Decreasing Complete Blood Count Clotting Rates: An Improvement Project in an Academic Neonatal Intensive Care Unit.
Journal
Advances in neonatal care : official journal of the National Association of Neonatal Nurses
ISSN: 1536-0911
Titre abrégé: Adv Neonatal Care
Pays: United States
ID NLM: 101125644
Informations de publication
Date de publication:
01 Dec 2021
01 Dec 2021
Historique:
pubmed:
31
3
2021
medline:
15
12
2021
entrez:
30
3
2021
Statut:
ppublish
Résumé
In premature and critically ill infants, a complete blood count (CBC) is commonly collected via the heel-stick method, which is preferred because of the ongoing requirements to preserve intravenous sites. However, because of sample clotting, these specimens are often rejected, leading to unnecessary repeat heel sticks, painful stimuli, and increased costs. The purpose of this quality improvement project was to decrease the rate of clotted CBC samples obtained from neonates admitted in the neonatal intensive care unit. The RE-AIM translation model, which stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance, was adopted to decrease the rate of clotted CBC samples through staff education, randomized audits of the staff's heel-stick technique, and the development and implementation of a standardized capillary blood sampling protocol. The primary outcome measure was the rate of clotted CBC samples, which was defined as the proportion of clotted CBC samples. CBC clotted sample rates decreased by 27%, resulting in a cost saving of $1136, and overall CBC rejection rates decreased by 23%. All hospital units should provide staff with an evidence-based resource, recurrent education, and evaluation of skills to avoid unnecessary repeat heel sticks and prevent increased pain sensitivity, social hypervigilance, and avoidance behavior in early infancy. Future efforts should focus on the long-term benefits of routine education and its effects on clotted sample rates and whether samples drawn by laboratory phlebotomy staff versus registered nurses/patient care technicians result in disproportionate rejection rates.
Sections du résumé
BACKGROUND
BACKGROUND
In premature and critically ill infants, a complete blood count (CBC) is commonly collected via the heel-stick method, which is preferred because of the ongoing requirements to preserve intravenous sites. However, because of sample clotting, these specimens are often rejected, leading to unnecessary repeat heel sticks, painful stimuli, and increased costs.
PURPOSE
OBJECTIVE
The purpose of this quality improvement project was to decrease the rate of clotted CBC samples obtained from neonates admitted in the neonatal intensive care unit.
METHODS
METHODS
The RE-AIM translation model, which stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance, was adopted to decrease the rate of clotted CBC samples through staff education, randomized audits of the staff's heel-stick technique, and the development and implementation of a standardized capillary blood sampling protocol. The primary outcome measure was the rate of clotted CBC samples, which was defined as the proportion of clotted CBC samples.
RESULTS
RESULTS
CBC clotted sample rates decreased by 27%, resulting in a cost saving of $1136, and overall CBC rejection rates decreased by 23%.
IMPLICATIONS FOR PRACTICE
CONCLUSIONS
All hospital units should provide staff with an evidence-based resource, recurrent education, and evaluation of skills to avoid unnecessary repeat heel sticks and prevent increased pain sensitivity, social hypervigilance, and avoidance behavior in early infancy.
IMPLICATIONS FOR RESEARCH
CONCLUSIONS
Future efforts should focus on the long-term benefits of routine education and its effects on clotted sample rates and whether samples drawn by laboratory phlebotomy staff versus registered nurses/patient care technicians result in disproportionate rejection rates.
Identifiants
pubmed: 33783390
doi: 10.1097/ANC.0000000000000853
pii: 00149525-202112000-00017
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E171-E179Informations de copyright
Copyright © 2021 by The National Association of Neonatal Nurses.
Déclaration de conflit d'intérêts
The author declares no conflicts of interest.
Références
McCoy J, Tichon T, Narvey M. Reducing CBC clotting rates in the neonatal patient care areas. BMJ Qual Improv Rep. 2016;5(1):u215456.w4946. doi:10.1136/bmjquality.u215456.w4946.
Szlachetka DM. Laboratory and diagnostic test interpretation. In: Verklan MT, Walden M, eds. Core Curriculum for Neonatal Intensive Care Nursing. Pp. 235–252. St Louis, MO: Elsevier Saunders; 2015.
Folk LA. Guide to capillary heelstick blood sampling in infants. Adv Neonatal Care. 2007;7(4):171–178. doi:10.1097/01.ANC.0000286333.67928.04.
Evans JC, McCartney EM, Lawhon G, Galloway J. Longitudinal comparison of preterm pain responses to repeated heelsticks. Pediatr Nurs. 2005;31(3):216–221. https://search-ebscohost-com.ezproxy-v.musc.edu/login.aspx?direct=true&db=ccm&AN=106496663&site=ehost-live . Accessed February 28, 2020.
Rooper L, Carter J, Hargrove J, Hoffmann S, Riedel S. Targeting rejection: analysis of specimen acceptability and rejection, and framework for identifying interventions in a single tertiary healthcare facility.J Clin Lab Anal. 2017;31(3):e22060. doi:10.1002/jcla.22060.
