Congress Abstracts 2006

7

CATCHING THE BUG WHILE IT IS ACTIVE. Janelle Wood, RN, BSN, Judy Delgado, RN, BSN, and June Eilers, PhD, RN, BC, CS, Nebraska Medical Center, Omaha, NE.

Infections remain a leading cause of death in patients with cancer. Due to the nature of the disease and its treatment induced suppression of the immune system patients are at a significant risk for increased morbidity and mortality related to systemic infections. Rapid identification of causative organisms is essential for optimum patient outcomes. Discussion with staff and examination of blood culture data revealed inconsistencies in our practice

Our goal was to use evidence-based practice to standardize blood culture collections, thus improving yield for the initiation of appropriate antimicrobial therapy.

Our performance improvement team worked with the Oncology/Hematology and Infectious Disease physicians to review current blood culture policy and make recommendations for an evidence-based protocol. We provided education through speaking at unit meetings, sending e-mails, and placing posters and handouts on the units to inform staff regarding the new policy and its rationale. Compliance with the protocol was monitored based on weekly reports from the laboratory. Variations in practice were addressed on a regular basis.

Comparison of current data with that from an equivalent period of time prior to protocol change revealed excellent compliance with the newly established policy and procedure. There were 28 clinically useful blood culture reports during a three-month study period as compared to 15 during a prior three-month period. This is attributed to drawing cultures from multiple sites at the same time. In addition, the probable contamination rate during the study period was below the 3% ASM/CAP benchmark rate. This project demonstrates the ability of a unit-based performance project to promote improved standardization of care and compliance with policy and procedure for blood cultures.

Our data demonstrates how drawing a minimum set of two blood cultures from different sites improves yield and helps increase the number of clinically useful results. Nursing staff plays a pivotal role in the identification of patients requiring blood cultures and obtaining the necessary specimens in a timely accurate manner. The results of this project illustrate how implementation of evidence-based practice can serve to improve the quality of care delivered