Value of improved nursing measures and enhanced nursing management to reduce the occurrence of adverse events in pediatric infusion

Abstract

BACKGROUND

Intravenous infusion is a common method of drug administration in clinical practice. Errors in any aspect of the infusion process, from the verification of medical orders, preparation of the drug solution, to infusion by nursing staff, may cause adverse infusion events.

AIM

To analyzed the value of improving nursing measures and enhancing nursing management to reduce the occurrence of adverse events in pediatric infusion.

METHODS

The clinical data of 130 children who received an infusion in the pediatric department of our hospital from May 2020 to May 2021 were analyzed and divided into two groups according to the differences in nursing measures and nursing management: 65 patients in the control group received conventional nursing and nursing management interventions, while 65 patients in the observation group received improved nursing measure interventions and enhanced nursing management. The occurrence of adverse events, compliance of children, satisfaction of children’s families, and complaints regarding the transfusion treatment were recorded in both groups.

RESULTS

The incidence of fluid extravasation and infusion set dislodgement in the observation group were 3.08% and 1.54%, respectively, which were significantly lower than 12.31% and 13.85% in the control group, (P < 0.05), while repeated punctures and medication addition errors in the observation group were 3.08% and 0.00%, respectively, which were lower than 9.23% and 3.08% in the control group, but there was no significant difference (P > 0.05). The compliance rate of children in the observation group was 98.46% (64/65), which was significantly higher than 87.69% (57/65) in the control group, and the satisfaction rate of children’s families was 96.92% (63/65), which was significantly higher than 86.15% (56/65) in the control group (P < 0.05). The observation group did not receive any complaints from the child’s family, whereas the control group received four complaints, two of which were due to the crying of the child caused by repeated punctures, one due to the poor attitude of the nurse, and one due to medication addition errors, with a cumulative complaint rate of 6.15%. The cumulative complaint rate of the observation group was significantly lower than that of the control group (P < 0.05).

CONCLUSION

Improving nursing measures and enhancing nursing management can reduce the incidence of fluid extravasation and infusion set dislodgement in pediatric patients, improve children’s compliance and satisfaction of their families, and reduce family complaints.

Key Words: Improved nursing measures, Improved nursing management, Pediatric infusion, Adverse events, Compliance, Family complaints

Core Tip: This study analyzed the value of improving nursing measures and enhancing nursing management to reduce the occurrence of adverse events in pediatric infusion.Improving nursing measures and enhancing nursing management can reduce the incidence of fluid extravasation and infusion set dislodgement in pediatric patients, improve children’s compliance and satisfaction of their families, and reduce family complaints.

INTRODUCTION

Intravenous infusion is a common method of drug administration in clinical practice. Errors in any aspect of the infusion process, from the verification of medical orders, preparation of the drug solution, to infusion by nursing staff, may cause adverse infusion events[1]. Pediatric infusion rooms have the highest requirements for medical care services. Children are prone to emotional breakdowns, limb twisting, crying, and lack of cooperation during infusion, which not only hinder the work of nursing staff but also lead to accidents such as fluid extravasation and infusion set dislodgement, requiring repeated venipuncture, which in turn aggravates the childrens’ negative emotions. This makes treatment more difficult and leads to increased dissatisfaction of parents with increased complaints, which is not conducive to building a harmonious nurse-patient relationship[2].

Working in this environment is stressful for nursing staff and increases the risk of adverse events such as medication dosing errors. Therefore, the prevention of adverse events should be emphasized in pediatric infusion rooms[3]. Improved nursing measures are a progressive model of care in which problems and deficiencies in existing nursing care are observed, discussed, and appropriate improvement measures are developed to optimize the quality of care[4]. This study analyzed the value of improved nursing measures and enhanced nursing management to reduce the occurrence of adverse events in pediatric infusesion.

