Versiti Blood Centers of Michigan Hickory Corners, Michigan, United States
Background/Case Studies: During a 2022 yearly audit of success rates, the upper Midwest based blood centers experienced an increasing Quantity Not Sufficient (QNS) rate due to phlebotomy losses during the COVID-19 pandemic. There was an experienced increase of 3.6% QNS to 4.5% (0.9%) from March 2020 to March 2022. The purpose of this project was to mitigate the increase of QNS results through implementation of previously learned phlebotomy processes and standardization of education opportunities that would impact multiple donor centers in different states.
Study
Design/Methods: All non-successful donations from January 2020 through June 2022 were reviewed and placed into one of three categories: failed venipunctures, blood loss venipunctures or donor reactions. In June 2022, fifty random phlebotomists were observed to pinpoint any deviations from standard operating procedures. At the end of June there was a reinforcement of the standard operating procedure (SOP) that phlebotomists are to offer donors the ability the use of both arms and must inspect viability of those options. Phlebotomists were encouraged to fill out a vein viability form to assist with increased vein access success probability.
Results/Findings: Review of non-successful donations showed that there was a total of 14,572 QNS results equating to, 7393 failed sticks (50%), 6321 Blood losses (44%) and 858 Reactions (6%) from January 2020 to June 2022. During the direct observation period of June 2022, we observed that 64% of phlebotomists were not offering the donor the ability to use either arm for cannulation purposes but taking the word of the donor and did not observe all viable options for phlebotomy. Phlebotomists relied heavily on the donor’s choice and did not initiate inspection unless medically notated that choices were unavailable for cannulation. Process improvement of 0.155% occurred during the reinforcement implementation of the process. In January of 2022, the average QNS rate for the observation area was 5.05%. At the end of the implementation in November 2022, QNS was 4.18%, an effective drop of 0.87%. Conclusions: Enforcement of the Standard Operating Procedure regarding the designated phlebotomist being required to inspect both donor arms prior to phlebotomy unless otherwise noted and the utilization of a vein viability form tool improved the QNS rate statewide assisting in the process for donors in vein choice viability.
Importance of research: This research is important for the field to clarify the vein viability options in blood donor cannulation procedures and the importance of training to improve phlebotomy success which subsequently impacts positive results and improved experience for donors
