The document describes a quality improvement project to implement a written "Blood Board" to improve staff satisfaction with the laboratory blood draw process on a cardiac unit. Staff satisfaction was measured before and after the change using a survey. Initially, satisfaction averaged 3.33 out of 5. After introducing the Blood Board, satisfaction increased to an average of 3.87 out of 5, though the goal of 4.0 was not yet reached. The project aimed to better coordinate drawing blood by incorporating the existing electronic health record system while improving communication between staff.

1. Improving Staff Satisfaction of Laboratory Blood
Draws with a Written Blood Board
Christie Hovis, MSN(c), CNL(c)
Saint Louis University School of Nursing
BACKGROUND: AIM:
CONCLUSION:
METHODS:
OUTCOME DATA:
The focus of my capstone project is to improve the
process for ordering laboratory tests and collecting
blood specimens for patients on a high-risk cardiac unit
at a large teaching hospital.
• Lab tests are ordered using a computerized provider
order entry (CPOE) system where a nurse practitioner
or physician enters the order into the computer
• The nurses and patient care technicians (PCTs) are
responsible for identifying orders, collecting blood
specimens, and sending them to the centralized
laboratory
• The nurse collects blood specimens from a patient with
a PICC line or central line, and the PCT is responsible for
those patients with peripheral lines
• Many of the patients receive anticoagulants and require
multiple lab tests at varying times per day
• Timely collection of these tests may impact the
patient’s ability to undergo a procedure that day or may
indicate that a patient is within therapeutic levels for
discharged.
• Missed or delayed lab work could potentially delay a
patient’s procedure, delay discharge, and/or delay
interventions indicated for anticoagulation therapy.
• Potential benefits of using electronic health records and
CPOE systems, include increasing the quality and
efficiency of healthcare delivery
• However, in order to benefit from these technological
advances, health care providers need to be able to
effectively use these systems in the clinical field.
(Khajouei, Wierenga, Hasman, & Jaspers, 2011)
It is important to find a system for this unit that will
effectively incorporate the usage of their current CPOE
system and promote higher satisfaction with the blood
draw process.
Through the implementation of a “Blood Board”, I aim to improve upon
and increase staff satisfaction with the blood draw process. My goal is
to increase the staff’s rating of the process from a baseline of 3.33 out
of 5 to an average rating of 4.0 out of 5.
Introduction and implementation of this process improvement project occurred
from November 2014 to April 2015. Through input received from my nursing
preceptor, the nurse manager, and the staff members of the unit, in the form of
a survey, the process of ordering laboratory tests and collecting the blood
specimens for patients was identified to be in need of improvement.
A Blood Board template was introduced to staff on February 19, 2015 during a
unit practice council meeting, and unit-wide implementation of the Blood Board
began soon after. Follow up surveys were collected to identify staff satisfaction
with the blood draw process after the introduction of the Blood Board.
Staff satisfaction of the blood draw process was
measured in November 2014. The average rating of this
process was 3.33 on a scale of one to five, with one
being poor and five being excellent.
After implementation of the Blood Board, a follow up
survey collected in April 2015 demonstrated an
increased satisfaction with the current process. The new
average staff rating for the blood draw process was 3.87
on a scale of one to five.
As the medical field continues to rely more heavily on
technology, it is important to consider how well that
technology is fitting into the day-to-day clinical workflow
of a unit. Ease-of-use of a CPOE system is important;
however, effective communication rather than reliance
on technology is an important component. Whether
using the handwritten blood board or entering an order
into the computer, orders are best identified when verbal
communication of a new order is included.
Where’s the Breakdown??
3.33
3.87
0
1
2
3
4
5
1st Survey (Nov 2014) 2nd Survey (April 2015)
Measuring Staff Satisfaction:
Average Rating of Blood Draw Process
goal = 4.0
References:
Khajouei, R., Wierenga, P. C., Hasman, A., & Jaspers, M. W. M. (2011). Clinicians
satisfaction with CPOE ease of use and effect on clinicians’ workflow, efficiency
and medication safety. International Journal of Medical Informatics, 80(5), 297-
309. doi: http://dx.doi.org/10.1016/j.ijmedinf.2011.02.009
Patient needs
labs ordered
Health Care
Provider is notified
OR
HCP identifies need
for lab work
HCP enters orders
for labs in Compass
(CPOE)
Nurse/PCT
Identifies or learns
about lab orders
Does the
patient have a
PICC line?
Nurse draws blood
and sends it to lab
PCT
Draws blood and
sends it to lab