MATERIALS AND METHODS

General information

The clinical data of 130 children who underwent infusion in the pediatric department of our hospital between May 2020 and May 2021 were retrospectively selected for analysis, and 65 children aged 8 months to 10 years who received conventional nursing care and nursing management intervention between May 2020 and December 2020 were selected as the control group. The observation group included 65 children aged 7 months to 10 years, who received improved nursing measures and nursing management interventions between January 2021 and May 2020. All children were eligible for infusion. The duration of continuous infusion was > 3 d, and the general characteristics were balanced between the groups (P > 0.05) (Table 1).

Table 1 Comparison of general data between the two groups.

Group	n	Gender, n (%)	Age (mean ± SD)	Infusion time [(mean ± SD), d], χ2	Admission diagnosis disease type, n (%)
		Male /Female			Respiratory diseases	Digestive system diseases	Nervous system disease	Urinary system disease
Control group	65	35 (53.85)/30 (46.15)	6.89 ± 2.12	5.85 ± 1.47	34 (52.31)	23 (35.38)	5 (7.69)	3 (4.62)
Observation group	65	33 (50.77)/32 (49.23)	6.82 ± 2.24	5.92 ± 1.43	32 (49.23)	24 (36.92)	7 (10.77)	2 (3.08)
χ2/t		0.123	0.160	0.241	0.615
P value		0.725	0.873	0.810	0.893

Nursing methods

In the control group, conventional nursing and nursing management interventions were administered, and nursing management was performed by a head nurse. Three checks and seven reviews were performed for nursing care, and aseptic operating procedures were strictly enforced. Parents’ cooperation was obtained during the puncture to prevent the child from crying or struggling. After a successful puncture, the infusion set was connected, the drip rate was adjusted, and the parents were informed of the precautions and asked if any other assistance was needed.

The observation group adopted improved nursing measures to intervene in and enhance nursing management. An improved nursing intervention group consisting of the head and charge nurses was established. Weekly meetings were held to discuss adverse events occurring in pediatric intravenous infusions to improve the risk prevention awareness of the nursing staff. The causes of adverse events were summarized and analyzed to identify gaps in nursing care and propose corresponding improvement measures. The analysis revealed that the occurrence of fluid extravasation, repeated punctures, and infusion set dislodgement were related to poor puncture techniques of nursing staff, uncooperative and agitated children, etc. The proposed improvement measures included the nursing staff checking the label on the infusion bottle with the child’s parents before infusion and confirming that it was correct before performing the intravenous puncture. Before the puncture, nursing staff should have more contact with the child, and small toys and cartoons should be used to divert their attention. If the vessel does not fill well, it should be patted to promote vascular filling and avoid repeated punctures. The child who is crying and agitated should be soothed verbally, and those who appear afraid should be encouraged with words such as ‘You are such a brave boy’, ‘You are awesome’, and parents’ help should also be solicited. After successful puncture, securely fix the needle and strengthen the patrol during infusion to check the needle fixation. When the child is crying and very agitated, explain to the parents and provide bandage fixation or braking after obtaining their consent. It was found that medication addition errors were related to poor risk awareness in nursing staff and failure to strictly implement checking regulations. The improvement measures included: conducting regular legal knowledge training to enhance risk awareness of nursing staff with regular standardized assessment. The outcome of the assessment was related to their performance pay; if the staff failed twice, they were temporarily suspended. They could return to work only after passing the examination.

Observation indicators

The occurrence of adverse infusion events in the two groups was recorded, including liquid extravasation, dosing errors, repeated punctures, infusion set dislodgement, and rapid infusion.

Compliance of the children: A hospital-designed scale was used by nurses to evaluate the children and their families, which covered the assessment of children’s care at the puncture site before, during, and after infusion. The 100-point scale, where a high score indicates high infusion compliance. A score of 90 suggests active compliance, while 70–89 indicates basic compliance, and scores below 70 indicate noncompliance. Scores over 70 were classified as compliance.

Satisfaction of the children’s families: The 100 point hospital-designed scale was filled by the children’s families, covering various aspects such as the nurse’s technique, attitude, and environment, where scores were proportional to satisfaction. A score of 90 and above was considered very satisfied, 70–89 was considered ordinary, and a score below 70 was considered dissatisfied. Scores above 70, were considered satisfactory.

