Share Your Story, Share Your Best Practice Global Poster Submission

Improving Peipheral IV Line Care

• Amrita Institute of Medical Sciences,Kochi,India(1200 bed university hospital)

• Sai Bala Madathil• From January 2008 onwards till date

Complications related to Peripheral IV Cannulation

• 95% patients admitted underwent a peripheral I/V cannulation and were at risk of complications

• On observation and by analysis of general incident reporting system it was found that there was a high incidence of extravasation and infiltration and phlebitis.

• We were hoping to educate nurses on complications related PIVC , reporting and its prevention and thus to improve patient care, to take at corrective measures develop a data depository for further research.

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 standadisation of dug

dilutions, protocols for administering certain drugs eg(cordorane,dopamine)

• Protocol for adminstration of vesicant drug• Standardisation done and protocol established by

May 2008• Monitoring of PIVC site recorded in nurses chart

The Intervention was planned in Different Phases• Phase : 2 Evaluation of existing protocols • Incidence of phlebitis reported. Extravasation rates

reduced by September 2008.Phlebitis rates varied.• Trainers training and inservice education followed• Phase :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 improvement

The Intervention was planned in Different Phases• Phase 4 :Started a two day certification program

on best practices on peripheral IV Cannulation, this was given for all senior nurses

• Improvised the incident reporting form to capture all complication related to peripheral i.v .

• All new recruits joining after the month of June 2010 were also certified.

• Formation of IV team to audit and strengthen best practices.

The Results• Reporting of phlebitis started in 2008 jan varied from 6per

month to 11 per month between 2008,2009,2010• Reporting of IV complication increased from June 2010(avg

6 cases /month) to avg 20 per month after implemenation of certification program

• Infiltration started getting reported.• No of errors in reporting reduced to 0% .• By April 2011 no.of phlebitis decreased average 10 cases

per month .• Overall awareness improved resulting in queries related to

Osmolarity and pH of the infusate used , discussions on dilutions strategies and evaluating standards.

Engaging Others• Process was initiated by the senior nursing

leaders supported by the training wing of Nursing. • 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 programme in peripheral IV cannulation.

Greatest Learnings / Largest Challenges

• The greatest learning was “Where there is a will there is a way”

• Major challenges were – Developing a culture of reporting– Education of Nurses (RN strength 1400)– Convincing physicians for the need of drug dilution

administration protocols based on scientific data

Your Best Advice

• Key to success– Education, Education, Education.– Monitoring– Analysis– Feed back – Appreciation.

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