Peer-to-Peer Rounding to Reduce the Number of Peripheral Intravenous Infiltrations and Extravasations

Abstract

Introduction: Early identification and quick response to an intravenous (IV) infiltrate are imperative to preventing harm. Peripheral IV (PIV) therapy is regarded as routine in hospitalized pediatric patients. IV infiltrate complications range from irritation and discomfort to serious harm, such as permanent skin and soft-tissue loss, impaired limb function, compartment syndrome, distal vascular compromise, and even loss of partial or complete limbs. A standardized intervention bundle to prevent harm was established at a Midwestern pediatric hospital as the standard of practice; however, bundle consistency and reliability were suboptimal despite communication and education through online and newsletter formats. Methods: Peer-to-peer rounding using a Kamishibai card was implemented to facilitate discussion between the bedside nurse and a PIV champion. The Kamishibai card consisted of questions for the champion to ask nurses to assess knowledge, application to practice, and give feedback to improve practice. Each month, 1 unit was selected for champions to round with nurses. Results: Rounding was well received by unit leadership and nurses. Maintenance bundle compliance was sustained >90% for 11 of 12 months in 2017 (Fig. 1). Approximately, 90 less children were harmed by moderate or severe infiltrates when comparing data from 2016 to 2017, which exceeded the target goal of a 20% reduction (Fig. 2).Fig. 1.: Peer-to-peer rounding began in November 2015 and continued throughout 2017 with marked improvement in maintenance bundle compliance over time.Fig. 2.: Percent of infiltrates by year: a 30% decrease in the number of moderate/severe infiltrates was noted between 2016 and 2017 with the utilization of a peer-to-peer rounding intervention.Conclusion: Targeted rounding by PIV champions engaged nurses in reducing harm and improving bundle reliability for pediatric patients with a PIV. Through peer-to-peer rounding, nurses heard consistent messages and had opportunities to discuss best practices and conquer barriers. ACKNOWLEDGMENTS The authors thank the peripheral intravenous champions for their hard work and perseverance in decreasing patient harm from peripheral IV infiltrations and extravasations.