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Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Improving Detection of IV Infiltrates in Neonates
Colleen Driscoll Md1, Melissa Langer1, Susan Burke1
1University of Maryland Medical Center, U.S.A.
Insights
Implementing an evidence-based guideline and checklist improved the detection of intravenous (IV) catheter infiltrates in neonates. This quality improvement initiative also significantly reduced severe Stage 4 infiltrates, enhancing patient safety in the neonatal intensive care unit.
Area of Science:
- Neonatal intensive care
- Pediatric patient safety
- Medical device complications
Background:
- Intravenous (IV) catheter infiltrates cause significant morbidity in neonatal intensive care units (NICUs).
- Underreporting of adverse events in voluntary systems complicates monitoring of low-incidence events like IV infiltrates.
- Severe IV infiltrates observed in the NICU prompted a quality improvement initiative.
Purpose of the Study:
- To enhance the detection of all IV infiltrates in neonates.
- To reduce the incidence of Stage 4 IV infiltrates.
- To implement an evidence-based guideline for improved surveillance, prevention, and management of IV infiltrates.
Main Methods:
- Developed and implemented an evidence-based guideline for IV infiltrate management.
- Instituted educational interventions for faculty and staff.
- Utilized a compliance checklist for guideline adherence and surveillance.
Main Results:
- The overall IV infiltrate rate increased from 5 to 9 per 1000 line days post-intervention, indicating improved detection.
- Checklist use enhanced the monthly detection of IV infiltrates.
- The incidence of Stage 4 infiltrates, measured by nitroglycerin ointment use, was significantly reduced.
Conclusions:
- Quality improvement interventions effectively enhanced the detection of IV infiltrates in neonates.
- An evidence-based guideline for managing IV infiltrates can decrease the occurrence of severe injuries.
- Improved surveillance and management protocols are crucial for patient safety in the NICU.
Abstract:
Neonates and infants in the neonatal intensive care unit suffer significant morbidity when intravenous (IV) catheters infiltrate. The underreporting of adverse events through hospital voluntary reporting systems, such as ours, can complicate the monitoring of low incidence events, like IV infiltrates. Based on severe cases of IV infiltrates observed in our neonatal intensive care unit, we attempted to improve the detection of all infiltrates and reduce the incidence of Stage 4 infiltrates. We developed, and initiated the use of, an evidence-based guideline for the improved surveillance, prevention, and management of IV infiltrates, with corresponding educational interventions for faculty and staff. We instituted the use of a checklist for compliance with guidelines, and as a mechanism of surveillance. The baseline incidence rate of IV infiltrates, determined by the voluntary reporting system, was 5 per 1000 line days. Following initiation of the guidelines and checklist, the IV infiltrate rate increased to 9 per 1000 line days. In most months, the detection of IV infiltrates was improved by use of the checklist. During the post-intervention period the rate of Stage 4 infiltrates, as measured by usage of nitroglycerin ointment, was significantly reduced. In conclusion, the detection of IV infiltrates was improved following our quality improvement interventions. Further, use of an evidence-based guideline for managing infiltrates may reduce the most severe infiltrate injuries.
