Honors Theses and Capstones

Date of Award

Spring 2023

Project Type

Capstone

College or School

CHHS

Department

Nursing

Program or Major

Direct Entry Master's In Nursing, Clinical Nurse Leader

Degree Name

Master of Science

First Advisor

Kaitlyn Liset MS, RN, CNL

Second Advisor

Justin Woods MS, RN, CNL

Abstract

BACKGROUND: Blood cultures are a widely utilized tool that aids in diagnosis and treatment plans. Contaminated cultures are incredibly costly, resulting in increased length of stay, opportunistic infections, pharmacy costs, repeated laboratory tests, and decreased reimbursements. Evidence suggests higher incidence rates of blood culture contaminations (BCCs) are seen in emergency departments (ED) compared to any other unit within a hospital system. The internationally accepted threshold of 3% is not often met, although recent studies suggest a lower rate is possible, even in critical care environments. A literature review resulted in data showing that educational-based interventions focusing on adherence to facility policy, standardization, and evidence-based practice successfully decreased BCC rates. This quality improvement initiative aimed at reducing BCC in a rural emergency department to under 2% following one month of educational interventions.

LOCAL PROBLEM: This project was conducted in a 45-bed (25 hospital rooms, ten hallway beds, six overflow beds, and six additional rooms in the annex for psychiatric holds) rural emergency department. Inconsistent BCC rates ranged from 0.7% to 3.9% in a year. A previous quality improvement project conducted in the same microsystem in 2022 displayed an information graphic for staff reeducation. Rates initially reduced; however, the decrease did not continue. After partnering with key stakeholders, it was decided that additional interventions were warranted to create sustainable change and promote better healthcare outcomes.

METHODS: This quality improvement initiative utilized a Plan-Do-Study-Act model to evaluate a previous quality improvement project conducted in the same microsystem and adjust the intervention to promote sustainability. This current project utilized a before and after study design to assess for decreased BCC rates following an adjusted educational intervention.

INTERVENTION: To promote adherence to facility protocols and best practices, informational graphics were created and displayed throughout the ED. They were placed on intravenous (IV) supply carts where collection supplies are kept, and areas like staff bathrooms and highly trafficked lounges. A poster detailing the current state of the microsystem and costs associated with increased BCC rates was created to offer feedback and displayed in the main breakroom. Site visits were made weekly to assess for damaged materials and to answer any questions from staff.

RESULTS: The goal of decreasing BCC rates below 2% was achieved. Following the month-long interventions in June 2023, the BCC rate fell to 1.7% from a high of 3.9% at the beginning of the year.

CONCLUSIONS: Many factors affect BCC rates in a microsystem. Very little time and resources can be devoted to learning in critical care environments like an ED. It is essential to bring education to staff to promote participation. Consistent and recurring reinforcement of education and real-time feedback is crucial in creating change and ensuring sustainability.

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