Journal of Patient Safety & Quality Improvement

Journal of Patient Safety & Quality Improvement

Enhancing Intravenous Injection Safety Through a PDCA cycle approach: Quality Improvement Initiative in a Tertiary Care Cardiac Hospital

Document Type : Original Article

Authors
Khyati Pandya 1
Archana Trivedi 1
Silviya Vasaiwala 2
Kinjal Christian 3
Mittal Kadikar 4
1 Medical Clinical Coordinator, U.N.Mehta Institute of Cardiology and Research Center Ahmadabad, Gujarat, India.
2 Cardiac Assistant Matron, U.N.Mehta Institute of Cardiology and Research Center Ahmadabad, Gujarat, India.
3 TCSN CC-2, U.N.Mehta Institute of Cardiology and Research Center Ahmadabad, Gujarat, India.
4 Trained Cardiac Staff Nurse Grade 2, U.N.Mehta Institute of Cardiology and Research Center,Ahmadabad, Gujarat, India.
10.22038/psj.2026.94811.1525
Abstract
Background:
IV injection is a routine nursing task in hospitals but carries preventable risks like hospital-acquired infections, medication errors, and needle-stick injuries for staff. Global guidelines from WHO, CDC, and ISMP are clear, yet consistent adherence in busy wards remains difficult. We tested if a structured Plan-Do-Check-Act (PDCA) quality improvement approach could improve nurses' compliance with IV injection safety practices and indirectly benefit infection control.

methods:
This pre- and post-intervention observational study was done in adult critical care, non-critical wards, and paediatric units of our tertiary cardiac hospital. A standardized checklist based on WHO, CDC, and ISMP guidelines audited 19 IV injection safety indicators. 337 baseline observations were compared with post-intervention and focused PDCA follow-up audits. Descriptive statistics, Chi-square, and Fisher’s Exact tests were used. Monthly CLABSI rates were monitored.

Results:
PDCA implementation led to significant improvement (p ≤ 0.05) in all 16 changeable indicators. Largest gains occurred in injection site antisepsis, infectious waste segregation, multi-dose vial handling, syringe labelling, and hand hygiene. Baseline 100% compliant indicators stayed stable (ceiling effect). A clear downward trend in CLABSI rates post-intervention suggested better infection control.
Conclusions:
The PDCA approach significantly boosted adherence to IV injection safety practices with sustained results. It is a practical, low-cost, and scalable method to strengthen nursing habits, enhance patient safety, and support continuous quality improvement in busy clinical settings.
Keywords
Injection safety
Nursing quality improvement
Patient safety
CLABSI
Subjects
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Journal of Patient Safety & Quality Improvement
Volume 14, Issue 4
Autumn 2026
Pages 237-244