Peripheral Intravenous (PIV) access is the less invasive treatment of choice for Miami Children’s Hospital (MCH) patients when drug therapy for antibiotics is required. One of the risks involved with the use of PIV therapy is the potential to develop an infiltration that leads to serious health complications. To minimize the risk of infiltration, proper care and awareness of infiltration degree is necessary. Monthly monitoring of MCH’s quality indicators for IV infiltrations determined that its rates for infiltration were 11 percent greater than the national benchmark. A multi-disciplinary task force came together to identify performance or process gaps that led to this high rate of infiltrations. Among the gaps identified were staff’s perception on how to properly assess PIV sites, staff’s ability to recognize complications, and the use of a grading scale that was not specific to the pediatric population.
As a result of the gap analysis, the multi-disciplinary task force developed the Miami Amjad (M-A) Scale that was piloted and validated through research by a pediatric physician group that specializes in wound care.
Program Details
Prior to the scale implementation, more than 800 nurses were trained on how to properly care for PIVs and how to identify infiltrations based on the new scale. Part of this training initiative included:
- The development of visual aids in each patient care area
- Badge buddies disseminated to each patient care provider to use as a reference at the bedside
- The new scale was integrated into MCH’s electronic health record system to classify infiltrations and to automatically guide the staff on which treatment is required.
In addition to the training provided to the staff, MCH partnered with patients and families to actively engage in the care process. As such, a “Hand in Hand, Together We Can” campaign was created to educate families on prevention tips and empower them to be a part of their child’s care. An educational pamphlet was included in the admission packets and a just-in-time video was streamed on the patient TV channel prior to any first time PIV start on a child.
To sustain this initiative, a self-paced online module was created to use as a just-in-time intervention that can be accessed via desktop computer, iPad, or any mobile device. The module is intended as a reference tool to reinforce hands-on practice on the unit, as well as to educate all new clinical nurse hires. In addition, weekly audits have contributed to reinforcement of learning.
Results
Prior to the implementation of training, MCH’s severe infiltration rate was 1.58. This meant serious implications for the child impacted by the infiltration. Since training inception in July 2013, zero severe infiltrations have been documented. Weekly monitoring reports 91 percent compliance with basic preventive and management practices, including the use of standardized taping and standardized treatment. This MCH initiative has sparked interest among top children’s hospitals and has been presented for nationwide implementation in pediatric institutions.
