What's in a Name? Reducing False Positive Blood Cultures by Making Care Truely ‘Accountable’

Abstract

False positive blood culture (FPBC) contamination causes increased health care costs related to unnecessary testing, antibiotic treatment and increased length of stay. The Emergency Department (ED) at Riverside Regional Medical Center (RRMC) was identified as being a key driver in total blood culture collections and incidence of FPBCs. Our hypothesis was that in order to build a sustainable solution to reduce FPBC, we had to hardwire the process in the ED. RRMC is a level 2 Trauma center; on average, over 13,000 blood culture samples are collected annually. A descriptive study design was utilized to evaluate the total number of blood cultures collected, total number of positive samples and then of these, the total number of “false” positive cultures. A FPBC was identified when one of two blood culture sets were positive with organisms considered to be contaminants. In 2006 when the first FPBC team began, we revised our blood culture collection policies and developed educational presentations to standardize and improve the collection process. These presentations were provided to physicians in various meetings and via computer based learning program modules to nurses and phlebotomists. The data was segregated according to incidence on units. In 2012, due to the high incidence of FPBCs coming from the ED, a focused improvement process based on accountability began. Department wide education was provided through skills fairs, shift change education and awareness training. Interventions included identification of the individual responsible for drawing the blood culture sample, focused observation and education of technique by the phlebotomy supervisor. If repeated FPBC were identified from the same collector, further retraining and supervision was provided. RRMC’s annual blood culture contamination rate prior to the initiative was consistently above the benchmark of 3%. Implementation of education and policy changes led to initial success below 3%, but when variances could be directly tied to the Emergency Department collectors, we were able to significantly reduce FPBC results. Reducing these errors in blood culture collection has led to rates below 2% for the last two years and a cumulative cost avoidance of over 1 million dollars since 2006. Education is an important foundation, but personal accountability, attention to detail and following protocols was what created two years of sustained and consistent reduction in FPBC collection and results. Previously, the ED was the leading cause of FPBC results; now they are in the minority.