Implementing a clinical practice guideline to improve pediatric intravenous infiltration outcomes

The focus on quality, efficiency, and cost containment has spurred development of clinical practice guidelines to facilitate the use of research-based knowledge and expert opinion to promote desired outcomes. At the University of Iowa Hospitals and Clinics, pediatric nursing took a leadership role in developing multidisciplinary guidelines for the prevention and treatment of intravenous infiltrations in pediatric patients, following the Iowa Model. The 3-year collaborative effort has resulted in a synopsis of the literature; a quick reference sheet based on the latter; infiltration staging guidelines; an infiltration decision algorithm; a table of recommended antidotes; and a standard of care. Outcome data showed improvement in ongoing intravenous site assessment, extent of infiltration and estimated infiltration volume assessment, physician notification of infiltrations, documentation of severity, and compliance with use of the guidelines and use of antidotes. The guideline recently has been revised, and outcomes will continue to be tracked.