1220 / New blood sampling devices to prevent hemolysis

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Blood / Blood products
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Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
Total quality in laboratory diagnostics is a challenge which requires high degrees of safety, standardization and thoughtful monitoring of all activities of testing process. Evidence show that pre-analytical variables play a prevailing role in decreasing the quality of testing, and contextually increase the likelihood of diagnostic errors. The pre-analytical phase typically entails all those activities concerning patient preparation before testing, collection, handling, transportation and preparation of biological specimens. Among these phases, blood drawing represents indeed the most vulnerable step, which bears the highest probability of generating low quality and/or unsuitable samples, especially when consistent criteria for complete filling , appropriate mixing and suitable storage of primary blood tubes are not fulfilled. Among the different sources that may influence the quality of in vitro diagnostics, spurious hemolysis is indeed a foremost issue, because hemolyzed specimens are the most prevalent cause of sample rejection in most clinical laboratories, thus causing important safety, organizational and economical drawbacks, due to prudent suppression of unreliable test results. Hemolyzed specimens are a rather frequent occurrence in laboratory practice, and the rate of hemolysis is remarkably higher in specimens obtained in the Emergency Department (ED) as compared with other wards or outpatient phlebotomy services.
Description of the Patient Safety Practice
 
The Emergency Department and the Clinical Chemistry and Hematology Laboratory of the University Hospital of Parma, following a regular procedure for authorization, introduced the new S-Monovette devices. In contrast with other commercial systems, the S-Monovette is a primary blood collection system that combines the “vacuum” with the “aspiration” method, thus allowing a more gentle blood aspiration compared to traditional vacuum systems. Furthermore, it entails a less traumatic collection of blood cells.
The effectiveness of the new devices was assessed by comparing the number of hemolyzed samples (observed in the pre-implementation, 4 months) with the number of hemolyzed samples observed in the post-implementation 4 months. The number of blood samples was 14.155 during the pre-implementation months and 13.319 during the post-implementation period. The total number of hemolyzed specimens was 624 during the first 4-months period and 342 during the second 4-months period. Accordingly, The hemolysis rate was 4,41% with the use of conventional vacuum devices and 2.57% using S-Monovette, with a highly significant reduction of 42% (Chi-square test = 67.98; p < 0.0001). In conclusion, the adoption of these new devices has shown an effective optimization of blood collection in the Emergency Department: In the 4-month period, more than 300 patients avoided diagnostic delays and longer stay in the ED.
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
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Successful implementation's level  of this Patient Safety Practice across settings
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Involved health care staff
 
Physicians
Nurses
Scientific staff / researchers
Technical support / technician
Clinical manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
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Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/questionnaire.aspx?id=4998
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
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List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Gianfranco Cervellin; Giuseppe Lippi
Country: ITALY
Organisation: AZIENDA OSPEDALIERA DI PARMA
E-mail: gcervellin@ao.pr.it
Phone: There is no specified text here
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