Page 43 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
PP-05

Reducing the High Incidence of Phlebitis among Children in General Paediatric Ward
Hospital Pulau Pinang

Lim VL, Geraldine C, Sivamaghesvari S, Ling KL, Statila MD, Fazliana AW
Paediatric Department, Hospital Pulau Pinang, Pulau Pinang

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Cannula insertion is the commonest procedure in a general paediatric ward. Data from January 2019 showed
that 8% of hospitalised children in our ward developed phlebitis. Children with phlebitis endured pain and
prolonged hospitalisation with additional antibiotic use, thus incurring additional costs to the Ministry of
Health (MOH).

KEY MEASURES FOR IMPROVEMENT:
This project aimed to reduce the incidence of phlebitis to ≤2.5%. Phlebitis is determined by Visual Infusion
Phlebitis (VIP) score of ≥2 among hospitalised children.

PROCESS OF GATHERING INFORMATION:
A quality improvement study of 3 phases (1 pre-remedial and 2 cycles post-remedial) was carried out in
December 2019-February 2021. Patients requiring cannulation within the first seven days of admission were
included. Daily scoring of VIP charts was used to determine the incidence of phlebitis, observational checklists
to evaluate cannula care and cannula anchoring and stabilising techniques and a questionnaire to assess
caregivers’ awareness of phlebitis.

ANALYSIS AND INTERPRETATION:
The pre-remedial phase of phlebitis incidence was 8.8%. Shortfalls include inappropriate anchoring and
stabilising of cannula (60%) and non-compliance to aseptic technique (50%). Only 16.7% of parents were
aware of cannula care, 27.3 % of nurses complied with standard cannula care and 30% used the VIPS chart.

STRATEGIES FOR CHANGE:
A standardised way of anchoring with new anchoring material (tubular fixator) was introduced to ensure
visibility of the insertion point. Monthly house officers’ teaching was organised on the aseptic cannulation
technique. Cannula care also became a compulsory topic during nurses’ CNE teaching. Parents were educated
upon ward orientation on cannula care and reminded via posters.

EFFECT OF CHANGE:
Post-remedial, the incidence of phlebitis reduced from 8.8% to 1.2%. Contributory factors were improved as
compared to the pre-remedial phase; parents’ empowerment (6.7% to 70%), early detection (30% to 100%) and
new anchoring material with compliance to the aseptic technique (50% to 75%).

THE NEXT STEP:
We aim to share these strategies with other hospitals and perform a regular audit cycle to ensure sustainability.

39