2.50
Hdl Handle:
http://hdl.handle.net/10755/162396
Type:
Presentation
Title:
Top Guns: Creating Blood Culture Aces in the ED
Abstract:
Top Guns: Creating Blood Culture Aces in the ED
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Neira, Paula M., RN, JD, CEN
P.I. Institution Name:The Johns Hopkins Hospital
Title:Nurse Educator
Contact Address:600 N. Wolfe Street, Marburg B-181, Baltimore, MD, 20175, USA
Contact Telephone:443-287-7161
Co-Authors:Kathy DeRuggiero, RN, MSN; Peter M. Hill, MD, FACEP
[ENA Annual Conference - Evidence-based Practice Presentation]
Purpose: Contaminated blood cultures contribute to increased treatment costs and in-patient length of stay. Core measure reporting, and its impact on market competition, drives ED leaders to ensure performance meets established metrics. This project established an ongoing program to ensure a minimum of 90% monthly compliance with Community-Acquired-Pneumonia (CAP) core measures for obtaining blood cultures before antibiotic administration while reducing contamination rates to meet the 3% national benchmark.

Design: This was an evidence-based, quality-improvement project that implemented new procedures and work flows for obtaining blood cultures in the emergency department.

Setting: The emergency department of an urban, academic, level 1, trauma center in the Mid-Atlantic region implemented this project.

Participants/Subjects: From a nursing staff of approximately 150 nurses and technicians, 27 clinical technicians participated. Criterion excluded nurses because clinical technicians routinely performed the bulk of phlebotomy duties. A further inclusion criterion was that selected clinical technicians must work at least one shift/week.

Methods: Project implementation required selection and training of a cadre who then were the only staff authorized to obtain routine, peripheral blood cultures. This group received 1:1 training, emphasizing meticulous sterile technique, procedural observations and return demonstrations. To ensure standardization, a sole evaluator audited every participant. The department implemented new work flows and communications procedures. Each shift, a single blood culture technician was designated and provided with a phone for notification of required draws. ED nursing leadership demonstrated its commitment to emphasizing blood culture compliance by giving this new position, created without adding resources, an organizational priority. To ensure prompt communication and management oversight, the director of nursing instructed the technician to contact her directly to resolve issues implicating core measure compliance. Nursing leadership created an on-line log to document blood cultures and checked it daily to identify issues or trends. Departmental and hospital QA nurses monitored core measure compliance on a daily basis, using electronic chart auditing with near real-time reporting of potential incidents of non-compliance. The pathology lab reported contamination data retrospectively on a monthly basis. The training evaluator analyzed the data and for each contaminated specimen, the electronic chart was reviewed; the technician involved identified, and remedial training conducted as needed.

Results/Outcomes: The modifications implemented in this project, begun in April 2009, have been very successful. When comparing blood culture contamination data from April-November 2008 with data from April-November 2009, the rate of blood culture contamination has been reduced by approximately 60%, from an average monthly contamination rate of 5.7% in 2008 to 2.3% in 2009. Compliance with CAP core measures has increased from 76% (May-November 2008) to 98% (May-November 2009).

Implications: Based on this data, emergency department leaders can take several steps to improve blood culture performance. First, leaders must establish that proper blood culture compliance is a departmental priority. Second, a well-trained cadre to perform in a discrete position, following a standardized collection process, should be created. Finally, leaders must provide ongoing auditing and performance feedback to ensure sustainability.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleTop Guns: Creating Blood Culture Aces in the EDen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162396-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Top Guns: Creating Blood Culture Aces in the ED</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Neira, Paula M., RN, JD, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The Johns Hopkins Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Educator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">600 N. Wolfe Street, Marburg B-181, Baltimore, MD, 20175, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">443-287-7161</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">pneira2@jhmi.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Kathy DeRuggiero, RN, MSN; Peter M. Hill, MD, FACEP</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/>Purpose: Contaminated blood cultures contribute to increased treatment costs and in-patient length of stay. Core measure reporting, and its impact on market competition, drives ED leaders to ensure performance meets established metrics. This project established an ongoing program to ensure a minimum of 90% monthly compliance with Community-Acquired-Pneumonia (CAP) core measures for obtaining blood cultures before antibiotic administration while reducing contamination rates to meet the 3% national benchmark. <br/><br/>Design: This was an evidence-based, quality-improvement project that implemented new procedures and work flows for obtaining blood cultures in the emergency department. <br/><br/>Setting: The emergency department of an urban, academic, level 1, trauma center in the Mid-Atlantic region implemented this project.<br/><br/>Participants/Subjects: From a nursing staff of approximately 150 nurses and technicians, 27 clinical technicians participated. Criterion excluded nurses because clinical technicians routinely performed the bulk of phlebotomy duties. A further inclusion criterion was that selected clinical technicians must work at least one shift/week. <br/><br/>Methods: Project implementation required selection and training of a cadre who then were the only staff authorized to obtain routine, peripheral blood cultures. This group received 1:1 training, emphasizing meticulous sterile technique, procedural observations and return demonstrations. To ensure standardization, a sole evaluator audited every participant. The department implemented new work flows and communications procedures. Each shift, a single blood culture technician was designated and provided with a phone for notification of required draws. ED nursing leadership demonstrated its commitment to emphasizing blood culture compliance by giving this new position, created without adding resources, an organizational priority. To ensure prompt communication and management oversight, the director of nursing instructed the technician to contact her directly to resolve issues implicating core measure compliance. Nursing leadership created an on-line log to document blood cultures and checked it daily to identify issues or trends. Departmental and hospital QA nurses monitored core measure compliance on a daily basis, using electronic chart auditing with near real-time reporting of potential incidents of non-compliance. The pathology lab reported contamination data retrospectively on a monthly basis. The training evaluator analyzed the data and for each contaminated specimen, the electronic chart was reviewed; the technician involved identified, and remedial training conducted as needed.<br/><br/>Results/Outcomes: The modifications implemented in this project, begun in April 2009, have been very successful. When comparing blood culture contamination data from April-November 2008 with data from April-November 2009, the rate of blood culture contamination has been reduced by approximately 60%, from an average monthly contamination rate of 5.7% in 2008 to 2.3% in 2009. Compliance with CAP core measures has increased from 76% (May-November 2008) to 98% (May-November 2009).<br/><br/>Implications: Based on this data, emergency department leaders can take several steps to improve blood culture performance. First, leaders must establish that proper blood culture compliance is a departmental priority. Second, a well-trained cadre to perform in a discrete position, following a standardized collection process, should be created. Finally, leaders must provide ongoing auditing and performance feedback to ensure sustainability.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:30Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:30Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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