Moeller Dawn
Barrington, IL.
J Emerg Nurs. 2017 Mar;43(2):126-132. doi: 10.1016/j.jen.2016.07.001. Epub 2016 Oct 26.
Our emergency department struggled with unacceptable blood culture contamination rates for several years. The objective of this project was to create a self-governing culture within nursing that would generate and sustain the achievement of monthly blood culture contamination rates below the national benchmark of 3% and the hospital laboratory acceptable threshold of 2.3%.
The ED shared governance council partnered with the laboratory team to review the monthly epidemiology reports for all adult and pediatric ED patients having blood cultures performed from January 2010 through December 2015. A written competency assessment test completed by ED personnel performing phlebotomy showed opportunity for improvement. After a review of the literature, a blood culture collection education tool was created and implemented. The final step was to design a monthly monitoring and peer-review process to perform ongoing causal analysis with those individuals who were linked with contaminated specimens.
The evidence shows that the new process decreased the blood culture contamination rate from a baseline rate of 5.37% to 1.76%.
The chief recommendation is to engage staff through clinical leadership. This quality-improvement project translates to improved patient care and a reduction in unnecessary treatment and costs.
多年来，我们急诊科的血培养污染率一直处于不可接受的水平。本项目的目标是在护理团队中营造一种自我管理的文化，以实现并维持每月血培养污染率低于3%的国家基准以及医院实验室可接受的2.3%的阈值。
急诊部共享治理委员会与实验室团队合作，审查了2010年1月至2015年12月期间所有接受血培养的成年和儿科急诊患者的月度流行病学报告。由进行静脉穿刺的急诊部人员完成的书面能力评估测试显示有改进的空间。在查阅文献后，创建并实施了血培养采集教育工具。最后一步是设计一个月度监测和同行评审流程，对与污染标本相关的人员进行持续的因果分析。
证据表明，新流程将血培养污染率从基线率5.37%降至1.76%。
主要建议是通过临床领导力来调动员工积极性。这个质量改进项目转化为改善患者护理以及减少不必要的治疗和成本。
