Authors (including presenting author) :
Wong KY (1)(2)
Affiliation :
(1) Department of Surgery, (2) Princess Margaret Hospital
Introduction :
IV access is commonly utilised in surgical settings for multiple purposes. Nonetheless, improper IV access care could lead to severe or even life-threatening complications. This CQI project aims to mitigate these risks by implementing a comprehensive care strategy encapsulated in the acronym “ P.A.T.I.E.N.T”, which stands for “Patency”,“Accurate assessment”, “Transparent dressing”, “Indication”, “Early removal of idle IV access”, “Number of IV access”and “Treatment if indicated”.
Objectives :
1)To enhance the quality of IV access care; 2) To foster staff competency on managing phlebitis; 3) To prevent life-threatening complications resulted from drip site infection
Methodology :
A pilot trial was commenced in one surgical ward in July 2024 and was then fully implemented across the department by August 2024. An ongoing review process ensures continuous improvement base on staff feedback and ICN policy changes.
Five key aspects underpin the CQI project initiative: environmental changes, behavioural changes, accurate documentation, audit and monitoring as well as education.
Environmental changes focus on arousing staff awareness on signs of phlebitis and appropriate IV access care. A newly-designed E-poster promoting the concept of “P.A.T.I.E.N.T” and the VIP (Visual Infusion Phlebitis) score has been applied in iPAD Lock Screen and wallpaper as assistive tools for promulgation.
Behavioural changes aims to reinforce ward inspection and developed an IV access table to facilitate staff handover.
Accurate documentation facilitated by template documentation easily accessible via mobile “My HR App”.
Audit and monitoring involves engaging junior nursing staff as monthly PVC auditor to ensure proper IV access care in sustainable manner.
Education targets both nurses and family members. Apart from PVC bundle of care and case review, daily Chlorhexidine bathing for patient with central venous catheter as evidenced by research articles would be reinforced.
Result & Outcome :
1)The overall PVC care compliance improved with up to >90% in December 2024
2) 21% of improvement on PVC documentation accuracy was noted: from 63% to 84%
3) 96% of staff self-reported with enhanced awareness and competency on nursing management to patient with signs of phlebitis after execution of this improvement plan
Conclusively, the holistic approach project could effectively cultivate the culture of staying vigilance on up-to-standard IV access care, thereby could improve outcomes in surgical department in long run.
