Falls/Injury fall rates

Mission of Project: To decrease the incidence of peripheral IV infiltration on 6 West medical unit at Axon Medical Center.

Problem:

• Internal evidence (data) shows that the peripheral IV (PIV) infiltration rate has increased 50% during the pandemic from pre-pandemic levels on 6 West Medical. There have been several major patient injuries that have resulted in patient’s having to have tissue debridement and skin grafts due to tissue necrosis. During the pandemic, March 2020 to present, there has been an increased rate of PIV infiltration. In the first quarter the 50 patients had PIV infiltrations, five of those caused emergent and long-term injuries to patients. PIV infiltrations rates hospital wide are 10% or less. This is aligned with national benchmarks of an PIV infiltration rate of 3.5%. The rate on 6 West medical is currently at 30% and has decreased post pandemic from 40%. To address the PIV infiltration rate on 6 West Medical, our team is proposing the development of a best practice advisory (BPA) in the EPIC EHR for medications that are delivered via PIV that have a high chance to cause tissue damage and necrosis if extravasation occurs. When these medications are ordered there will be an automatic order for every hour PIV site assessments while these medications are being administered. There will also be an associated documentation of the assessments in the flow sheet in the EHR.

Justification:

·        PIV infiltrations can be extremely uncomfortable and painful for patients. They can also cause severe tissue damage and death that will need to be treated medically and/or surgically to correct. There is also the possibility of infections, nerve damage, and loss of extremity functions. Therefore, we are proposing that a BPA be implemented in the EPIC EHR to ensure hourly PIV site checks are performed and documented when high-risk medications are infusing. BPAs have been found to affect clinician practice patterns.

Project Objectives (Scope Definition):

·         Decrease PIV infiltration rates by 50%, the current rate is 30%, so we would like to achieve a PIV infiltration rated of 15% 6 months post BPA implementation.

Estimated Costs and Funding:

1. The development of the BPA by in house analyst– 10 hours by the Clinical Informatics Analyst (~$500).

1. Monitoring of the BPA post implementation by clinical nurse II – 8 hours per month (~$320).

1. Random observation audits of PIV site assessments by clinical nurse II – 8 hours per month ($320).

1. Training of the new BPA to 6 West nursing staff by clinical nurse III – 10 hours per month (~400).

Measures of Success:

• The PIV BPA will be triggered 100% each time one of the high-risk medications is ordered by the provider upon implementation.
• Observation audits of hourly assessments will be completed by an independent reviewer and nurses will be witnessed assessing the PIV sites hourly when high-risk medications are infusing 100% of the time upon implementation of the BPA.
• The documentation of the hourly site assessments on the EHR flowsheet will be 100% 1 month after implementation.
• Nurses will complete an incident report 100% of the time there is PIV infiltration.
• PIV infiltrations will be reported immediately (within 30 minutes) 100 % of the time to the IV Team for further evaluation upon implementation.

Key Stakeholders:

1. Project lead
2. Project team members
3. Nurses of 6 West Medical
4. Providers of 6 West Medical
5. Patients and families of 6 West Medical
6. IV team
7. Risk management team
8. Charge nurses of 6 West Medical
9. Nurse managers and directors of 6 West Medical
10. Clinical systems analyst

Milestones and Estimated Dates:

The BPA implementation is estimated to completed over a 7 -month period beginning in November 2022 and concluding in May 2023.

Key Milestone and Estimated Dates are listed below:

• Nov/Dec 2022 – Design and build of the PIV BPA is developed in conjunction with the clinical system analyst.

• Jan/Feb 2023 – Functional and integrated end-user testing of the BPA is completed.

• March 2023 – 6 West nurses and providers are trained on the new BPA

• April 2023 – BPA is turned on in live system for 6 West patients.

• May 2023 – Post project evaluation of project objective and measures conducted, revisions needed are completed, and project is closed.

Risks:

• The BPA may be more technically challenging to create than initially anticipated and may require more time develop.
• Nurse may find hourly PIV site assessments excessive.
• Nurses may not have time to document hourly PIV site assessments.
• PIV infiltration rates will not decrease.

Assumptions:

• There is a fully functioning and integrated EHR that has the structure to support BPAs.
• There is an in-house clinical information systems analyst that will be able to assist with design, build, and implementation of BPA.
• The proposed project has the support of unit management and nursing staff.

Constraints:

• Axon Medical Center is currently experiencing nursing staff shortages.
• Axon Medical Center is currently preparing for an accreditation.
• 6 West Medical has a small budget to complete the project.