Author(s): Judith Guidash, BSN, RN, CPHQ
Quality Improvement Specialist
Nemours Children's Health

Judith Guidash brings more than 30 years of healthcare experience to leading quality improvement initiatives in healthcare. She has worked in a variety of clinical settings improving patient outcomes. She graduated from the University of Delaware with a Bachelor of Science in Nursing and maintains her RN licensure. After 20 years in pediatric clinical care, she transitioned to the improvement field, working in database management, measuring patient outcomes, and coordinating and facilitating quality improvement projects. Her quality improvement experience spans across outpatient and inpatient settings, acute care, and intensive care, as well as specialty care. In 2018, she joined NAHQ and earned her CPHQ certification. Currently, she is a member of the Quality and Safety Department at Nemours Children's Health, Delaware and leads, facilitates, and mentors teams working to improve patient outcomes.

Competency Domain: Performance & Process Improvement

Description: The clinical decision-making process for obtaining a blood culture in the pediatric population is highly variable and not standardized. Contamination and false positive results can result in unnecessary antibiotic exposure. We aimed at reducing the rate of blood cultures in the CICU by 33% from a baseline of 17.56 blood cultures/ 100 patient days to 11.7/100 patient days.Problem:Clinical decision-making processes for obtaining a blood culture in pediatric populations is highly variable and not standardized. Contamination and false positive results can result in unnecessary antibiotic exposure. Goal: reduce the rate of blood cultures in the CICU by 33% from of 17.56 blood cultures/ 100 patient days to 11.7.Measurement:We tracked the rate of blood cultures per 100 patient days monthly as our outcome measure. A delay in treatment of sepsis was tracked as a balancing measure. We performed chart reviews on all positive cultures to identify treatment delays and areas of opportunity.Analysis:We used control charts and standard rules using The Health Care Data Guide to identify common and special cause variations. For antimicrobial use, inpatient days was provided by the financial department. Days of therapy was extracted from the EMR using QlikView. Data was aggregated and analyzed using Microsoft Power BI.Implementation:We created an algorithm to standardize the clinical decision-making process for obtaining blood cultures. We developed an order set in the electronic medical record to prevent unnecessary repeat blood cultures from being ordered and drawn. We shared data regularly with the multidisciplinary team in the unit to optimize engagement.Results/DiscussionThe blood culture rate decreased from 17.56/100 patient days to 10.40/100 patient days demonstrating a 41% improvement from baseline. No missed sepsis events were identified during the study period. There was a direct correlation between the decrease in blood cultures drawn and a decrease in broad spectrum antibiotic usage.

Evaluation: Complete Poster Evaluation