Impact of a Modified Protocol for Blood Collection on Hemolysis Rates and Nurses' Perceptions About Improving Their Practice Environment.

PURPOSE: In 2019, approximately 5% of blood draws in the postanesthesia care unit (PACU) were hemolyzed compared to 1.1% across other hospital units. A preliminary review showed almost 60% of patients sampled blood employing arterial lines in the unit. The purpose of this quality improvement study was to improve blood drawing practices and reduce the occurrence of hemolysis. A secondary aim was for PACU nurses to lead this unit-based initiative. DESIGN: Team members led by PACU nurses used the Deming model of quality improvement as a framework to better the process of specimen collection. METHODS: The team employed the Plan-Do-Check-Act procedure to organize their improvement efforts. Specimen collection protocol was modified to include manual aspiration from arterial lines and hemolysis data was retrieved from laboratory generated reports and electronic medical records. FINDINGS: By changing blood drawing practices, the hemolysis rate was significantly reduced from 5.2% to 3.6%. Two years postimplementation, rates continue to decline with the current rate at 1.97%. CONCLUSION: This nurse-led interdisciplinary improvement initiative identified and trialed evidence-based solutions to reduce blood specimen hemolysis.

Creating a Business Case for Success.

Health care is a highly competitive environment where managers must compete for finite resources. The Centers for Medicare & Medicaid Services-directed reimbursement models such as value-based purchasing and pay-for-performance heavily focused on quality improvement and nursing excellence are having a major impact on financial reimbursement for health care services in the United States. As such, nurse leaders must function in a business-focused environment where decisions regarding resource allocation are driven by quantifiable data, the potential return on investment, and the organization's ability to provide quality patient care in an efficient manner. It is imperative for nurse leaders to recognize the financial impact of potential additional revenue streams, as well as avoidable costs. Nurse leaders must also be skilled at translating the return on investment for nursing-centric programs and initiatives, often hidden in anecdotal terms and cost avoidance rather than revenue generation, to ensure appropriate resource allocation and budgetary assumptions. This article uses a case study framed within the business case to review a structured approach to operationalizing nursing-centric programs and highlights key strategies for success.