Background/problem Extravasation injuries are a recognised cause of avoidable harm. Baseline data collection identified 35 such injuries to children in our hospital in 2014. In addition to the adverse effect on patients and the distress to their families and staff involved, several of these injuries resulted in litigation proceedings. Litigation resulted in £170 00 paid out in 2014.
Aims Reduce harm caused by extravasation in children by half within two years.
Methods A multi-disciplinary continuous improvement approach was adopted. The first task was to map the process for extravasation occurrence and identify where improvements could be made. Potential improvements were identified in a number of domains including systems, equipment, human interaction and education. Concurrent plan, do, study, act (PDSA) cycles were undertaken to address the areas identified. Interventions included: working with theatre staff to change dressing practice, improving awareness of high-risk drugs, education on training days including IV study days, mandatory training and doctor’s induction, standardisation of management of extravasation injury and regular MDT in-situ simulations.
Results/measures Number of extravasations have reduced from 3/ year to 6 in 6 months:
Measures collected include of the number of extravasations requiring: irrigation, observation only, plastic surgery input or financial payout occurred. The education based improvement programme was fully implemented mid 2015.
Furthermore, no cases have occurred which required plastic surgery input. We understand there were no payouts in the last year for litigation (awaiting final confirmation).
Lessons for practice We believe this example shows how utilising a multi-disciplinary team approach to improvement can result in considerable success. Embedding classroom and IT based skills and knowledge acquisition alongside an in-situ simulation programme has aided the success. Standardisation of process and practice has ensured all staff know what should occur and members of the team are able to aid those less familiar.
We plan to adopt similar methods for improvement in other areas.
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