A-344 Don't Get Rejected: Reduce Specimen rejection in Phlebotomy

Abstract Background Pre-analytical specimen rejection plagues laboratories, patient care decisions, and satisfaction. Rejection data used for quality improvement varies often excludes pediatric-only populations. With an outdated benchmark of 2.2% total rejections, our phlebotomy department was maintaining a baseline rate 1.39%. We assessed only tests where result not able to be given reasons of: Quantity Not Sufficient (QNS), Clotted, Hemolyzed, improperly collected or handled, unlabeled mislabeled. While exceeded current benchmarks, continued improvements were desired provide the best experience. collaborated with Vascular access team (VAT) at institution improve processes. Methods Specimen defined as any sample(s) analysis performed due Clot, Hemolysis, improper collection/handling, unlabeled/mislabeled specimens. Over next 3 months, samples obtained by outpatient inpatient phlebotomist draws reviewed pre-analytical errors. VAT began meeting monthly developed 1-day shadow experience new hires mechanism identify DVA patients. In collaboration Information Management, coping comfort plans (CCP) implemented in medical record which documented preferences staff observations potentially painful procedures. The CCP paved updates tip sheets, purchases transilluminators, stock heat packs stations. Additional aids purchased areas. A communication center installed allowed area write down room numbers DVAs display rates. Improved regarding rejected publicly posted on name. These characterized type number rejections well stoplight color coding depict acceptable, risk, unacceptable errors phlebotomists monthly. Goals center. 18 months allotted implementation final goal ≤0.5% allowing quarterly reports, changes, PDSA cycles. Results Initial surveys discovered 71% unaware their samples, 57% this monitored metric, 100% agreed importance. During quarter one reporting, it assumed that all would fall ≤1.25% Q2-Q3, ≤1.00% Q4, Q2 following fiscal year ≤0.50%. average rates were: Q1: 1.05%, Q2: 1.0%, Q3: 0.69%, Q4: 0.70%. 2 0.5%, 0.3%. Post-implementation survey conducted resulting aware important. Staff additionally suggested have noted higher morale trust within group partnering project workflows. Average 1- 2-year post implementation: 0.05% 0.42% respectively. Conclusion causes waste but risk patients results treatment can delayed. By changing configurations workflow, tools, records, key drivers change