The complaints of both groups were counted and the reasons for the complaints were recorded.

Statistical methods

SPSS 126.0 software was used for processing, and the measurement data conforming to normal distribution by the Kolmogorov-Smirnov test were described by mean ± SD, including infusion time and age, and the t-test was applied for comparison. Count data such as diagnosis on admission and infusion adverse events were described by the number of cases (%) and χ² test was used for comparison. P < 0.05 was considered statistically significant.

RESULTS

Comparison of adverse infusion events

The incidence of fluid extravasation and infusion set dislodgement in the observation group were 3.08% and 1.54%, respectively, which were significantly lower than the 12.31% and 13.85% in the control group (P < 0.05). Repeated punctures and medication addition errors in the observation group were 3.08% and 0.00%, respectively, which were lower than the 9.23% and 3.08% in the control group, but there was no statistically significant difference (P > 0.05) (Table 2).

Table 2 Comparison of adverse infusion events between the two groups.

Group	n	Fluid extravasation		Dosing error		Repeated puncture		Needle falls off
		Number of cases (n)	Incidence (%)	Number of cases (n)	Incidence (%)	Number of cases (n)	Incidence (%)	Number of cases (n)	Incidence (%)
Control group	65	8	12.31	2	3.08	6	9.23	9	13.85
Observation group	65	2	3.08	0	0.00	2	3.08	1	1.54
χ2		3.900		2.031		2.131		0.693
P value		0.048		0.154		0.144		0.008

Comparison of family satisfaction between the two groups

The satisfaction rate of children’s families was 96.92% (63/65), which was significantly higher than 86.15% (56/65) in the control group (P < 0.05) (Table 3).

Table 3 Comparison of family satisfaction between the two groups, n (%).

Group	n	Very satisfied	Generally	Dissatisfied	Satisfaction
Control group	65	30 (46.15)	26 (40.00)	9 (13.85)	56 (86.15)
Observation group	65	46 (70.77)	17 (26.15)	2 (3.08)	63 (96.92)
χ2					4.866
P value					0.027

Comparison of child compliance

The compliance rate of children in the observation group was 98.46% (64/65), which was significantly higher than 87.69% (57/65) in the control group (P < 0.05) (Table 4).

Table 4 Comparison of compliance between the two groups of children, n (%).

Group	n	Active compliance	Basic compliance	N on-compliance	Compliance rate
Control group	65	37 (56.92)	20 (30.77)	8 (12.31)	57 (87.69)
Observation group	65	48 (73.85)	16 (24.62)	1 (1.54)	64 (98.46)
χ2					5.849
P value					0.016

Comparison of nursing complaints

The observation group did not receive any complaints from the children’s families, while the control group received four complaints, two of which were due to the crying of the child caused by repeated punctures, one due to the poor attitude of the nurse, and one due to medication addition errors, with a cumulative complaint rate of 6.15%. The cumulative complaint rate of the observation group was significantly lower than that of the control group (P < 0.05) (Table 5).

Table 5 Comparison of nursing complaints between the two groups.

Group	n	Repeated puncture		The nurse has a bad attitude		Dosing error		Cumulative complaints
		Number of cases (n)	Incidence (%)	Number of cases (n)	Incidence (%)	Number of cases (n)	Incidence (%)	Number of cases (n)	Incidence (%)
Control group	65	2	3.08	1	1.54	1	1.54	4	6.15
Observation group	65	0	0.00	0	0.00	0	0.00	0	0.00
χ2								4.127
P value								0.042

DISCUSSION

Doctor-patient and nurse-patient conflicts in medical institutions in recent years has become increasingly severe, especially in pediatrics, where the complaint rate is often higher than that of other departments. This leads to higher risks and hidden dangers in the infusion process, which may cause a variety of adverse events due to children’s mobility, crying, poor cooperation, and small blood vessels[5]. Therefore, the clinical requirements for medical care in pediatric infusion rooms are high. Improving nursing measures not only reduces adverse nursing events and alleviates the suffering of children but also helps to build a harmonious nurse-patient relationship and maintain the relevant interests of nursing staff[6]. Nursing management is an important guarantee for the quality of nursing work. By establishing an improvement nursing intervention group composed of head nurses and responsible nurses, regular training and case discussions for nursing staff can help improve their risk prevention awareness, identify loopholes in the nursing process, and propose corresponding improvement measures to better enhance the quality of nursing work.

