VIP score quality improvement project
Abstract:
Introduction: The VIP (visual infusion phlebitis) score was introduced to monitor cannulation for early signs of phlebitis. This is an avoidable morbidity of hospital inpatients risking cellulitis and potentially increasing length of stay. Nevertheless, a tool is only as effective as the hand that wields it. This quality improvement project aimed to improve VIP score documentation and reduce the rate of inpatient phlebitis.
Method: Baseline measurements of VIP documentation, subjective VIP score, cannulation dates and non-flushing cannulas were recorded over the 3 surgical wards at a district general hospital. This was followed by 2 Plan-Do-Study-Act (PDSA) cycles. In PDSA 1, baseline measurements were displayed in an eye-catching poster and dispensed evenly amongst the wards. For PDSA 2 face-to-face teaching sessions were delivered to clinical teams highlighting both the importance of the VIP score and its documentation.
Results: At baseline, 26% cannulas had appropriate VIP score documentation and 6.5% cannulas had VIP score >2 indicating early phlebitis signs. With implementation of PDSA 1, this rose to 43.8% documentation and reduction to 2.3% early phlebitis. After PDSA 2 education sessions, VIP documentation reached 91.5% and early phlebitis rate was 2.1%.
Conclusions: This QIP has successfully reduced early phlebitis rate in this patient population to 2.1%, which is now in-keeping with CDC guidance of <5%. In addition, there was a 65.5% improvement in documentation of VIP score demonstrating increased application of the tool in clinical practice. These results are replicable and necessary to improve patient care in both surgical and medical wards.
Reference:
C O’Donnell, A Fardanesh, O Bakare, A Spiteri, L Dewan, A Rohatgi, 544 The VIP QIP – Reducing the Rate of Inpatient Phlebitis, British Journal of Surgery, Volume 111, Issue Supplement_6, July 2024, znae163.244, https://doi.org/10.1093/bjs/znae163.244.