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Background There was a significant increase in intravenous (IV) infiltration in the month of March 2016 in the Pediatric Emergency Department - KASCH. The Acute Care team noted an increase in IV-related incidence and there were 30 generated safety reporting system (SRS) reports from January to March 2016. This prompted the unit leaders to create a taskforce in order to review the causes and the factors leading to incidence and causing patient harm. Methods Using the PDSA (plan-do-study-act) quality model, the quality improvement team collected data generated through the SRS on IV infiltration/extravasation. The reports were analyzed as to the causes and harm of the incident. Using a cause and effect diagram, the team identified the root causes as non-adherence to the insertion and sterility technique, staff competency on IV insertion and monitoring, type of dressing used, lighting, and lack of guidelines to support the practice. In order to draw a reliable conclusion, several PDSA cycles were tested and implemented: (1) data collection and audit tool design; (2) staff education and standardized documentation; (3) formulation of the escalation process and guidelines; and (4) continuous monitoring and auditing of IV infiltration/extravasation and regular reporting to the daily key performance indicator (KPI). Results For the initial throughput of the project, the IV Watchers on the Move Team noted a marked decrease in infiltration in August 2018 as evidenced by the nurses’ compliance in IV infiltration prevention strategies - i.e., (1) hourly IV site checks, (2) mandatory use of smart pumps, and (3) timely and accurate documentation of IV assessment. Conclusion The IV Watchers on the Move QI Project was able to design a mechanism to reduce the potential harm caused by infiltration. Part of the intervention was the hourly assessment and early recognition of impending infiltration. Nurses were instructed to be cautious when administering highly concentrated medications. With all of the efforts and initiative shown throughout, the pediatric patients benefited from the successful interventions that finally led to the safe delivery of nursing care.

Prolonged waiting times and length of stay in Pediatric Emergency Department, are the two of the most challenging patient and clinical outcomes of healthcare institution. These emerged due to various reasons, namely: the use of triaging process and patient flow criteria that eventually lead to bottlenecks and overcrowding in the ED. After realizing the root causes of the prolonged waiting times and length of stay, the KASCH ED instigated a team to study the factors and thereby arrive at a considerable conclusion that will result in an improvement. The quality improvement project was initiated and steps were undertaken to improve the flow, reduce the waiting times, and reduce the overcrowding in Pediatric Emergency Acute Care Unit. The primary cause identified was inadequate team awareness and lack of the ED process flow, thus creating confusion as to where the type of patients based on the triage level will be assessed, managed and treated. Using the Canadian Triage and Acuity Scale (CTAS) as guide in triaging patients, a theory called Pediatric Rapid Assessment and Management (PRAM) was introduced in the Acute Care Unit. This certain model is basically aimed to rapidly assess and managed the patients who were triaged as Level III and Level IV within a period of 30 minutes. Several PDSA cycles were tested and implemented in order to assure that the process fit the criteria and the process flow will be improved. Following the completion of each cycle, significant improvements were noted, such as patients being assessed in Initial Assessment Room on average time less than the target of 15 minutes. In like manner, patients' length of stay on average less than 15 minutes in PRAM bed. The total time for assessment and plan of management is with a target time of less than 30 minutes. The team continuously drive th process and monitored the key performance indicators of the PRAM during the study period and subsequent improvement strategies were likewise implemented.