This study found that the incidences of fluid extravasation and infusion set dislodgement were significantly lower in patients who received improved nursing care and enhanced management interventions than in those who received conventional nursing care and nursing management interventions. These results suggest that improving nursing measures and enhancing nursing management can reduce the risk of pediatric infusion fluid extravasation and infusion set dislodgement, thereby reducing pain in children. Because of the active cultivation of love, patience, care, and responsibility of the nursing staff under improved nursing measures and enhanced management interventions, more contact and reassurance were provided to the child before the puncture. In order to get a smooth stick, the cooperation of parents also needs to be enlisted if necessary[7,8]. After a successful puncture, the needle was fixed firmly, the inspection was strengthened, and the parents were informed that the main reason for fluid extravasation, repeated punctures, and dislodgement of the infusion set was the child’s fidgeting. They would pay attention to protecting the needle during infusion or agree to bandage fixation or braking to improve the quality of infusion care[9,10].

This study found that no medication-dosing errors occurred in those who used improved care measures and elevated management interventions; however, there was no statistical difference in the incidence of medication-dosing errors between the two groups. This result suggests that there is no significant advantage to improved care measures and increased management interventions in reducing dosing errors. Medication addition errors are serious nursing errors that may lead to serious adverse reactions and even threaten the life of the child and are a common cause of nurse-patient disputes. Therefore, each department in each medical institution attaches great importance to the “three checks and seven reviews” in the nursing process, so the incidence of medication addition errors is relatively low. Under the improved nursing care and management intervention model, the work is first checked by two nursing staff, parents also participate in and manage the process, and the nursing staff and parents jointly check and confirm the infusion labels. Parents’ active participation plays a supervisory role in eliminating errors[11,12]. In addition, this study found that dosing errors were related to poor risk awareness among nursing staff and failure to strictly enforce checking regulations. Measures such as regular legal knowledge training can enhance the risk awareness of nursing staff, while regular standardized operation assessments can help nursing staff improve risk awareness, which is one of the important methods for reducing the risk of dosing errors to zero[13].

This study found that the child’s compliance and the family satisfaction rates were significantly higher with improved care measures and enhanced management interventions than with conventional care and management interventions, suggesting that these interventions improve children’s compliance and parental satisfaction. This is due to the fact that reassuring and communicating with the children before intravenous infusion can effectively alleviate their fear and resistance. Measures, including giving them small toys and watching cartoons, can divert their attention, improve the one-time completion rate, and avoid the pain caused by repeated punctures. Verbal encouragement and praise are also provided to ensure that the children are more willing to cooperate and the parents are more satisfied[14].

This study also found that no complaints were received from the child’s family when improved care measures and enhanced management interventions were used; four complaints were received when routine care and care management interventions were used, two were caused by crying due to repeated punctures, one due to poor attitude of the nurse, and one due to incorrect dosing by the nurse, for a cumulative complaint rate of 6.15%. This suggests that improving nursing measures and enhancing nursing management can reduce complaints from children’s families. When nursing staff receive regular continuing education and training through improved nursing measures and enhanced management interventions, which can effectively regulate their nursing behavior, improve their professional skills and the quality of their work, improving awareness of risk and prevention and control of possible adverse events will be conducive to reducing nurse-patient conflicts[15].

However, the sample size of this study is only 130 cases, which may cause some bias in the results. And the single source of the sample and the under-representation of the results are also major limitations of this study. In future clinical work, attention should be paid to accumulating large sample studies to further explore the advantages of improving nursing measures and enhancing nursing management in pediatric nursing work.

CONCLUSION

Improving nursing measures and enhancing nursing management can reduce the incidence of fluid extravasation and infusion set dislodgement in pediatric infusions, increase the compliance of children, the satisfaction of their families, and reduce complaints from their families.