Here's how families can work with bedside nurses to reduce peripheral intravenous harm.
By Jillian Rojas, M.S., RN, NE-BC and Erin Benish, B.S.N., RN, CNML
It was a challenge for bedside nurses at Ann & Robert H. Lurie Children's Hospital of Chicago to thoroughly assess peripheral intravenous (PIV) sites every hour and complete Touch, Look, Compare (TLC) education with caregivers daily.
The hospital set a goal to increase patient and family engagement, encourage families to raise concerns about their child's PIV with providers, increase compliance with nurses providing TLC education, and decrease the number of moderate or severe PIV extravasations.
A committee implemented and tracked factors that could decrease extravasations. The committee outlined barriers to compliance, which included nurses' discomfort with asking families for additional help to assess the patient's PIV. This barrier sparked interest from committee chairs, who conducted a literature search to uncover how other pediatric hospitals have overcome this obstacle. The committee decided to adapt strategies outlined in a 2016 article published in Pediatric Nursing detailing how one institution used an interactive education system to engage families.
The hospital's interactive care network vendor built a question into the existing network that asked patients and families about the child's IV. A 48-bed inpatient unit of general medicine patients volunteered to be the pilot. The committee engaged leadership, charge nurses and bedside nurses, and provided one-on-one education, emails and flyers outlining the pilot. These tactics encouraged staff to ask questions, verbalize concerns, and helped implement TLC teaching into daily routines.
The interactive care network sent a question twice daily to in-room TVs asking if the child has an IV. If a parent selected "yes," the question would ask if the IV was puffy, painful, red, hot or cold. If the parent selected "yes" again, the system paged the floor charge nurse who would alert the bedside nurse to assess the patient's IV for an extravasation or perform real-time education with the family and patient.
The committee took measures to monitor if a parent selected "yes" due to concern for an extravasation or by accident. The hospital's vascular access team, along with nursing leadership, received a page if parents selected "yes" in this situation. Leadership and nurses would follow up with families and solicit feedback. Providers cross-referenced these patients against a hospital-wide extravasation log and safety-reporting system for several days after the alert to monitor if an extravasation occurred within 24 to 48 hours.
The IV question went live on in June 2016 and is active today. The committee collected data for 10 months during and retrospectively from the same time the previous year to monitor a decrease in extravasations and an increase in TLC education with families. Results showed TLC compliance increased 14 percent, and there was a 23 percent reduction in the overall extravasation rate.
- Families are eager to be engaged in their child's care to prevent potential harm.
- Engage frontline caregivers, supervisors and high-level leadership early
- Educate staff that a false alert is still an opportunity for patient and family education
- Technology supports staff members who are uncomfortable asking families for help monitoring IV sites.
- Ensure technology is working appropriately after upgrades or downtimes.
This initiative encouraged families to actively participate in their child's care by partnering with the bedside nurses. This increased collaboration and built a pathway of trust and open communication. After a successful pilot with one unit, the committee expanded the IV question to a 48-inpatient bed pediatric surgery unit and a 34-inpatient bed neurosurgery unit. The committee will implement the question throughout the hospital, including intensive care units and the hematology/ oncology floor in an effort to continue to educate families and decrease harm from PIV extravasations.
Jillian Rojas, M.S., RN, NE-BC, is director of patient care operations and Erin Benish, B.S.N., RN, CNML, is patient care operations manager at Ann & Robert H. Lurie Children's Hospital of Chicago. Send questions or comments.