(49) Implementing Best Practices to Decrease Hemolyzed Lab Specimens in an Outpatient Infusion Center

Title: Implementing Best Practices to Decrease Hemolyzed Lab Specimens in an Outpatient Infusion Center

Abstract : Basis of inquiry

In our Children’s Hospital, the outpatient infusion center (OPI) draws over 1200 blood specimens per month. In fiscal year 2023, 4.8% of blood specimens were rejected due to hemolysis. When a specimen is rejected, it necessitates a re-draw. This results in an increased workload for nurses and lab staff, greater patient distress, treatment delays, and higher institutional costs.

Purpose/Objectives

The purpose of this project was to identify the causes of hemolysis and implement targeted interventions. We set a goal to decrease the rate of hemolyzed specimens in the OPI to less than 2% by June 30th, 2024.

Methods

We assessed the current state of lab draws and collaborated with the lab to determine the types of specimens that were frequently hemolyzed. We identified specific nurses who had higher rates of hemolyzed specimens and those who were more successful.

Highly successful nurses outlined their techniques, which were compiled into best practice guidelines for all staff. Some of the common practices included having the patient take a deep breath, using a larger syringe (5-10cc), pulling back slowly and gently, inverting the tube multiple times, and sending specimens down ASAP. Some successful nurses reported using vacutainers instead of syringes.

Open discussions addressed misconceptions about the causes of hemolysis, reinforcing evidence-based practices. Best practices were shared, and staff collectively committed to improvement.

Findings or Outcomes

Staff are now highly aware of the best practices. The rate of hemolyzed specimens for the second half of FY24 was 1.76%. This improvement has been sustained with a current rate of 0.93%. This project highlights the impact of interdisciplinary collaboration in driving quality improvement.