Reducing IV-contaminated blood specimens in the clinical laboratory: A Quality Improvement Project

• Published in: American journal of clinical pathology Vol. 156; no. Supplement_1; pp. S117 - S118
• Main Authors: Harrington, A, Kroft, S H, Wells, T, Gannon, V
• Format: Journal Article
• Language: English
• Published: 28.10.2021
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqab191.251

Abstract Introduction/Objective Preanalytical errors constitute the most common errors in the laboratory, with improper specimen collection accounting for many errors. In our laboratory, we had a sentinel event related to repeated deletions of suspected IV-contaminated draws, and herein report our quality improvement project (QIP) to reduce deleted test results and IV-contaminated specimens. Methods/Case Report Our QIP initiated with creating a core-lab task force. Several interventions were launched: (A) policy/definition standardization, (B) nursing IV-line/cathedar in-services, (C) in-services on deleting test results and identifying IV-contamination, (D) policy updates to reflect no deletions without evidence of IV-contamination, and (E) mitigation steps requiring supervisory approval for result deletions. We measured: patient safety events (PSRs); RECOLLECTION comment usage and efficacy (disclaimer attached to results thought to be IV-contaminated, requesting recollection); and mitigation failures. Efficacy of the comment usage was measured by comparing subsequent collections to the original and determining likelihood of IV-contamination (contaminated, not contaminated, and unsure). Prior to the QIP, lab practice was to delete suspected IV-contaminated results and those requested by the care team. Results (if a Case Study enter NA) PSRs attributable to IV-contamination dropped from 47/mo. (time 0) to 18/mo. over an 11-month period (min-8/mo.; max-64/mo.), with the greatest decrement seen following intervention C. The RECOLLECTION comment was attached to 38 results (0.06% of total accessions) at the start and 73 results (0.12% of total accessions) at time 11 mos. and showed greatest increase in use immediately prior to interventions C and D (approximately 3-fold increase). At time 0, 54% of RECOLLECTION comments were deemed contaminated and 31% were not; at time 11mos., 74% (50/68) were contaminated and 24% (16/68) were not. Mitigation failures numbered 5/mo. initially and 1/mo. at time 11 mos. Conclusion With multiple educational and supervisory interventions, we demonstrate a reduction in PSRs attributable to IV-contamination collections at our hospital. Use of cautionary disclaimers was overall minimal and appropriately used.