For the last five years, Cincinnati Children’s Vascular Access Team has been working to eliminate preventable harm related to peripheral intravenous infusions (PIV). Now, the team is sharing its experiences with other pediatric hospitals.
“Lurie Children’s is the first major pediatric institution to implement our prevention work, including the new documentation tool. Denver Children’s will adopt the system in June, and some smaller hospitals have already implemented it on their own. We are hoping it will spread to more children’s hospitals across the country,” says Neil Johnson, MD, the team’s medical director.
Chances of that happening are good, since the 78 US children’s hospitals that are part of the Solutions for Patient Safety collaborative have adopted PIV extravasation prevention as their next safety project.
“When we started our work in 2009, a national system existed for grading extravasations, but it was not helpful for quality and prevention work,” says Johnson, “It’s adult-based, with a mainly descriptive grading system that gives as much weight to an extravasation with a tiny bit of swelling as to a much more serious injury. It didn’t make sense as an effective guide for assessing and preventing harm.”
The Vascular Access Team’s success is based on four components:
- Reliable hourly bedside nursing PIV checks
- An evidence-based three-tier medication tissue toxicity list
- A new two-part extravasation assessment and documentation tool that measures:
a) the size of swelling as a percentage rather than an arbitrary “grade”
b) the type of infusate and its local skin toxicity potential
- Real cross-cultural leadership and team development
Over the past five years, Cincinnati Children’s has reduced serious harm to patients from PIV extravasation to nearly zero.
Developing the new assessment tool has been a team effort, involving frontline nurses, physicians, pharmacists, quality improvement consultants in the Anderson Center, analysts in Information Services and senior leadership. Sylvia Rineair, RN, clinical director, Vascular Access Team, and Barb Tofani, RN, assistant vice president, Perioperative Services, are principal collaborators.
“It’s taken five years of testing, tweaking and adjusting to get to this point,” says Johnson. “But we’ve based everything we’ve done on one question: What would we do for our own children? When you think like that, then there’s no question about what direction we’re heading. We don’t want even one child in this or any other pediatric hospital to suffer a preventable PIV extravasation injury.”
Learn more about our extravasation assessment tool.