Improving Peripheral IV Line Care


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Improving Peripheral IV Line Care

  1. 1. Improving Peripheral IV Line Care Amrita Institute of Medical Sciences Kochi, India , (1200 bed university hospital) Sai Bala Madathil From January 2008 onwards till date
  2. 2. Complications related to Peripheral IV Cannulation • 95% patients admitted underwent a peripheral I/V cannulation and were at risk of complications p • On observation and by analysis of general incident reporting system, it was found that there was a high incidence of extravasation e tra asation and infiltration and phlebitis phlebitis. • We were hoping to educate nurses on complications related to PIVC, reporting and its p , p g prevention, and thus to improve , p patient care, to take at corrective measures to develop a data depository for further research.
  3. 3. The Intervention was Planned in Different Phases Phase 1: Develop a separate incident report for phlebitis and extravasation and training of nurses – Established by 2008 January – Reports indicated need for standardization of dug dilutions, protocols for administering certain d d i i t i t i drugs eg(Cordorane, D (C d Dopamine) i ) – Protocol for administration of vesicant drug – Standardization done and protocol established by May 2008 – Monitoring of PIVC site recorded in nurses chart Phase 2: Evaluation of existing protocols – Incidence of phlebitis reported. Extravasation rates reduced by September 2008. Phlebitis rates varied – Train the trainer program and in-service education followed
  4. 4. The Intervention was Planned in Different PhasesPhase 3: Monitoring and analysis of existing values – It was found that there was more than 20% error in reporting which included omission, wrong diagnosis under reporting. With the existing data provided, it was difficult to identify areas for improvementPhase 4: Started a two day certification program on bestpractices on peripheral IV Cannulation, this was given for allsenior nurses – Improvised the incident reporting form to capture all complications related to peripheral IV – All new recruits joining after the month of June 2010 were also certified – Formation of IV team to audit and strengthen best practices
  5. 5. The Results• Reporting of phlebitis started in 2008 January varied from 6 per month to 11 p month between 2008 to 2010 p per• Reporting of IV complication increased from June 2010 (average 6 cases/month) to average 20 per month after implementation of certification program• Infiltration started getting reported.• Number of errors in reporting reduced to 0% .• By April 2011, number of phlebitis decreased to average 10 cases per month• Overall awareness improved resulting in queries related to Overall, Osmolarity and pH of the infusate used, discussions on dilutions strategies and evaluating standards
  6. 6. Engaging Others• Process was initiated by the senior nursing leaders supported by the training wing of Nursing. g g g• All nurses were supportive of the process which was the result of increased awareness of problem and need for process change.• Difficulty was faced in convincing Physicians about the standardization of drug dilutions protocols for administration and need for a structured consistent training p g g programme in p p peripheral IV cannulation.
  7. 7. Greatest Learnings / Largest Challenges Your Best AdviceThe greatest learning was: Key to success “Where there is a will Where will, – Education, Education, there is a way” EducationMajor challenges were: – Monitoring– Developing a culture of reporting – Analysis– Education of Nurses – Feedback (RN strength 1400) t th – Appreciation– Convincing physicians for the need of drug dilution administration protocols based on scientific data
  8. 8. Sustaining Change• Results were continuously monitored.• Analysis was done, corrective actions taken.• Feedback to nurses, physician and administration and appreciation for best practices• Consistent ,focused training by a dedicated team• Introduction of IV team• Strong ,unswerving leadership