reducing blood draws in critically ill patients · reducing blood draws in critically ill patients...
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Reducing Blood Draws in Critically Ill Patients Melissa McLenon, DNP, APRN, ACNP-BC, Gregory Botz, MD Natalie Clanton, RN, CCRN, Latoi Tatum, MHA, Blake Brookshire, MD
Introduction • Diagnostic laboratory testing is a significant contributor to anemia in critically ill patients • Phlebotomy practices contribute to the frequency of red blood cell transfusions, and is associated with higher
mortality and longer ICU LOS • We recognized the need to decrease the frequency of blood draws among critically ill patients in our ICU. Aim Statement
To reduce the frequency of blood draw events, per 24 hours, per critically ill patient, by 20% within 3 months of implementation of our intervention
Measure of Success
• Our team collected 4 weeks of baseline data to determine the frequency and volume of blood draws per 24 hours, per critically ill patient in a 10 bed medical ICU pod
• We then collected an additional 3 months of data
PLAN the Improvement
6am – 12pm 12pm – 6pm 6pm – 12am 12am – 6am Room 1
Number of Vials/Tubes
cc of Blood
Number of Draws
Room 2
Number of Vials/Tubes
cc of Blood
Number of Draws
Room 3
Number of Vials/Tubes
cc of Blood
Number of Draws
Room 4
Number of Vials/Tubes
cc of Blood
Number of Draws
Room 5
Number of Vials/Tubes
cc of Blood
Number of Draws
DO the Implementation
Communication
• Enhance communication among ICU team, Use of the daily rounding checklist
Education
• Education of all staff members through in-services. Give autonomy to key staff members
Awareness
• Increase overall awareness including the necessity of labs to be done daily and the complications of frequent lab draws
STUDY the Results
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10
ml o
f Blo
od D
raw
n (p
er p
t per
day
)
Average Daily Volume of Blood Draws Post- intervention MEAN = 36.84 Pre-intervention MEAN = 46.79
Inte
rven
tion
00.5
11.5
22.5
33.5
44.5
55.5
66.5
7
2/13
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103/
11
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Fre
quen
cy o
f Dra
ws (
per p
t per
day
)
Average Frequency of ICU Blood Draws Post-Intervention MEAN = 2.97 Pre-intervention MEAN = 3.99
Inte
rven
tion
Return on Investment • Decrease costs associated
with laboratory tests • Reallocation of resources
(LLTs) • Decrease in PRBC
transfusions • Decrease in costs and
complications of PRBC transfusions
• Decrease in catheter related blood stream infections
• Improved ICU “throughput” • Improved communication
among the team
• Brainstorm session with key players to identify factors that were important to blood draws in the ICU
• Developed an affinity diagram into
clusters that became the elements of the Ishikawa diagram
• Developed a process map to identify
where we may have the greatest impact
• Generated run charts to reflect the
data over time Figure 1. Ishikawa Diagram
Figure 2. Sample Data Collection Spreadsheet Figure 3. Process for Lab Ordering
Challenges and Barriers Difficulty with data
collection Multiple causes of variation Inconsistent support from
leadership “Open” ICU
Expand scope of project to include critically ill surgical patients
Explore other process steps that were identified by the team
Efforts to improve communication and coordination of laboratory ordering among the healthcare team
Create a decision support tool for use on daily rounds to address laboratory ordering strategies
ACT on Next Steps
Graph 1: Average Daily Volume of Blood Draws
Graph 2: Average Frequency of ICU Blood Draws