Background There was a significant increase in intravenous (IV) infiltration in the month of March 2016 in the Pediatric Emergency Department - KASCH. The Acute Care team noted an increase in IV-related incidence and there were 30 generated safety reporting system (SRS) reports from January to March 2016. This prompted the unit leaders to create a taskforce in order to review the causes and the factors leading to incidence and causing patient harm.

Methods Using the PDSA (plan-do-study-act) quality model, the quality improvement team collected data generated through the SRS on IV infiltration/extravasation. The reports were analyzed as to the causes and harm of the incident. Using a cause and effect diagram, the team identified the root causes as non-adherence to the insertion and sterility technique, staff competency on IV insertion and monitoring, type of dressing used, lighting, and lack of guidelines to support the practice. In order to draw a reliable conclusion, several PDSA cycles were tested and implemented: (1) data collection and audit tool design; (2) staff education and standardized documentation; (3) formulation of the escalation process and guidelines; and (4) continuous monitoring and auditing of IV infiltration/extravasation and regular reporting to the daily key performance indicator (KPI).

Results For the initial throughput of the project, the IV Watchers on the Move Team noted a marked decrease in infiltration in August 2018 as evidenced by the nurses’ compliance in IV infiltration prevention strategies - i.e., (1) hourly IV site checks, (2) mandatory use of smart pumps, and (3) timely and accurate documentation of IV assessment.

Conclusion The IV Watchers on the Move QI Project was able to design a mechanism to reduce the potential harm caused by infiltration. Part of the intervention was the hourly assessment and early recognition of impending infiltration. Nurses were instructed to be cautious when administering highly concentrated medications. With all of the efforts and initiative shown throughout, the pediatric patients benefited from the successful interventions that finally led to the safe delivery of nursing care.