The Use of Cross-Sectoral Cooperation to Reduce Emergency Room Blood Specimen Coagulation and Hemolysis Rate

Chu, Tsui-Ping

Monday, 22 July 2013

Tsui-Ping Chu, RN, MS¹
Mei Ling Lin, RN, BS²
Yi Jung Lu, RN, BS³
Ya Ying Lin, RN, BS²
(1)Department of Nursing, Chiayi Chang Gung Memorial Hospital, Chiayi Chang Gung Memorial Hospital, CHIAYI HSIEN, Taiwan
(2)Nursing of department ,Chiayi Chang Gung Memorial Hospital, Chiayi Chang Gung Memorial Hospital, CHIAYI HSIEN, Taiwan
(3)Nursing of department ,Chiayi Chang Gung Memorial Hospital, Chiayi Chang Gung Memorial Hospital, CHIAYI HSIEN,, Taiwan

Learning Objective 1: The learner will be able to develop effective processes for reducing the coagulation and hemolysis rate of blood specimen in ED.

Learning Objective 2: The learner will be able to is essential to develop the “Blood Specimen Collection Standard.

Purpose: Coagulation and hemolysis of blood samples create significant delays in the treatment and disposition of patients in the emergency department (ED). Although coagulated and hemolyzed specimens may reflect the presence of hemolytic anemia, in most cases they are due to preanalytical sources related to incorrect blood collection procedures, handling and storage of the samples; some of these are typical of the ED. It is essential to develop effective processes for reducing the coagulation and hemolysis rate of blood specimen in ED.The purpose of this project was to establish a comprehensive specimen collection process, to reduce the blood sample rejection rate through a cross-sectoral cooperation.

Methods:

The project term member included ED physicians, ED nurses, and Medical technologists. Several strategies, such as providing in-service education, using vacuum blood collection techniques, finding a blood collection angle, applying DC-extension tube for blood collection, employing smaller capacity blood collection tubes, and developing a “Blood Specimen Collection Standard Operating Books” and teaching CD for nurses who were responsible for collecting blood, were utilized to accomplish the project purposes.

Results:

In the first stage, the blood sample coagulation rate was decreased from 0.51% to 0.23%. However, the hemolysis rate increased from 0.47% to 1.48%. In the second stage, we decided to have a 3ml tube for blood collection. The blood sample coagulation and hemolysis rate were decreased to 0.14% and 0.70%. Blood specimen rejection rate was decreased from 1.23% to 0.81%.

Conclusion:

The “Blood Specimen Collection Standard” can effectively reduce hemolysis and coagulation rate of blood specimen, as well as the rejection rate.

Key words: emergency department (ED), blood specimen, coagulation rate, hemolysis rate

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