Measures Against Phlebitis: A Dmaic Methodological Analysis

Purpose: From July 2016 to June 2017, St. Luke's Medical Center-Global City has a total of 12 cases (2 incidences per month) of phlebitis/ thrombophlebitis on non-risk patients at the Emergency Care Services (ECS) which resulted to the following: readmission in the ECS; service recovery; infusion-related complications to the patient (e.g. pain on IV site, Inability/ limited movement of affected part, nerve injury). The goal of the study is to lower the monthly incidence rate of phlebitis/thrombophlebitis on non-risk patients from 2 per month to 1 per month in July to August 2017. It also aims to determine the causes of concerns related to phlebitis/thrombophlebitis and to lower its occurrence and re-admission of patients to Emergency Care Services; to improve the safety of the patient and patient care satisfaction; and to prevent possible litigation.

Methods: The study utilizes the sequential multi-stage DMAIC (Define, Measure, Analyze, Improve, and Control) Methodology. There were 36,360 intravenous insertion opportunities that were measured and yielded a Six Sigma score of 5.31. A Root Cause Analysis was done and tabulated against an Impact vs Control and Prioritization matrices, which revealed that Proton Pump Inhibitors, antibiotics, intravenous COX-2 Inhibitors, and particular pain medications (Paracetamol and Tramadol) have been noted to frequently produce phlebitis to patients apart from other causes such as various infusion practices and deviation from protocol. Furthermore, data showed that most of the solutions prioritized were gearing towards standardization of infusion practices in the ECS such as saline flushing, rate of administration, and compliance to infection control practices. With this, an Infusion Bundle was developed in collaboration with the Medical Practice and Supply Chain Groups: 1. IV Start Kit; 2. IV Administration Kit; 3. Health Education Script; and 4. IV Insertion Bundle Checklist.

Results: After the implementation of the bundle from June 2017 to August 2018 (15 months) with 38,250 intravenous insertion opportunities, there has been a decrease in the incidences of phlebitis to 2 with a rate of 0-1 per month, which yielded a Six Sigma score of 5.75.

For the clinical outcome, the bundle has significantly decreased incidences of phlebitis in the ECS. Issues related to this complication have been prevented as the measures are employed. For financial viability, the hospital incurred savings in service recovery for phlebitis treatment of Php 56,000 excluding surgery and other diagnostics which may be higher. Also, it created savings in its creation of a new bundle kit through a decrease in its unit cost, but still utilizing the same selling price.

Conclusion: The Infusion Bundle against Phlebitis improved the infusion process in the emergency Care Services, which created an exemplary impact on operations, clinical outcomes, and financial viability.