Meera Patel (ECU Brody School of Medicine), Triona Henderson (ECU Brody School of Medicine, Vidant Medical Center), Jeremy Yates (ECU Brody School of Medicine, Vidant Medical Center), Stephen Smith (ECU Brody School of Medicine, Vidant Medical Center)
Blood draw contamination rates are continually reported among hospital-wide quality improvement and patient safety measures. Contamination can result in increased administration of inappropriate antibiotic treatments, increased patient length of stay (LOS), and subsequently increased patient costs. Such factors can significantly dampen patient experience and quality and safety of care received.
Current VMC data show hospital-wide mean blood draw contamination rates consistently below threshold due to the heavy influence of ED rates alone, while other adult hospital units show achievement of the threshold goal when the ED is excluded. Changing ED draw practices could elicit significant improvement in hospital-wide rates, positively affecting numerous system factors and achieving safer and effective high quality patient care.
Global Aim: Reduce the rate of ED blood draw contamination to: 1) improve laboratory workflow, staff satisfaction, and results turn-around time, 2) promote stronger antibiotic stewardship practices and patient safety, 3) bring hospital-wide contamination rates within acceptable threshold, 4) reduce hospital and patient costs, and 5) improve patient satisfaction and quality of care.
Specific Aim: Reduce the monthly rate of ED blood draw contamination by an absolute 2.0% (33% decrease) below the monthly mean (6.0%) by June 2018, with the long-term goal of achieving a contamination rate at or below the accepted threshold of 2.5% at VMC.
Improvement initiatives were implemented utilizing Plan-Do-Study-Act (PDSA) quality improvement method.
PDSA 1: ED Nurse Mass Re-education on Blood Draw Collection Procedures—April 2017
PDSA 2: ED Nurse Individual Re-education Sessions with Checklist for Blood Draw Techniques as Needed—October 2017
PDSA 3: Addition of Blood Draw Supplies Cart, Informational Poster, Instructional Badge Cards, and Deidentified Compliance Board Highlighting Monthly Contamination Events—November 2017
PDSA 4: Increase Frequency of Reporting Contamination Data from Monthly to Weekly Rate—November 2017
PDSA 5: New Data Collection to Assess Efficacy of Previous Change Implementations—Ongoing 2018
- From January to October 2017, the average ED contamination rate was 6.0%.
- PDSA cycles 1 and 2, both education initiatives, resulted in an immediate sharp decline in rates followed by a slight rise in subsequent months.
- A challenge with PDSA 1 and 2 was sustaining education after loss of educators and hiring of new staff.
- This challenge provided an opportunity for further drill-downs and a need to brainstorm education reinforcement strategies.
- PDSA cycle 3 resulted in the most significant absolute drop (1.7%; 26% relative drop) in contamination rates observed from October to November.
- This indicates that tangible material aids may have more longevity of usefulness for sustainable impact.
- Further results are anticipated.
The aim to reduce monthly ED blood culture contamination rates to 2.0% below the monthly mean was not met by December 2017. However, rates declined at points coinciding with PDSA cycles.
As PDSA cycles occurred in rapid succession, it may help to expand the period of time in between cycles to allow staff to adjust.
Thus, changes made ultimately showed immediate improvements in contamination rates, but varying levels of long-term success. Future goals will include further assessment to identify/finetune methods to sustain implemented changes.
Implications for the Patient
Patient experience is significantly affected by blood draw contamination. By nature, reducing contamination rates subsequently improves staff satisfaction, treatments administered, LOS necessitated, and patient costs. Thus, better workplace and clinical quality, greater attention and time for direct personal patient care, and elevation of the institutional standard of care are achieved.