Innovative System Reduces IV Extravasation Harm at BWC Hospital

Extravasation, the accidental leakage of liquid from a vein into surrounding tissues during IV administration, has long been a critical yet under-researched complication, often leading to severe patient harm and tissue necrosis. Recognizing an urgent need for improvement, the Birmingham Women’s and Children’s NHS Foundation Trust (BWC) implemented a comprehensive extravasation care bundle to mitigate these risks. Central to this bundle is the red, amber, and green (RAG) extravasation risk rating system for all intravenous (IV) medicines. This system standardizes the approach to observing IV access sites and tracking infusions, significantly enhancing patient safety. The implementation, backed by thorough research and audits, charts a new course in the mitigation of extravasation-related injuries.

Understanding Extravasation and Its Impact

Extravasation poses a serious threat when administering IV medicines, potentially causing tissue damage and severe patient harm. Despite being a known complication, it is surprisingly under-researched. Incidents of moderate and severe harm repeatedly highlighted the urgency of addressing this issue at BWC. These alarming reports acted as a catalyst for a dedicated initiative to reduce the incidence and harm of extravasation. The development of a comprehensive care bundle became a cornerstone for mitigating these risks, ensuring a more reliable and safer administration of IV medicines.

By emphasizing the critical nature of extravasation, the initiative sought to mobilize a proactive stance among healthcare providers. The necessity was evident—extravasation not only affects patients’ health but also incurs substantial costs to healthcare organizations. The BWC’s strategy aimed at understanding the depths of this challenge and crafting a robust solution to curb the detrimental impact of extravasation incidents.

Initial Findings and Root Causes

Initial investigations at BWC revealed a multitude of factors contributing to the higher rates and severity of extravasation incidents. The findings spotlighted gaps such as inadequate clinical guidelines for checking IV-line sites, which is crucial for early detection of extravasation. Furthermore, insufficient documentation for multiple infusions and devices hindered timely interventions. The lack of ergonomic principles in existing guidelines and the absence of systematic recording of ongoing infusions compounded these challenges, leading to delayed detection of extravasations.

The root cause analysis underscored the importance of a structured and systematic approach to IV administration. Healthcare providers at BWC recognized the critical need to establish a rigorous framework to monitor and manage IV administration effectively. By addressing these root causes, the initiative aimed to transform the IV administration landscape, ensuring a higher degree of diligence and precision, thus significantly reducing the risk of extravasation-related harm.

Multidisciplinary Scoping Exercise

A multidisciplinary team comprising frontline nurses, a pharmacist, tissue viability nurses, a plastic surgeon, an intensivist, and a patient safety specialist with human factors training was formed to conduct a comprehensive scoping exercise. This team undertook a detailed review of past clinical incidents, IV guidelines from other hospitals, and international literature, coupled with clinical observations and audits of current practices at BWC. The scoping exercise was pivotal in identifying gaps in BWC’s processes, revealing complex risk assessments, insufficient risk ratings for IV medicines, and a lack of specific guidelines for IV device selection based on risk.

The exercise brought to light the need for simpler and more actionable guidelines to assist healthcare providers in making informed decisions. Identifying these gaps propelled the team toward developing a streamlined, effective, and safer system for IV administration. This comprehensive evaluation of existing practices and international standards set the stage for significant improvements aimed at mitigating the risk of extravasation.

Development of Medicine Risk Rating System

The existing extravasation risk rating was revamped and expanded to encompass all IV medicines administered at BWC. This led to the creation of a RAG rating system, categorizing medicines based on their probability of causing severe harm if extravasation occurred. For each risk level, specific guidelines recommended appropriate IV devices and included additional 30-minute checks for high-risk medicines. The system also tailored IV site checking timing and escalation procedures, aiming to minimize the potential harm from extravasations.

The structured approach facilitated standardization in the administration of IV medicines, ensuring healthcare providers could determine the safest course of action based on the risk associated with each medicine. By prioritizing patient safety through a meticulous classification of risk levels, the new system bolstered confidence among healthcare providers, ultimately safeguarding patients from the severe consequences of extravasation.

Redesigning Bedside Documentation

The redesign of bedside documentation integrated critical elements of the new guidelines and enabled seamless tracking of specific IV devices used in administering medicines. Nurses struggled to navigate through guidelines and identify devices associated with extravasations, especially with patients requiring multiple infusions. The redesigned documentation process sought to overcome these hurdles by streamlining the workflow and making vital information readily available to healthcare providers.

