The Use of Data-driven Quality Strategy to Improve the Processes of Patient Identification and Pre-transfusion Specimen Collection Documentation at Sidra Medicine

Abstract

Background: Regardless of healthcare technology advancements and widespread use of barcode identification technology, patient identification errors still occur. Several studies and benchmark programs have shown that patient misidentification is the leading cause of transfusion-associated reactions and fatalities. Therefore, it is recommended to use barcode technology to reduce and possibly eliminate avoidable blood transfusion errors. However, none of the available studies so far has investigated the compliance with using barcode technology to identify patients and specimens during the process of specimen collection for transfusion. Aims: This project aims are (1) Identify the prevalence of noncompliance in barcode scanning assisted patient identification at the pre-analytical phase during specimen collection at Sidra Medicine; and (2) Evaluate the causes of barcode scanning noncompliance; and finally (3) Develop quality improvement action plans that could reduce noncompliance events. Materials and Methods: The frequency of blood typing specimen collection noncompliance events between January 1, 2019 and December 31, 2019 were retrieved from the Laboratory Information System (LIS) module of Transfusion Medicine Laboratory report. Quantitative and qualitative analyses of data included stratification of collections by role and collection event, and finding possible sources of errors were performed. Accordingly, process improvement plans specific to each department involved in specimen collection were established. Results: Collection compliance rates of a total of 6387 blood typing specimens were evaluated. Full barcode scanning identification of both patient and specimen was utilized in only 33.6% of total collections during the baseline study period. The remaining two thirds of collections were override events, in which no barcode scanning at all represented 31.3%, and the sample accession label was scanned but not the patient armband in 32.3% of total collections. In addition, there were significant differences between phlebotomists and nurses with more phlebotomists performing the full scanning and specimen label scanning only, while more nurses obtained specimens without scanning either identification of patient or specimen (p<.001). Conclusion: Our study highlights poor utilization of barcode scanning to verify patient and specimen identification during specimen collection. We launched a quality improvement project that identified the causes contributing to non-compliance practices, and formulated improvement strategies.