PEDIATRIC BLOOD SPARING: AN INTERDISCIPLINARY IMPROVEMENT
INITIATIVE TO REDUCE PRE-ANALYTICAL BLOOD COLLECTION
ERRORS
Issue: Most laboratory test result errors are due to problems with sample collection, not analysis. Pre-analytical errors result in test cancellations, re-draws, delays in patient diagnosis and treatment, and can result in patient harm. Inefficient clinical practices impact institutional quality, financial performance, patient satisfaction scores, and recruitment of future clients. The volume of blood test cancellations that required repeat draws was identified as a problem in this pediatric hospital.
Project Description: An interdisciplinary task force comprised of pediatric practitioners, laboratory managers and medical directors collaborated to improve the quality and safety of pediatric blood collection practices. Seven months of laboratory test data were reviewed to identify the 50 most frequently ordered pediatric blood tests and reasons for test cancellations. The following strategic improvement initiatives were implemented to resolve the identified issues:
(1) development of standardized blood volume guidelines published as a pediatric reference tool for the most frequently ordered pediatric tests which included: preferred, minimum for processing, and add on test volumes; correct tube selection, special handling requirements and order for draws; and Blood Bank requirements.
(2) clarification of hospital practice for proper labeling of test specimens.
(3) development of a computerized staff education learning module focused on appropriate blood collection techniques for all nursing and medical staff members.
Results: The establishment of an interdisciplinary task force that meets monthly to address ongoing laboratory and test-related issues and to share responsibility for implementing and monitoring initiatives. The daily reporting of laboratory equipment and specimen test issues at the morning leadership safety call. The expansion and publication of the “Pediatric Blood Sampling Guidelines” reference tool for easy staff access both electronically and in printed form. No increase in total number of canceled lab tests or turnaround time was identified with implementation of the minimum blood draw volumes. A decrease from 65% to 38% occurred in the use of microtainers for collecting blood samples and in the reporting of “quantity not sufficient” test results. The blood collection education module was included in the yearly staff mandatory review.
The total number of mislabeled/unlabeled specimens sent to the lab decreased from 35 per month to 4 per month.
Lessons Learned: Only 30% of change projects achieve intended outcomes. Successful changes with sustainable results requires knowledge of and buy in to the purpose, meaningful data communicated across disciplines that easily translates into action plans for change, and champions who strategically leverage and monitor the change process.
Submitters: Paula L Forsythe, CNS, ( paula.forsythe@uhhospitals.org
), Rainbow Babies
& Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
44106; Ruth A Natali, MT, ( ruth.natali@uhhospitals.org
), University Hospitals Case
Medical Center, Cleveland, OH 44106.