Improving Peripheral Cannula Safety in Older People’s Medicine Through Ward-Round and Safety-Huddle Review

Introduction

Peripheral venous cannulas are invasive devices associated with phlebitis, local infection and bloodstream infection. Older people may be vulnerable because of frailty and multimorbidity. Safe cannula care requires reliable documentation, Visual Infusion Phlebitis (VIP) monitoring and reassessment of clinical need. This audit evaluated whether embedding cannula review into ward processes could improve safety on an older people’s medicine ward at St James’s University Hospital, Leeds.

Methods

A two-cycle clinical audit was undertaken in October 2025. Cycle 1 reviewed 39 inpatients from 07/10/2025 to 11/10/2025. Data included cannula presence, documentation, daily VIP score completion and clinical indication. The intervention incorporated cannula review into ward rounds and safety huddles, prompting assessment of cannula condition, documentation, VIP monitoring and ongoing need, with removal requested where no valid indication remained. Cycle 2 reviewed 36 inpatients from 18/10/2025 to 22/10/2025 using identical criteria.

Results

In cycle 1, 16/39 patients had a cannula in situ; 7/16 had complete documentation and 3/16 had a daily VIP score documented. Six of 16 lacked a valid ongoing indication. Following intervention, 13/36 patients had a cannula. Documentation improved to 12/13 (Fisher’s exact p=0.008) and daily VIP scoring to 12/13 (p<0.001). There was no significant change in cannulas without valid indication: 6/16 (37.5%) versus 5/13 (38.5%; p=1.00). In two cycle-2 cases, removal had been requested but the cannula remained in situ.

Conclusions

Embedding cannula review into ward rounds and safety huddles significantly improved documentation and VIP monitoring. However, sustained improvement may depend on continued prompting by motivated individuals and may be vulnerable to staff rotation and changing ward teams. Embedding cannula review into routine safety-huddle processes, with clear multidisciplinary task ownership and confirmation of removal, may reduce reliance on individual champions. Re-audit is recommended to assess whether improvements are sustained across staff rotations.