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Improving Detection of IV Infiltrates in Neonates.

Colleen Driscoll Md1, Melissa Langer1, Susan Burke1

  • 1University of Maryland Medical Center, U.S.A.

BMJ Quality Improvement Reports
|January 7, 2016
PubMed
Summary

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.

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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.

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  • 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.