Improving Peripheral Cannula Safety through Enhanced VIP Score Documentation and Timely Removal

Background: Peripheral intravenous cannulas (PIVCs) carry significant risks of phlebitis and hospital-acquired bacteraemia, particularly in elderly patients. Royal Berkshire Hospital trust policy CG321 recommends daily review, VIP (visual infusion phlebitis) scoring, and removal within 72 hours unless extended to 96 hours with documented senior justification. This QIP aimed to improve PIVC documentation, review, and timely removal across two acute geriatric wards.

Methods: Baseline data were collected on Ward A (general geriatrics, n=8) and Ward B (orthogeriatrics, n=11) in March 2026, with a 72-hour re-audit assessing baseline PIVCs only. A staff survey (n=18) assessed knowledge of PIVC care and VIP scoring; 89% identified a need for further training. 

PDSA Cycle 1 (April 2026) delivered multi-modal education via nursing safety huddle teaching and microbiology teaching on bacteraemia prevention. 

PDSA Cycle 2 (June 2026) deployed "Record, Review, Remove" mini posters across nursing stations and mobile workstations to standardise Electronic Patient Record (EPR) logging, promote daily VIP scoring, emphasise removal within 72 hours and discourage primary antecubital fossa (ACF) placement.

Results: Post-PDSA 1, both wards demonstrated improved insertion (+14–15%) and removal (+15–16%) EPR documentation, alongside increased 72-hour removal compliance (+13–17%). Post-PDSA 2 revealed divergence: Ward A (general geriatric ward) achieved 100% compliance across VIP scoring, EPR insertion/removal documentation, and physical date stickers, alongside an 83% 72-hour removal rate. Conversely, Ward B (orthogeriatric ward) stagnated (13% 72-hour removal rate; 38% insertion, 25% removal, and 63% VIP compliance). Primary ACF cannulation remained fixed across cycles (Ward A: 0%; Ward B: 12.5%). Findings were presented at local clinical governance.

Conclusion: Targeted visual and educational interventions significantly enhanced PIVC governance and timely removal on a general geriatric ward. However, persistent challenges on the orthogeriatric ward reflect complex surgical workflows—including multiple perioperative PIVC insertions—and highlight ward-specific operational barriers to sustainability. Future work will engage trust clinical educators to standardise training and address ward-level disparities.