De la Salle B. Pre- and postanalytical errors in haematology. Int J Lab Hematol. 2019;41(suppl 1):170–176. doi:10.1111/ijlh.13007.
Crous L, Armstrong SJ. The bloody truth: investigating nurse phlebotomy competencies at a private laboratory in Johannesburg, South Africa. Health SA Gesondheid. 2016;21(1):339–347. doi:10.1016/j.hsag.2016.06.002.
WHO guidelines on drawing blood: best practices in phlebotomy. http://whqlibdoc.who.int/publications/2010/9789241599221_eng.pdf . Published 2010. Accessed February 28, 2020.
Krleza JL, Dorotic A, Grzunov A, Maradin M; Croatian Society of Medical Biochemistry and Laboratory Medicine. Capillary blood sampling: national recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb). 2015;25(3):335–358. doi:10.11613/BM.2015.034.
Smith M. Mosby's Nursing Skills Endorsed by AACN. Elsevier; 2006. https://www.elsevier.com/about/press-releases/clinical-solutions/mosbys-nursing-skills-endorsed-by-aacn . St. Louis, MO. Accessed February 28, 2020.
Arslan FD, Karakoyun I, Basok BI, et al. The effects of education and training given to phlebotomists for reducing preanalytical errors. J Med Biochem. 2018;37(2):172–180. doi:10.1515/jomb-2017-0045.
Dikmen ZG, Pinar A, Akbiyik F. Specimen rejection in laboratory medicine: necessary for patient safety? Biochem Med (Zagreb). 2015;25(3):377–385. doi:10.11613/BM.2015.037.
White KM, Dudley-Brown S, Terhaar MF. Translation of Evidence Into Nursing and Health Care. Rev ed. New York, NY: Springer Publishing Company; 2016. https://web-a-ebscohost-com.ezproxy-v.musc.edu/ehost/ebookviewer/ebook/bmxlYmtfXzExOTM3OThfX0FO0?sid=620c6983-995a-4e67-8722-1e4fe7542ee7@sdc-v-sessmgr02&vid=4&format=EB&rid=1 . Accessed February 28, 2020.
Weegar MA, Pacis D. A comparison of two theories of learning-behaviorism and constructivism as applied to face-to-face and online learning. Paper presented at: Proceedings e-Leader Conference; 2012; Manila, Philippines. https://d1wqtxts1xzle7.cloudfront.net/34484829/compare_of_two_teory.PDF?1408476887=&response-content-disposition=inline%3B±filename%3DCompare_of_two_teory_PDF.pdf&Expires=1607989300&Signature=cqJGaZdTJj5z6sem1mfnetZmrEosFPQH9bRvosYExJizKaSU8Fr-az6ro1OaMyTC6zpRVC63Kqmphrx6UjojLJ5riVa2RpCMyztswuwkWJxBnnxaD5PxgucvpFLm5Zg-BOPlBOkRvYibuotH∼mGQ0CuwDG∼ZtIzmBGgLGapdPJzlqmRNdzcAxRZzeix8gobZCd1X∼7A∼HHdIZBHtMveg3gnUqJmlo21Iz2Rs-HS14BdIMCo5D1TuLzvg7PU6mXBl4w7fIr30FiFvU2WOkHJ2nGns7FAbmtsNVHKE1b-P1ESfuH0EoaeUVff∼SIbrYS3skWpuKGOuLRQYW2ECTp5Lpg__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA . Accessed December 12, 2020.
Niwinski N. Capillary blood collection: best practices. LabNotes. 2009;20(1):1–8. file:///C:/Users/DALUSER-sjchNICU/Downloads/BC-Labnotes-Volume20Number1_TB_EN.pdf . Accessed August 3, 2020.
Dixon N. Guide to managing ethical issues in quality improvement or clinical audit projects. Healthc Qual Improv Partnersh. https://www.hqip.org.uk/wp-content/uploads/2017/02/guide-to-managing-ethical-issues-in-quality-improvement-or-clinical-audit-projects.pdf . Updated February 2017. Accessed February 28, 2020.
Sylvia ML, Terhaar MF. Clinical Analytics and Data Management for the DNP. Rev ed. New York, NY: Springer Publishing Company; 2018.
Christensen RD, Baer VL, Gerday E, et al. Whole-blood viscosity in the neonate: effects of gestational age, hematocrit, mean corpuscular volume and umbilical cord milking. J Perinatol. 2014;34(1):16–21. doi:10.1038/jp.2013.112.
Kluckow M, Evans N. Low systemic blood flow in the preterm infant. Semin Neonatol. 2001;6(1):75–84. doi:10.1053/siny.2000.0035.
Stephen du Toit. Haemolysed or clotted samples—preventable causes of unsuitable samples. https://lab.waikatodhb.health.nz/assets/Guides/Haemolysed-or-Clotted-Samples-1.pdf . Accessed June 30, 2020.
Page GG. Are there long-term consequences of pain in newborn or very young infants? J Perinat Educ. 2004;13(3):10–17. doi:10.1624/105812404X1725.