P11 Extravasation of drugs in children – an analysis of a voluntary incident reporting system
Authors: Sarah Cowans , Joanna Williams , Chi Huynh , Rhian Isaac 
Published: January 2018

Aim

The aim of this project was to perform an evaluation of the voluntary incident reporting system in place at a tertiary care paediatric hospital, with respect to extravasation injury. This was accomplished by looking at links between events and extravasation risk factors, number of mandatory fields completed within the reports, with respect to hospital guidance and the number of drugs involved in incidents which have a monograph in the local Injectable Medicine Guide with an extravasation risk rating.

Method

A retrospective review was carried out on anonymised extravasation IR1 reports completed across all medical specialities between 1 st January 2015 and 31 st December 2016. All patients across all medical specialities were eligible for inclusion. A standardised data collection form was used to collect date of incident, time of incident, drug involved and its concentration, area of injury, location of injury, type of access, type of line, treatment given, clinical outcome, level of harm, if aspiration was attempted, if medical staff were informed, was the nurse in charge informed, was the cannula left in situ, was it referred to Plastics, when did Plastics review it and what did they advise and was the area marked out. The Injectable Medicine Guide was used to find the corresponding drug monographs. The data was then analysed using IBM SPSS Statistics 23.

Results

347 extravasation incident reports were included in the evaluation, representing 3.05% of IR1s submitted over the study period. 90.2% of injuries involved use of peripheral access and 23.1% of injuries occurred within Paediatric Intensive Care (PICU). The most common location of injury was the hand (33.2%). The top three drugs involved were IV fluids (saline and dextrose), IV fluids (saline, dextrose and potassium) and aciclovir, collectively representing 19.6% of reports. None of the 347 reports contained all eight factors which are required to be documented according to hospital policy. The percentage of each factor completed ranged from 100% for date and type of access, to 10.4% for area of injury. The median number of fields completed was 4, with an interquartile range of 2.

61 out of 347 reports (17.6%) involved drugs which had an explicit extravasation risk rating in the Injectable Medicine Guide (24 different drugs). A further 19 cases had a partial risk rating and involved one further drug not found in the 61 reports. Of the 80 reports with a risk rating, 30 were rated red for at least one risk factor therefore should have been given centrally if possible. 267 reports involved drugs with no extravasation risk rating (27 different drugs).

Conclusion

Voluntary reports for extravasation injuries are completed, however not all information is being recorded. Factors contributing to this may include formatting of the reporting form, staff attitudes to reporting and lack of knowledge on what to include in the reports. The hospital extravasation group is being reconvened and will be able to prioritise completion of missing drug monographs for the Injectable Medicine Guide and update current monographs to contain an extravasation risk rating.