As a relief charge, Chair of the Unit Practice Council, and member of the Shared Governance Council, my team members and I created a PDSA regarding phlebotomy requests. Inpatient nurses in an acute care setting are trained to complete bloodwork for our patients when ordered by the physicians. Our confidence levels should be high, and we should be able to attempt on our own with each order by using the proper resources we have in hand alongside other patient care responsibilities. This of course would be the best-case scenario. C2SU has a very high number of lab assist requests causing more work for the technicians while feeling overwhelmed. Attempting to identify the root cause and identify barriers we began to research and interview our staff, we have found that some nurses feel they are not adequately trained in phlebotomy techniques and the frequency of this training is once a year which can lead to improper blood collection and patient discomfort. Other reasons include time constraints as they already have a busy workload that can lead to time pressures. One of the most vital pieces that we found to increase these requests is that within EPIC, the nurses can easily switch the collection for a patient from unit to lab. As leaders we were allowing for this switch without even knowing at times, once it is switched to the lab then a phlebotomist would come up and draw the blood, leaving more work for them, delay in care, and one less thing for the nurse to worry about while also losing the knowledge of the skill along the way. The feedback received from lab technicians is that some of these patients had veins that were easily accessible to draw blood and found no need for the request. We started looking at numbers from January 2024 (23%) up to October 2024 (13%). Our goal was to reach the lowest percentage possible of lab assist requests with a benchmark of 10% by December 2024. To reach this goal we added the following process:

EVERY SHIFT:

• Verify collection is set to UNIT unless SBAR handoff states the need for LAB. (very hard stick, pt preference) Notify leader

• EVALUATE/ ATTEMPT: The RN will evaluate pt’s veins, and proceed to draw blood, if

unsuccessful,

• Notify the leader to attempt

• LEADER:

• Evaluate and attempt. If no success,

• ONLY the leader will change the collection to LAB

• RN/LAB TECH:

• RN should be with the tech to learn/discuss tips for better

results with the next attempt.

The nurse leader can take the nurse with them and attempt/review together as additional education. Make use of the resources around us as well. We have heating pads as a technique to help make veins more visible. We have vein finders which help tremendously in finding veins and accuracy of the blood draw as they guide you so you are to poke. We have dates for our staff meeting and the vein finder brand manager will come out and teach us how to make the best use of the machine. By the time we finished our project and analyzed all the data, we ended the year with 9% lab requests. We continue to keep the process in place.

(Conroy et al ) 20221 states that reducing unnecessary lab assist requests is crucial for improved patient safety, reduced healthcare costs, and efficient resource utilization by minimizing unnecessary testing, potentially leading to fewer complications and better patient outcomes.

Conroy, M., Homsy, E., Johns, J., Patterson, K., Singha, A., Story, R., Finnegan, G., Shively, K., Faherty, K., Gephart, M., Cape, K., Exline, M. C., Ali, N., & Besecker, B. (2021). Reducing Unnecessary Laboratory Utilization in the Medical ICU: A Fellow-Driven Quality Improvement Initiative. Critical Care Explorations, 3(7), e0499. https://doi.org/10.1097/CCE.0000000000000499