![[ Visit ANA's Website ]](../../../img/ana/webprogram/ndnqi12/banner.gif)
Blood culture contamination rates in the Emergency Department (ED) were up to 6.6%, double the national benchmark of 3%. ED technicians and nurses draw the specimens. A goal was to develop a plan to decrease contaminated specimens drawn by ED staff and hardwire processes for sustaining improvement
Significance:
Contaminated specimens result in patients receiving antibiotics not warranted or appropriate for their particular medical diagnosis, increase length of stay four to five days, and result in additional lab testing. Together these can decrease quality of care and increase cost over $5,500 each.
Strategy and Implementation:
Lab resources did not permit moving the task of collection so strategy focused on involving the lab for education and training. The lab supervisor provided inservices to ED staff creating a poster with step by step instructions, which was stationed in a visible area in the ED. The ED adopted the same competency checklist for phlebotomy and blood culture collection used by the lab with 100 supervised venipunctures. Lab staff made copies of the collection tube labels of contaminated specimens to share with the ED leadership for tracking specific staff members. Staff were provided with coaching and those with three or more contaminated specimens over several months were assigned for retraining in the lab. Approach was presented positively for remedial training to avoid a punitive perception. New ED staff were assigned to train three shifts with a phlebotomist before performing blood cultures collection.
Evaluation:
The ED has achieved and sustained a decrease in the contamination rate from 6.6% to an average for calendar year 2010 of 2.7% and 2011 is at 1.85% with ongoing coaching and monitoring results from lab translating to a raw savings of $93,500 and with increased volume considered, over $500,000.
Implications for Practice:
A dedicated phlebotomy team to collect blood culture specimens is not an option at this time, mirroring best practice, and partnering with the lab have produced desired results. The process can be adopted on other units within the hospital who perform venipuncture and other EDs with these tasks.