DNP Scholarly Projects

Abstract

Purpose: The purpose of this project was to implement a quality improvement project to improve blood specimen acceptance rates at a specific Emergency Department (ED) using strategies to enhance knowledge, improve motivation, and reinforce skill. Background: Specimen acceptance rates continue to fall outside of the recommended target rate of 98% or higher at a specific ED. In this particular ED, the responsibility for specimen collection has shifted away from phlebotomists and towards nurses, many of whom have received little to no phlebotomy training. Without proper blood collection techniques, specimens are more likely to be rejected, and re-collection of rejected blood specimens delays patient care and decreases overall ED efficiency. While much research is available regarding evidence-based practices, blood specimen acceptance rates continue to fall out of the recommended target range. The project leader hypothesizes that the implementation of passive educational strategies could be one of several factors related to low specimen acceptance rates. Methods: The scholarly project was a quasi-experimental project with a pre/posttest design using the Informational-Motivational-Behavioral (IMB) Model as its theoretical foundation. Thirty-eight staff members’ knowledge and motivation regarding blood specimen collection were compared before and after the implementation of an educational module. Motivational and reinforcement strategies were provided to the intervention group. Pre/posttest scores were then analyzed and compared using Mann Whitney-U and Friedman’s ANOVA by Rank tests. Results: Despite the implementation of this scholarly project, acceptance rates remained out of the recommended target goal of 98% or higher in this specific ED. Statistical analysis revealed a significant difference in one-month posttest knowledge scores between the treatment and control groups. Although the mean rank knowledge score was higher in the treatment group as opposed to the control group, post-hoc analysis revealed a statistical difference in the control groups’ specimen acceptance rates. However, a significant difference was not discovered in the treatment groups’ specimen acceptance rates. Conclusion: The combination of enhanced knowledge, increased motivation, with reinforcement of blood specimen collection skills did not improve overall blood specimen acceptance rates in this ED. These results are not consistent with existing literature regarding the application of the IMB model, but ineffective implementation of the IMB model’s components may have contributed to the results. Results of this project substantiate the need for periodic venipuncture training among ED staff members due to knowledge degradation over time. Furthermore, adoption of standardized guidelines in this particular ED may improve blood specimen acceptance rates, which could ultimately improve the timeliness of patient care and ED staff efficiency.

Date

5-1-2017

First Advisor

Dr. Linda Wofford

Second Advisor

Dr. Tammy Legge

Department

Nursing, School of

College

Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project

Degree

Doctorate of Nursing Practice (DNP)

Degree Level

Doctoral

Degree Grantor

Belmont University

Keywords

behavior; blood specimen collection; education; Emergency Department; hemolysis; information; knowledge; motivation; nurse

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