intensive, activity that required commitment and collaboration between all of the departments represented on the committee. Because procedural sedation encompassed all levels of sedation, the scope of the project was to provide safe care for patients