Memorial Sloan Kettering Cancer Center, Division of Evidence-Based Practice, New York, NY, USA.
Worldviews Evid Based Nurs. 2020 Oct;17(5):385-392. doi: 10.1111/wvn.12470. Epub 2020 Oct 12.
Intravenous (IV) amiodarone has multiple indications including treatment of hemodynamically unstable patients and the prevention of atrial or ventricular arrhythmias after thoracic surgery. Inflammation of the vein, or phlebitis, is the most common adverse event associated with peripherally administered amiodarone. In 2017, a rise in reported phlebitis incidents was occurring at one large academic medical center.
This evidence-based quality improvement initiative aimed to decrease and enhance early detection of phlebitis in patients receiving amiodarone.
Due to the variation in assessment and management standards, evidence-based practice (EBP) methodology was utilized to establish a process for quality improvement. A thorough literature search was completed, identifying evidence-based interventions to decrease phlebitis and enhance early detection. Thorough critiques of the literature and synthesis of the evidence were completed. Multidisciplinary guidelines based on the literature were created. The guidelines included interventions such as an increase in IV assessment frequency, vein selection criteria, and the utilization of a standardized grading tool for assessment.
Phlebitis was reduced by 30%-88%. In the first 6 months post-intervention, there was a 48% reduction in phlebitis cases. In addition, the severity of phlebitis and the quality of reporting also improved dramatically.
This evidence-based quality improvement process led to identifying relevant knowledge gaps in care that could be streamlined into everyday nursing practice to decrease patient harm. This paper describes an in-depth process of how EBP helped to quickly take a clinical inquiry and adapt change based on findings from the evidence. Other organizations can utilize EBP to solve patient safety concerns using similar processes.
静脉注射（IV）胺碘酮有多种适应证，包括治疗血流动力学不稳定的患者和预防胸外科手术后的房性或室性心律失常。静脉炎（或静脉炎）是与外周给予胺碘酮相关的最常见不良事件。2017 年，一家大型学术医疗中心报告的静脉炎事件有所增加。
本循证质量改进计划旨在减少和加强接受胺碘酮治疗的患者静脉炎的早期发现。
由于评估和管理标准存在差异，因此使用循证实践（EBP）方法为质量改进建立了一个流程。完成了彻底的文献检索，确定了减少静脉炎和加强早期检测的循证干预措施。对文献进行了透彻的批判性评价，并对证据进行了综合。根据文献制定了多学科指南。这些指南包括增加 IV 评估频率、静脉选择标准以及使用标准化评估分级工具等干预措施。
静脉炎减少了 30%-88%。在干预后的头 6 个月，静脉炎病例减少了 48%。此外，静脉炎的严重程度和报告质量也有了显著改善。
这个循证质量改进过程有助于确定护理方面的相关知识差距，这些差距可以纳入日常护理实践中，以减少患者的伤害。本文详细描述了循证如何帮助快速提出临床询问，并根据证据发现进行调整的过程。其他组织可以使用类似的流程，利用循证来解决患者安全问题。
