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Description
QUALITY
Background: Peripheral Intravenous Infiltrations and Extravasations (PIVIE) occur in up to 78% of peripheral IVs (PIVs) in some pediatric studies. Proper site assessment is essential in preventing patient harm from PIVIEs, with hourly nursing assessments considered best practice for patients receiving continuous infusions. Many nurses work 12-hour shifts, and evidence suggests that inattentional blindness and cognitive bias can contribute to failure to notice physiologic differences in patient assessments over time. To address this challenge and ensure early identification of symptoms, the local project team proposed an innovative ‘buddy check’ approach to minimize patient harm.
Methods: This quality improvement project was developed as a change idea from the larger institutional PIVIE Steering Committee, in collaboration with a nurse residency evidence-based practice project. The buddy check process was initially outlined by project leaders to include intentionally timed PIV site assessments by a second nurse, midway through a 12-hour shift. This model was piloted for feasibility on four inpatient units using plan-do-study-act (PDSA) cycles.
Results: Qualitative data from nurses demonstrated 100% confidence in peer buddy check assessments, with 90% reporting zero or minimal disruption to the current workflow. During the pilot 77 PIVIEs occurred, with a majority detected in the mild stage (71%). 55% of mild were identified during buddy checks. For PIVIEs detected at later stages, moderate to serious harm, 77% were noncompliant with buddy checks. In September 2023, one unit formally implemented the buddy check practice, yielding a 76% reduction in moderate/serious PIVIEs from the pre-implementation phase. In January 2024, the practice was integrated system-wide, with early data demonstrating a decrease in moderate/serious PIVIE rate from 0.92 to 0.80.
Conclusion: Noncompliance with buddy checks correlated with higher degrees of harm, indicating that buddy checks facilitate earlier identification of infiltration. The buddy check process is a feasible intervention to augment current practice, yielding minimal nursing workflow disruption. This intervention is generalizable and can be easily adopted across pediatric care settings.
Publication Date
9-27-2024
Keywords
Peripheral IV Infiltrations and Extravasations, PIVIE, Infiltrations
Disciplines
Pediatric Nursing
Recommended Citation
Ruffini, Melissa; Coenraad, Ashlyn; Burris-Alcala, Rachael; Washington, Victoria; Jordan Ressman, Emily; and Birely, Alexandra, "PARTNERING UP TO PREVENT PEDIATRIC PERIPHERAL INTRAVENOUS INFILTRATION" (2024). 2024. 13.
https://scholarlycollection.childrens.com/nursing-anf2024/13
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This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
