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Purposeful Hourly Rounding to Decrease Peripheral Intravenous Infiltrations and Extravasations in Pediatrics
Mayra G Garcia1, Hayden Dutton1, Kiele Samuel1
1Children's Health Children's Medical Center, TX, USA.
Insights
Structured hourly rounding using the P.A.T.H. model significantly reduced moderate pediatric peripheral intravenous infiltrations and extravasations (PIVIE). This quality improvement initiative also enhanced patient satisfaction and safety outcomes.
Area of Science:
- Pediatric nursing
- Quality improvement science
- Patient safety
Background:
- Pediatric patients are vulnerable to peripheral intravenous infiltrations and extravasations (PIVIE).
- Structured hourly rounding is a proven method for improving healthcare quality outcomes.
- A significant need exists to reduce PIVIE rates in pediatric populations.
Purpose of the Study:
- To implement structured hourly rounding to decrease moderate PIVIE rates in pediatric patients receiving continuous IV fluids.
- To reduce the median PIVIE rate from 3.13 to 2.58 per thousand patient days over six months.
Main Methods:
- A pilot study was conducted using the P.A.T.H. model for hourly assessments of peripheral intravenous lines (PIV).
- Nurses assessed pain (P), PIV status (A), patient/family needs (T), and hospital-acquired conditions (H).
- Data on nurse-sensitive indicators and rounding compliance were collected.
Main Results:
- Structured hourly rounding successfully integrated hourly PIV assessments.
- The median moderate PIVIE rate decreased by 41% to 1.83 per thousand patient days.
- Unintended positive outcomes included 100% pain reassessment, a 30% increase in patient satisfaction, and a 29% reduction in patient falls.
Conclusions:
- Structured hourly rounding, utilizing the P.A.T.H. model, effectively hardwires hourly PIV assessments in pediatric care.
- Sustaining these improvements requires leadership support and nursing dedication.
- Implementing focused hourly rounding is recommended for addressing PIVIEs.
Purpose:
Pediatric patients are at high risk for peripheral intravenous infiltrations and extravasations (PIVIE) resulting in patient harm. Structured hourly rounding has demonstrated to improve quality outcomes. The purpose of this quality improvement project was to implement structured hourly rounding to decrease the median rate of moderate PIVIE rates from 3.13 to 2.58 per thousand patient days over a 6-month time period in pediatric patients with infusing continuous IV fluids.
Design And Methods:
A pilot was conducted to hardwire hourly assessments for peripheral intravenous lines (PIV) in pediatric patients with continuous fluids utilizing a structured hourly rounding process. Bedside nurses utilized the P.A.T.H. model to assess pain management (P), assess PIVs for early PIVIE recognition (A), address things patient and family may need (T), and reduce the occurrence in hospital acquired conditions (H). Data was collected on unit nurse sensitive indicators and compliance to hourly rounding.
Results:
Structured hourly rounding using the P.A.T.H. model successfully hardwired hourly PIV assessments. The unit reduced their median moderate PIVIE rate to 1.83 per thousand patient days, an 41% improvement. The pilot also had positive unintended consequences of improved pain reassessment from 67% to 100%, increased patient satisfaction scores of 67% to 97% and reduced patient falls by 29%.
Conclusions:
Structured hourly rounding using the P.A.T.H. model can positively hardwire hourly PIV assessments in pediatric patients.
Practice Implications:
Sustainability of hourly rounding requires leadership support and nursing commitment to impact quality metrics. Organizations should consider implementing focused hourly rounding to address PIVIEs.
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