Project setting: Large academic medical center: inpatient units, emergency and perioperative departments
Problem statement: Patient safety/staff workflow: Hundreds of mislabeled laboratory specimens annually result in unnecessary specimen collections (cost, patient discomfort/inconvenience, staff inefficiencies) often lead to unnecessary treatment or lack thereof. Duplicate work processes and manual data entry also contribute to errors.
Project objectives: Reduce patient identification errors, specimen labeling errors; prevent unnecessary needlesticks; identify, address unique workflow needs of specialty units; provide training that results in competent staff; provide support services during/after implementation phase to promote staff technology adoption and demonstrate patient safety benefits; evaluate effectiveness of phased implementation approach.
Intervention or change implemented, if any: Implement bedside lab verification (BLV) with automated label printing ("Mobilab" application, handheld printer), to include the following:
* display specimen collection list/reconcile orders with one user interface
* positive patient identification (scan wristband; second patient identifier)
* print label, scan label on collected specimen (bedside); match order with specimen, patient
Actions, processes, and methods used to solve the problem and meet the objectives:
* engage multidisciplinary team (lab, nursing IT, information services, nursing education, staff nurses, providers, respiratory therapy)
* project management using phased implementation approach including stakeholder engagement, hardware analysis, workflow analysis (pre/post)
* update departmental policies
* blended learning approach
* unit-based specialists (UBSs) for training, support, feedback
* focus groups of users, UBSs, and charge nurse met daily, weekly, biweekly: "core team"
Data, metrics, and methods used to determine whether the objectives were met:
* preimplementation and postimplementation documentation of mislabeled specimens
* evaluation of success factors for user adoption
* contextual observation of users
* automated audit reports (objective feedback to staff, post-implementation competency)
* lab time log in lab comparing manual to automated processes
* lab issues log by unit
* survey users (pre/post)
Outcomes:
(1) reduced mislabeled specimens by 88%
(2) decreased lab specimen processing time (certain tests) by 50% resulting in less time between collection and result notification (unanticipated benefit)
(3) reduced manual lab specimen processing: fewer opportunities for human error (unanticipated benefit)
(4) streamlined lab order reconciliation process: fewer duplicate orders and duplicate specimen collections
(5) focus groups of UBSs, educators, charge nurses, and analysts identified and addressed specific workflow needs, ie, placement of second wristband, creative placement of scanners in operating rooms to optimize workflow and safety
(6) postimplementation issues categorized into three action areas: practice/process, education/training, change management
(7) phased implementation approach allowed sufficient time and efficient use of project and unit resources for optimization of processes including successive building on lessons learned resulting in fewer post-go-live issues with each phase
Conclusions and recommendations for practice:
* importance of demonstrating relationship between BLV and enhanced patient safety to staff
* key indicators for success to optimize and advance information systems used by nurses included process modifications based on end-user recommendations
* importance of interdisciplinary implementation team engaged from project onset
* roles of UBS, core team, and clinical nurse specialists: gaining user buy-in, identifying/addressing workflow and post-go-live issues
* staff feedback: need additional hands-on training, more reliable test environment
* phased implementation approach: allowed focused attention with specialty-area users with unique workflow needs
* competency evaluation (analysis in progress) to be discussed
Contact the corresponding author:
Carrie Stein ([email protected]).