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

Abstract

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.

Keywords: arterial line; blood collection; hemolysis.