Incorporating these guidelines into the bedside documentation process not only simplified the nurses’ tasks but also ensured a higher standard of care. Through this, BWC enhanced the capability to monitor and manage IV administration efficiently, facilitating faster and more accurate responses to potential extravasation incidents. This improvement underscored the importance of an intuitive and accessible documentation system to enhance the overall quality of patient care.

Enhanced Intravenous Site Checking

To boost the detection of extravasations, the Touch, Look, and Compare (TLC) assessment guidelines from Cincinnati Children’s Hospital were adapted. This adaptation emphasized early signs of extravasation and ensured enhanced IV site monitoring procedures tailored to different risk levels. Implementing these guidelines enhanced the proactive monitoring of IV sites, allowing for timely intervention in the event of an extravasation.

The proactive approach to IV site monitoring necessitated a meticulous assessment framework that healthcare providers could rely on. By incorporating the TLC assessment guidelines, BWC transcended traditional monitoring methods, embracing a more vigilant and responsive strategy. This enabled timely detection and intervention, drastically reducing the likelihood of severe harm resulting from extravasations.

Positive Results and Feedback

Following the implementation of the new system, feedback from nurses and independent audits pointed to high compliance and positive reception of the changes. The number of reported extravasation incidents fell significantly, from 15.4 per month to 10.25 per month, with severe harm incidents dropping to zero. These promising outcomes demonstrated the effectiveness of the new approach, reinforcing the value of structured and systematic IV administration protocols.

The reduction in extravasation incidents and the elimination of severe harm cases validated the initiative’s success, instilling a renewed sense of security and confidence among healthcare providers. The positive feedback underscored the system’s practical benefits, translating into better patient outcomes and reinforcing the critical importance of continuing these improvements for sustained success.

Challenges and Solutions

Despite the positive outcomes, the initiative encountered several challenges, notably the lack of existing research on preventing extravasation injuries and the absence of readily available extravasation risk information for IV medicines. Additionally, the COVID-19 pandemic disrupted the integration of the new system, causing temporary non-compliance. However, funding for a temporary project post eventually facilitated high compliance levels, providing the necessary support to uphold the new system.

These challenges emphasized the necessity for ongoing support, resources, and adaptation to unforeseen circumstances. Ensuring the sustainability of the new system required continuous effort and diligence. Addressing these hurdles further validated the initiative’s resilience and highlighted the importance of maintaining a proactive stance in healthcare innovations.

Future Directions and Sustainability

To ensure long-term sustainability and ongoing compliance, BWC has embarked on several initiatives, including developing an electronic extravasation education package and incorporating extravasation risk ratings in the approval process for new medicines. This forward-thinking approach reflects BWC’s commitment to staying ahead of potential extravasation risks, continuously enhancing clinical practice, and fostering an environment of ongoing improvement.

Extending the practice changes to adult and obstetric areas marks another significant step toward broadening the initiative’s impact. Collaborating with technology experts, BWC aims to further reduce harm from extravasation through advanced monitoring and greater consistency across departments. These efforts signify a sustained commitment to elevating patient safety standards and mitigating the risks associated with IV administration.

Conclusion

The comprehensive and innovative strategy implemented at BWC to tackle extravasation harm has led to notably positive outcomes. By instituting an extravasation care bundle that incorporates a structured risk rating system and advanced monitoring protocols, the incidence and severity of extravasation-related injuries have been significantly reduced. The initiative faced various challenges, but strategic solutions ensured both its success and sustainability.

Continuous improvements and upcoming plans highlight how crucial it is to keep innovating and adapting in the field of healthcare. These efforts not only aim to further enhance patient safety but also improve the overall quality of care. By focusing on reducing harmful incidents through better risk management and monitoring, the initiative promises to set new standards in patient safety and medical practices.

In addition, the ongoing commitment to refining these protocols and extending their application demonstrates a long-term dedication to safeguarding patients and improving professional practices. The results at BWC serve as a compelling case for other healthcare institutions to adopt similar comprehensive strategies, emphasizing collective responsibility in achieving the highest standards in patient care. This forward-looking approach ensures that patient safety remains a top priority, fostering an environment where healthcare professionals continually strive for excellence.

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