Improving Pediatric Vascular Access on Nights and Weekends in a Children’s Hospital: A Pilot Quality Improvement Project

Purpose/Objectives: The ability to provide peripheral intravenous vascular (PIV) access in an efficient and patient-focused manner is key in a children’s hospital. PIV access is often necessary as standard of care treatment for the management of pediatric patients. Our institution does not have a standardized protocol for difficult PIV placement during the hours of 7PM-7AM and on weekends. This has created obstaclesin the process of obtaining PIV access as demonstrated by delays in administering medications and multiple attempts for access.We aimed to increase the percentage of successful PIV placement in 2 or less attempts from 48% to 70% over a 4-month period.

Design/Methods: This is a single center interprofessional quality improvement collaborative project. Our process measure studied vascular access attempts during weekdays 7PM-7AM & weekends. Our measurement was defined as the number of patients with IV placement in 2 or less attempts divided by the total number pediatric patients referred to after-hours expert clinician per week. Data collection completed by daily data sheets & EMR documentation. Interventions completed included incorporation of vascular access plan discussion during resident sign out, creation of a best practice information sheet, and creation of a calendar of available expert clinicians. Baseline median was obtained, and data analyzed for shifts and trends using a run chart.

Results: 26 patients were referred to an after-hours expert clinician for PIV placement. The average number of PIV escalation referrals per week was 2. Following interventions, the median weekly success rate by the after-hours clinical team member was 100%.

Conclusion/Discussion: After implementation of multiple interventions, required escalations were performed efficiently, communication between caregivers was improved, and our structured escalation plan revised. This project highlighted best practice for escalation and ensured high quality communication between caregivers.