Reducing the Incidence of Amiodarone‐related Phlebitis Through Utilization of Evidence‐based Practice

Abstract

Background: Intravenous (IV) amiodarone has multiple indications including treatment of hemodynamically unstable patients and the prevention of atrial or ventricular arrhythmias after thoracic surgery. Inflammation of the vein, or phlebitis, is the most common adverse event associated with peripherally administered amiodarone. In 2017, a rise in reported phlebitis incidents was occurring at one large academic medical center. Aim: This evidence-based quality improvement initiative aimed to decrease and enhance early detection of phlebitis in patients receiving amiodarone. Methods: Due to the variation in assessment and management standards, evidence-based practice (EBP) methodology was utilized to establish a process for quality improvement. A thorough literature search was completed, identifying evidence-based interventions to decrease phlebitis and enhance early detection. Thorough critiques of the literature and synthesis of the evidence were completed. Multidisciplinary guidelines based on the literature were created. The guidelines included interventions such as an increase in IV assessment frequency, vein selection criteria, and the utilization of a standardized grading tool for assessment. Results: Phlebitis was reduced by 30%-88%. In the first 6 months post-intervention, there was a 48% reduction in phlebitis cases. In addition, the severity of phlebitis and the quality of reporting also improved dramatically. Linking Evidence to Action: This evidence-based quality improvement process led to identifying relevant knowledge gaps in care that could be streamlined into everyday nursing practice to decrease patient harm. This paper describes an in-depth process of how EBP helped to quickly take a clinical inquiry and adapt change based on findings from the evidence. Other organizations can utilize EBP to solve patient safety concerns using similar processes.

Effect of the Kanghuier Transparent Hydrocolloid Dressing in Preventing Central Venous Catheter Infection and Phlebitis after Cardiac Surgery

“…However, it has been found in clinical practice that although these methods can reduce the incidence of infection and promote patient recovery to a certain extent, the procedures are difficult with high requirements for nursing staff and slow effects. Moreover, these methods limit the patients' range of motion and reduce their nursing comfort [12].…”

The incidence of phlebitis development of high concentration of continuous amiodarone infusion with in-line filter compared to the low concentration without in-line filter: a retrospective propensity score-matched analysis

“…The risk factors of AIP include high drug concentration, longer infusion time, lower infusion rate, and higher total accumulative dose [7]. The current recommendation from several consensuses suggests the use of a lower concentration of amiodarone, application of the in-line filter, and using central venous infusion [10]. Studies reported that an amiodarone concentration of 1.2 mg/ml resulted in a significantly lower rate of phlebitis than an amiodarone concentration of 1.8 mg/ml [5,11].…”

“…In addition, an integrated team approach with multidisciplinary healthcare providers for close monitoring of AIP development in amiodarone infusion cases, as well as hospital intravenous fluid team, were among the recommendation for AIP prevention [3,10]. However, these modalities are difficult to fulfill in some situations, for example, in an emergency setting where central venous catheterization is not suitable, and in fluid-restricted patients that could not tolerate the large volume of intravenous infusion.…”

Demonstrating the Value of the Clinical Nurse Specialist

“…Compiling the data from these logs will provide a visual representation of work effort that would otherwise not be captured in the medical record. 13 Both methods provide a way to identify themes and extrapolate data reflective of an extended period. Team-level data can be presented by summarizing the data from the individual level portfolios or consultation logs and disseminated via infographics, annual reports, team-level portfolios, or other communication methods that elevate the visibility.…”

“…Consultation logs can be used to track indirect (nonpatient) consultations with nurses or other healthcare team members over the course of a shift. Compiling the data from these logs will provide a visual representation of work effort that would otherwise not be captured in the medical record 13 . Both methods provide a way to identify themes and extrapolate data reflective of an extended period.…”