Nursing Annual Report 2025 | Sailing Towards Magnet Mastery

Chemotherapy Extravasation: A Nurse-Sensitive Quality Indicator

Maridel Liang, RN, Cancer Center, with patient in Infusion Center

At El Camino Health, nurses play a vital role in ensuring the safe administration of chemotherapy. A key aspect of this responsibility is the prevention of extravasation—a potentially harmful complication that occurs when chemotherapy leaks from a vein into the surrounding tissue. Preventing this event is a top priority, as it directly impacts patient safety and care quality.

Chemotherapy extravasation is recognized as a nurse-sensitive quality indicator, highlighting the strong link between nursing care and patient outcomes. At the El Camino Health Cancer Center, oncology nurses are at the forefront of preventing, detecting, and managing extravasation events. These nurses receive specialized training in chemotherapy administration, including vein selection, infusion techniques, and identification of extravasation risk factors.

All oncology nurses at the El Camino Health Cancer Center complete a comprehensive chemotherapy administration training program. Nurses are trained to assess IV site patency before and during infusions and to respond immediately at the first sign of complications. An extravasation algorithm provides clear guidance for timely intervention and accurate documentation.

Although no national vendor currently provides standardized benchmarks for chemotherapy extravasation, a 2017 Oncology Nursing Society study identified a 0.9% benchmark rate among National Cancer Institute-designated cancer centers (Jackson-Rose, 2017). El Camino Health uses this figure as a reference while continuously monitoring performance to uphold patient safety.

Notably, both the Los Gatos and Mountain View infusion centers have reported zero extravasation incidents over the past eight consecutive quarters. This success reflects the team’s dedication to education, vigilant monitoring, rapid response, and active patient engagement.

Through these efforts, El Camino Health Cancer Center nurses uphold the highest standards in chemotherapy delivery—ensuring safer, high-quality oncology care for every patient.

Reducing CAUTI: A Team Effort That Made a Big Difference

Catheter-associated urinary tract infections (CAUTIs) are a common and serious concern in hospitals. They can lead to longer hospital stays and increased healthcare costs—but the good news is they’re often preventable. At El Camino Health Los Gatos (LG), reducing CAUTIs has been a top priority, and our team has achieved remarkable success.

What Happened:
For 21 straight months (July 2021 – March 2022), our hospital had zero CAUTI cases—a testament to the dedication of our nursing staff. However, from April to June 2022 (4QFY22), we saw an unexpected increase in our CAUTI rate to 4.04 infections per 1,000 catheter days. This prompted immediate action from our infection prevention teams.

Who Got Involved:
A dedicated team made up of nurses, educators, infection preventionists, and hospital leaders came together to investigate the issue and find solutions. Frontline nurses BreAnna Grigsby (Medical-Surgical-Orthopedic) and Kristine Fredona (ICU) led the effort from the units, ensuring their colleagues were informed and involved.

What We Did:

• Identified issues in workflow, supplies, and staffing that contributed to the spike.
• Reinforced best practices like daily checks for catheter necessity using the HOUUDINI protocol.
• Introduced a new digital tool for easy auditing of catheter use (replacing paper forms).
• Provided targeted education to nurses and certified nursing assistants on foley catheter care.
• Integrated CAUTI prevention into daily huddles and handoffs.

The Result:
Thanks to these changes, we reduced the LG CAUTI rate from 4.04 to 0.00—a 100% improvement! From July 2022 through the end of 2024, there were no new CAUTI cases at Los Gatos.

This outcome shows the power of teamwork, leadership, and evidence-based nursing care. Through strong collaboration and a shared commitment to safety, our team not only addressed a problem—they eliminated it. We’re proud of the incredible work our nurses and partners have done to make El Camino Health a safer place for patients.