Leveraging Technology to Improve the Surveillance of Intravenous Infiltrations

Abstract

Problem & Purpose: Peripheral intravenous (PIV) catheters have a high failure rate, with infiltrations accounting for 24% of all failures. Hospitals largely rely on voluntary incident reports (VIR) to track these events, leading to poor organizational surveillance. A Mid-Atlantic Metropolitan hospital relied on VIR to track PIV infiltration events. In a four-week period, zero PIV infiltration VIR were submitted, creating concern for the reliability of VIR as a surveillance tool and the underreporting of these events by nursing. This quality improvement (QI) project aimed to capture the true frequency of PIV infiltration through a new surveillance process and to identify perceived barriers to incident reporting among nurses. Methods: An electronic health record (EHR) based report was developed, utilizing data mining in the EHR to identify PIV infiltrations. Data was collected on the aggregate number of infiltrations identified in each system and compared weekly over 14 weeks. Additionally, an online survey was distributed to inpatient nurses to assess perceived barriers to infiltration reporting. These results were used to tailor an educational module presented to nurses from each nursing unit. Results: The EHR report identified significantly more PIV infiltrations than the VIR system (p< 0.001). The EHR identified 353 infiltrations, compared to 3 identified through VIR. The percent infiltrations reported in the VIR system was 6% or less each week. The nursing survey identified knowledge deficits, staffing challenges, and time constraints as common barriers to VIR of PIV infiltrations. Conclusions: Implementing an EHR report to identify PIV infiltrations is a feasible intervention and provides more accurate surveillance than VIR. Despite nurse knowledge of VIR and the utility of reporting infiltrates, VIR alone is not a reliable surveillance tool. Use of the EHR report as a new surveillance method for PIV infiltrations should be continued. More efforts should be made to increase nurse engagement in VIR, and hospital policies should clearly identify reporting criteria for PIV complications.