Reduce patients’ irritation with blood draws, tests
Reduce patients’ irritation with blood draws, tests
Improvements came out of analysis of surveys
While venipunctures and IV starts are never a fun prospect, these procedures appeared to be particularly irritating to patients of the 99-bed, private, nonprofit Bay Area Medical Center of Marinette, WI, according to lackluster scores on patient satisfaction surveys.
In early 1996, when the hospital decided to make customer satisfaction its top priority, the overall hospital score placed it in the 75th percentile, meaning that 25% of other hospitals surveyed performed better.
The scores for specific aspects of blood draws and IV starts ranged from the 64th to the 87th percentile in surveys by Press, Ganey Associates Inc. in South Bend, IN. These areas became a chief target for improvement. "Our goal for the whole hospital in 1996 was to have the hospital score above the 90th percentile," says David Drebert, MS, MBA, MT, laboratory administrative director.
Bay Area Medical Center reached its goal in fall 1997 when its overall customer satisfaction score rose to the 98th percentile, placing it eight nationwide in the Press, Ganey database, Drebert says.
The actual overall hospital scores ranged from slightly more than 85% to above 88%. (See Bay Area Medical Center chart, p. 5.) Also, customer satisfaction with the venipunctures and IV starts rose to a percentile range of 92 to 99.
This is how the hospital succeeded in satisfying nearly all of its patients and how others could implement a similar program:
1. Follow the process improvement philosophy.
Bay Area formed teams to analyze, make recommendations, and develop action plans. "They created a blueprint that indicated what they wanted to get done and the time span in which they expected to get it done," Drebert explains.
The teams focused on professionalism, attitude, and facilities. For example, one team asked the staff to identify problems that are irritating to patients.
The professionalism team identified IV starts and venipunctures as an important issue, and a venipuncture team was formed. The team has closely monitored the customer satisfaction scores for areas related to these skills, including the skill of the IV starter, the courtesy of the IV starter, the skill in taking blood, and the courtesy of the tech.
They put goals in the initial blueprint, including the goal of scoring in the 90th percentile or better. And they included a goal of when they expected to find some results.
"We wanted to make sure these are not processes that keep on going forever and take on a life of their own," Drebert says. "We wanted [staff] to go in, do their jobs, get out, and be done."
2. Understand what is really happening.
They also began to tear the data apart, breaking down Press, Ganey’s information into departments and nursing floors to gain further insight into what were causing problems.
Patient comments were analyzed. "Some negative comments appeared more than once, and a lot of it had to do with IV starts," Drebert states.
Specifically, the team found that:
• 21% of patient comments were related to laboratory draws.
• 69% were related to nurses and paramedics.
• 43% were related to the number of attempts at IV starts.
• 43% were related to techniques or skill in starting IVs.
• 2% were related to the attitude of the person performing the venipuncture.
The team also reviewed hospital and department policies regarding IV starts and venipunctures and flowcharted the processes.
Those measures helped the team understand that the potential problems, which related to staff training, placing orders, equipment, access to the patient, patient education, and selection and care of the venipuncture site.
Drebert says they asked themselves: "What are the things that get in their way to keep them from doing a good job?" and "What sorts of things are told to the patient?"
3. Look for areas that may be improved.
The team focused on areas that presented hurdles or barriers to employees being able to do a good job, Drebert says.
Here are the process improvements the team selected:
• The hospital needed to enhance training for lab and nursing personnel, including starting a preceptor program that enabled a new employee to be paired with an experienced employee. Drebert says the nursing department already had a mentoring program, and the laboratory department then followed suit.
• Departments needed to revise the competency checklist for new employees and strictly enforce the requirement that employees have to perform 10 venipunctures with supervision before doing one on their own.
• Management needed to review and revise department policies to make sure they are consistent. One example included limiting phlebotomists to making only two attempts at venipuncture.
• Management needed to encourage staff to use Emla Cream as a local anesthetic for IV starts and to provide education on the procedure for using it.
• The hospital needed to improve lighting and access to a light switch at each patient’s bedside. "The way the beds were set up, you had to reach over the patient to pull the string to turn the light on," Drebert explains. "So that could be pretty irritating to the patients to have someone reach over them to do something like that." In addition, the lighting was glaring and disconcerting to patients who had been sleeping before the phlebotomist or nurse arrived.
• Management needed to educate nurses about different draw priorities and encourage combining tests to reduce the number of blood draws.
• The hospital needed to standardize venipuncture equipment so new products would not jeopardize performance.
• Nurses needed to discuss patient’s history and experience with venipunctures during the nursing assessment.
• Nurses needed to give patients an ID band that indicates whether a particular limb cannot be used.
• The hospital needed to purchase a restraining board for pediatric draws.
4. Make the necessary changes.
The various departments went right to work, but some changes took far longer than others, Drebert says.
For example, the change in beds and lighting required a major facility upgrade and took about two months to implement.
"We bought new beds throughout the hospital," Drebert says. "The lighting was changed so you could get more subtle lighting without the glare in patients’ eyes."
As part of another change, the laboratory staff created some printed material to educate patients about the lab tests. The material answered some commonly asked questions, such as what a patient should do if he is bruised.
The changes that worked well were made permanent, and when the customer satisfaction scores began to dip again in the fourth quarter, then department directors reinforced the policies and scores again improved, Drebert says. "We monitor all scores on a monthly basis."
[For more information, contact David Drebert, MS, MBA, MT, Laboratory Administrative Director, Bay Area Medical Center, 3100 Shore Drive, Marinette, WI 54143. Telephone: (715) 735-4200, Ext. 3336.]
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