Sustainable Reduction in Blood Culture Contamination in the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/306601
Category:
Abstract
Type:
Poster
Title:
Sustainable Reduction in Blood Culture Contamination in the Emergency Department
Author(s):
Dumont, Kim; Villavicendo, Diane
Lead Author STTI Affiliation:
Non-member
Author Details:
Kim Dumont, BSN, RN, CEN, kimmariern@hotmail.com; Diane Villavicendo, BSN, RN
Abstract:

Evidence-based Practice Abstract

Purpose: Current guidelines and quality measures have resulted in the increased use of blood cultures in the Emergency Department (ED). While blood cultures can provide important information in patients at risk for bacteremia, false positive results have associated patient costs, increased antibiotic usage, and prolonged hospital stays. Nationally, the goal is to have a blood culture contamination rate of 3% or less; St Francis Medical Center (SFMC) ED’s rate was an average of 12-14% in November 2011.

Objective: To decrease the percentage of blood culture contaminations collected in SFMC’s ED to less than 3%.

Design: Unit practice council members (comprised solely of direct patient care staff) created a standard protocol for drawing blood cultures in the ED. Once the protocol was created, the staff who designed the protocol began training 100% of the direct patient care ED staff.

Setting: A Level IV trauma ED that sees about 44,000 patients annually with 32% of its patients being classified as pediatric (age 16 years or less). SFMC ED is an accredited Chest Pain Center and Stroke Center of Excellence as well as a three-time recipient of Health Grades Award for Emergency Medicine since its inception in 2008.

Participants/Subjects: Any patient who had blood cultures ordered was logged into a spreadsheet. Tracking included how many cultures were ordered and which nurse/critical care technician drew the cultures. This information was compared to the Lab report of blood culture contaminations to determine which staff had a contaminated blood culture so re-education and accountability could be done.

Methods: Unit practice council members collaborated with physician partners to institute a process improvement plan to reduce the rate of contamination. The plan included three main points: 1) create a standard protocol, 2) Once the protocol was created, the staff who designed the protocol began training 100% of the direct patient care ED staff, and 3) report the post training contamination rate with repeat education if any staff member had a contamination. Training began December 2011 and was 100% complete by mid-January 2012.

Results/Outcomes: Within two months of the start of training, SFMC ED went from 12-14% false positive blood culture rate to 3%. Any staff member who had a contaminated culture was re-educated by members of the unit practice council. If a staff member had a contaminated culture two months is a row, the manager stepped in and did counseling because of continued quality of care violations; no staff member got to this level of discipline/feedback. When the ED experienced an overall rise over prior month, unit practice council members re-educated everyone during start of shift huddles. Since September 2012, SFMC ED has boasted a 0% blood culture contamination rate. This inexpensive educational and process improvement program resulted in a rapid, yet sustainable reduction in blood culture contamination.

Implications: Ensuring proper care for patients requires knowledge as to what organisms could be causing their illness. The ability to ensure blood cultures are properly collected helps the providers create an appropriate medical plan of care and ensures correct medications and therapies for our patients.

Keywords:
Reduction of blood culture contamination in the ED
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleSustainable Reduction in Blood Culture Contamination in the Emergency Departmenten_GB
dc.contributor.authorDumont, Kimen_GB
dc.contributor.authorVillavicendo, Dianeen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsKim Dumont, BSN, RN, CEN, kimmariern@hotmail.com; Diane Villavicendo, BSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306601-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Current guidelines and quality measures have resulted in the increased use of blood cultures in the Emergency Department (ED). While blood cultures can provide important information in patients at risk for bacteremia, false positive results have associated patient costs, increased antibiotic usage, and prolonged hospital stays. Nationally, the goal is to have a blood culture contamination rate of 3% or less; St Francis Medical Center (SFMC) ED’s rate was an average of 12-14% in November 2011.</p><p>Objective: To decrease the percentage of blood culture contaminations collected in SFMC’s ED to less than 3%.</p><p>Design: Unit practice council members (comprised solely of direct patient care staff) created a standard protocol for drawing blood cultures in the ED. Once the protocol was created, the staff who designed the protocol began training 100% of the direct patient care ED staff.</p><p>Setting: A Level IV trauma ED that sees about 44,000 patients annually with 32% of its patients being classified as pediatric (age 16 years or less). SFMC ED is an accredited Chest Pain Center and Stroke Center of Excellence as well as a three-time recipient of Health Grades Award for Emergency Medicine since its inception in 2008.</p><p>Participants/Subjects: Any patient who had blood cultures ordered was logged into a spreadsheet. Tracking included how many cultures were ordered and which nurse/critical care technician drew the cultures. This information was compared to the Lab report of blood culture contaminations to determine which staff had a contaminated blood culture so re-education and accountability could be done.</p><p>Methods: Unit practice council members collaborated with physician partners to institute a process improvement plan to reduce the rate of contamination. The plan included three main points: 1) create a standard protocol, 2) Once the protocol was created, the staff who designed the protocol began training 100% of the direct patient care ED staff, and 3) report the post training contamination rate with repeat education if any staff member had a contamination. Training began December 2011 and was 100% complete by mid-January 2012.</p><p>Results/Outcomes: Within two months of the start of training, SFMC ED went from 12-14% false positive blood culture rate to 3%. Any staff member who had a contaminated culture was re-educated by members of the unit practice council. If a staff member had a contaminated culture two months is a row, the manager stepped in and did counseling because of continued quality of care violations; no staff member got to this level of discipline/feedback. When the ED experienced an overall rise over prior month, unit practice council members re-educated everyone during start of shift huddles. Since September 2012, SFMC ED has boasted a 0% blood culture contamination rate. This inexpensive educational and process improvement program resulted in a rapid, yet sustainable reduction in blood culture contamination.</p><p>Implications: Ensuring proper care for patients requires knowledge as to what organisms could be causing their illness. The ability to ensure blood cultures are properly collected helps the providers create an appropriate medical plan of care and ensures correct medications and therapies for our patients.</p>en_GB
dc.subjectReduction of blood culture contamination in the EDen_GB
dc.date.available2013-12-09T17:00:34Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:34Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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