Has anyone been able to get their ED managers to work successfully with them to decrease the number of hemolyzed samples?  The lab believes that blood draws should be a separate peripheral stick, not drawn with the catheter to start the IV.  The hospital Quality Outcomes group is willing to look at data and to work with the lab. Any successful ideas would be greatly appreciated. Thank you.

That is a CQI project of ours.  We currently keep track of where all the hemolyzed samples come from and who drew them.  We are not yet to the data compilation stage, but I can tell you that more hemolyzed samples come from ED draws through IV sites.

"Has anyone been able to get their ED managers to work successfully with them to decrease the number of hemolyzed samples?" 

No and they have no intention of changing their procedure. Probably 1/4 of our samples from ER are hemolyzed due to collection from an IV start. They feel that it is better to re-stick 1/4 of the patients a second time than to stick all of the patients twice on admission. We never get around this argument at our place either.

LR 

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I think that no matter where you go, there are probems (especially hemolysis) from ED-drawn samples.  From the few facilites that I have worked at over the years, I have noticed this to be true. 

 A few months before I departed one facility, we started tracking all sorts of variables from ED samples - mislabeled, unlableled, hemolysis, short draws, contamination (drawn above IV, from medicated port, from heparinized port), more than one patient in a bag, etc.  I know that our one lab supv was a stickler for proper specimen integrity and would go to bat for us whenever a situation arose. 

They started to work on getting proper phlebotomy education out to them as well as the rest of the nursing floors, as they were all soon going to become responsible for a lot of their blood draws.  Were we going to be able to eradicate IV cathetar draws?  No.  Could we bring it to light for them that it could only increase turn around time by taking this common short cut, hopefully so. 

I, unfortunately, don't know the end result of this study, however, I do know that that tabulation sheet was often full by the end of the day.

This certainly is a common challenge across the industry. The key is working for a win-win spirit with ER leadership and getting them truly on board with you. We've seen some great results with IV start blood collection, especially using BD's adapter for direct vacutainer attachment. We've also provided inservices for staff, which can be helpful. Look for other laboratory service issues that both impact the ER and that you have more control of. Work for improvement in one or more areas and share that with the ER as evidence that you are really there for them. Truly, the most important issue is allowing the ER to see you as a partner in their patient's care, a department who is there proactively to support them with their goals of bed turnaround and throughput, etc.

Wake up the pathologist to back up REJECTION of spec's drawn from an IV start. Why bother "testing" a poor spec. which would lead to an error in diagnosing? This is a waste of time and resources.

  

Our latest "solution" is to assign the phlebotomists to a position in the ER... don't think that will help too much, but at least it's worth a try.  In a smaller facility, the lab works directly with the ER staff and can actually make changes for the benefit of the patient.

Cathy Listermann:

Has anyone been able to get their ED managers to work successfully with them to decrease the number of hemolyzed samples?  The lab believes that blood draws should be a separate peripheral stick, not drawn with the catheter to start the IV.  The hospital Quality Outcomes group is willing to look at data and to work with the lab. Any successful ideas would be greatly appreciated. Thank you.

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The nurses and may be others invlved in drawing blood samples in ED are not sufficiently trained. They use improper procedures and methods to draw the blood. Some common poor techniques are : IV draws for their convenience and reduce workload for peripheral vein sticks, they force the blood into the vacutainer system or several other improper techniques. My suggestion will be that the ED should hire Emergency room techs that should perform phlebotomy along with their other responsibilities.