(1225) Health System Policy Implementation for Prevention and Management of Infiltration and Extravasation

Introduction: Infiltration and extravasation of irritants and vesicants is a serious adverse event that may result in loss of limb and require surgical intervention. National nursing organization standards recommend establishing guidelines for prevention and treatment of infiltration and extravasation in organizational policies.

Methods: The objective of this study was to describe the process for a six-hospital health-system to develop and implement a health-system policy to provide clear, evidence-based guidance for interdisciplinary staff regarding prevention, early identification, and rapid treatment of infiltration and extravasation to reduce patient harm and standardize delivery of high-quality care. A logical framework was developed to determine associated process and outcome measures and increase likelihood of success. Process measures included dedicated pharmacist resources, interdisciplinary stakeholder identification, literature search to develop evidence-based list of vesicants and irritants with recommended infiltration/extravasation management, development of educational materials, and electronic health record (EHR) optimization.

Results: After stakeholder identification and workgroup formation, an evidence-based, alphabetical, and color-coded list of 157 irritant and vesicant medications was developed based on review of the literature and current institutional policies. Concise, step-by-step algorithms were created to provide clear guidance for staff to reduce time to treatment and minimize complications. Short-term outcomes were successful based on institutional implementation of a health-system policy. To ensure the policy remains evidence-based, literature and policy review will occur at least triennially and new irritant and vesicant medication formulary additions will be added to the policy.

Conclusions: Infiltration and extravasation are serious adverse events requiring organizational policies for prevention, early detection, and rapid treatment. Use of a logical framework supported development of a unified health-system policy. Comprehensive literature review, stakeholder engagement, and systems changes were key to successful policy development and implementation.