Abstract
Background: Healthcare-associated phlebitis remains a critical challenge in Indonesian hospitals, where incidence rates reach 31.7%, dramatically exceeding the national benchmark of less than 1%. A major contributing factor is poor adherence to integrated clinical pathways, particularly concerning incompatible intravenous drug combinations such as ceftriaxone administered with calcium-containing solutions.
Objective: We aimed to reduce phlebitis incidence through implementation of an online integrated clinical pathway compliance system (iCare System) among patients with high-volume, high-risk, high-cost conditions at provincial government hospitals in South Sulawesi.
Methods: This prospective quality improvement study was conducted at Indonesian regional hospital, located in Makassar, between April and July 2025. We enrolled 61 patients across seven diagnostic categories. The iCare System incorporated disease-specific clinical pathways with embedded phlebitis prevention and standardized Indonesian nursing documentation (SDKI-SIKI-SLKI). We collected prospective clinical data, monitored Visual Infusion Phlebitis (VIP) scores, assessed patient satisfaction, and performed cost-effectiveness analyses.
Results: Patient distribution included Pulmonary TB (n=24, 39.3%), Pneumonia (n=10, 16.4%), CKD (n=10, 16.4%), Bronchopneumonia (n=9, 14.8%), Carcinoma Mammae (n=4, 6.6%), Typhoid Fever (n=2, 3.3%), and Dyspepsia (n=2, 3.3%). The mean maximum VIP score was 1.30 (SD=0.989) with mean phlebitis episodes of 0.54 (SD=0.993) per patient. CKD patients showed highest VIP scores (1.40), while Pulmonary TB patients experienced the most phlebitis episodes (mean=0.83). Overall ICP compliance averaged 77.33 of maximum scores. We found a low positive correlation between ICP compliance and patient satisfaction (r=0.338, p=0.004), with mean satisfaction reaching 273.49 points (82.88%). Financial analysis revealed losses in Bronchopneumonia (-IDR 334,771) and Typhoid Fever (-IDR 1,225,344) where actual costs exceeded BPJS tariffs, while five diagnoses generated profits ranging from IDR 150,041 to IDR 18,817,806.
Conclusion: The iCare System offers a replicable model for integrated clinical pathway implementation in resource-constrained settings, effectively reducing phlebitis incidence while maintaining patient satisfaction.
Notes
Extensive reference list available in attached slide deck.
Sigma Membership
Beta Kappa
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Interprofessional and Interdisciplinary, Acute Care, Sustainable Development Goals, Cross Infection, Phlebitis, Indonesia
Recommended Citation
Rachmawaty, Rini; Bukhari, Agussalim; Wahyudin, Elly; Gaffar, Indra; Balena, Sarah Bernadette L.; and Malik, Gulzar, "iCare System Implementation for Phlebitis Prevention: A Quality Improvement Study" (2026). International Nursing Research Congress (INRC). 49.
https://www.sigmarepository.org/inrc/2026/presentations_2026/49
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-24
Funder
Hasanuddin University
iCare System Implementation for Phlebitis Prevention: A Quality Improvement Study
Toronto, Ontario, Canada
Background: Healthcare-associated phlebitis remains a critical challenge in Indonesian hospitals, where incidence rates reach 31.7%, dramatically exceeding the national benchmark of less than 1%. A major contributing factor is poor adherence to integrated clinical pathways, particularly concerning incompatible intravenous drug combinations such as ceftriaxone administered with calcium-containing solutions.
Objective: We aimed to reduce phlebitis incidence through implementation of an online integrated clinical pathway compliance system (iCare System) among patients with high-volume, high-risk, high-cost conditions at provincial government hospitals in South Sulawesi.
Methods: This prospective quality improvement study was conducted at Indonesian regional hospital, located in Makassar, between April and July 2025. We enrolled 61 patients across seven diagnostic categories. The iCare System incorporated disease-specific clinical pathways with embedded phlebitis prevention and standardized Indonesian nursing documentation (SDKI-SIKI-SLKI). We collected prospective clinical data, monitored Visual Infusion Phlebitis (VIP) scores, assessed patient satisfaction, and performed cost-effectiveness analyses.
Results: Patient distribution included Pulmonary TB (n=24, 39.3%), Pneumonia (n=10, 16.4%), CKD (n=10, 16.4%), Bronchopneumonia (n=9, 14.8%), Carcinoma Mammae (n=4, 6.6%), Typhoid Fever (n=2, 3.3%), and Dyspepsia (n=2, 3.3%). The mean maximum VIP score was 1.30 (SD=0.989) with mean phlebitis episodes of 0.54 (SD=0.993) per patient. CKD patients showed highest VIP scores (1.40), while Pulmonary TB patients experienced the most phlebitis episodes (mean=0.83). Overall ICP compliance averaged 77.33 of maximum scores. We found a low positive correlation between ICP compliance and patient satisfaction (r=0.338, p=0.004), with mean satisfaction reaching 273.49 points (82.88%). Financial analysis revealed losses in Bronchopneumonia (-IDR 334,771) and Typhoid Fever (-IDR 1,225,344) where actual costs exceeded BPJS tariffs, while five diagnoses generated profits ranging from IDR 150,041 to IDR 18,817,806.
Conclusion: The iCare System offers a replicable model for integrated clinical pathway implementation in resource-constrained settings, effectively reducing phlebitis incidence while maintaining patient satisfaction.
Description
This quality improvement study implemented the iCare System among 61 patients across seven categories at a South Sulawesi hospital to address Indonesia's high phlebitis rates (31.7% vs. <1% standard). Results showed low phlebitis burden (VIP=1.30, 0.54 episodes/patient), 35.12% ICP compliance, 82.88% satisfaction, and variable cost-effectiveness, offering a replicable model for resource-limited settings.