Children's Health Children's Medical Center, TX, USA.
Children's Health Children's Medical Center, TX, USA.
J Pediatr Nurs. 2021 Nov-Dec;61:59-66. doi: 10.1016/j.pedn.2021.03.009. Epub 2021 Mar 23.
Pediatric patients are at high risk for peripheral intravenous infiltrations and extravasations (PIVIE) resulting in patient harm. Structured hourly rounding has demonstrated to improve quality outcomes. The purpose of this quality improvement project was to implement structured hourly rounding to decrease the median rate of moderate PIVIE rates from 3.13 to 2.58 per thousand patient days over a 6-month time period in pediatric patients with infusing continuous IV fluids.
A pilot was conducted to hardwire hourly assessments for peripheral intravenous lines (PIV) in pediatric patients with continuous fluids utilizing a structured hourly rounding process. Bedside nurses utilized the P.A.T.H. model to assess pain management (P), assess PIVs for early PIVIE recognition (A), address things patient and family may need (T), and reduce the occurrence in hospital acquired conditions (H). Data was collected on unit nurse sensitive indicators and compliance to hourly rounding.
Structured hourly rounding using the P.A.T.H. model successfully hardwired hourly PIV assessments. The unit reduced their median moderate PIVIE rate to 1.83 per thousand patient days, an 41% improvement. The pilot also had positive unintended consequences of improved pain reassessment from 67% to 100%, increased patient satisfaction scores of 67% to 97% and reduced patient falls by 29%.
Structured hourly rounding using the P.A.T.H. model can positively hardwire hourly PIV assessments in pediatric patients.
Sustainability of hourly rounding requires leadership support and nursing commitment to impact quality metrics. Organizations should consider implementing focused hourly rounding to address PIVIEs.
儿科患者外周静脉输液渗出和外渗（PIVIE）的风险较高，导致患者受到伤害。有研究表明，定时巡视可以改善护理质量。本质量改进项目旨在实施定时巡视，以在 6 个月的时间内，将接受持续静脉输液的儿科患者中度 PIVIE 发生率从每千患者日 3.13 例降低至 2.58 例。
在儿科持续输液患者中，采用结构化定时巡视流程，对周围静脉置管（PIV）进行每小时评估，开展了一项试点。床边护士使用 P.A.T.H. 模型评估疼痛管理（P）、早期识别 PIVIE（A）、解决患者和家属的需求（T），以及减少医院获得性疾病（H）。收集了单元护士敏感指标和定时巡视依从性的数据。
使用 P.A.T.H. 模型的结构化定时巡视成功地实现了每小时 PIV 评估。该单元将中度 PIVIE 发生率的中位数从每千患者日 1.83 例降低到 41%，改善了 41%。该试点还产生了积极的意外后果，疼痛再评估从 67%提高到 100%，患者满意度从 67%提高到 97%，患者跌倒率降低了 29%。
使用 P.A.T.H. 模型的结构化定时巡视可以有效地对儿科患者进行每小时 PIV 评估。
定时巡视的可持续性需要领导层的支持和护理人员的承诺，以影响质量指标。各组织应考虑实施有针对性的定时巡视，以解决 PIVIE 问题。
