489 - Improving positive acceptance and reducing time taken for blood specimen collection in children

Publication Number: 489.5127

Jing Yu, Guangzhou Women and Children's Medical Center,Guangzhou Medical University, Guangzhou, Guangdong, China (People's Republic); Bing Li, Women and children's hospital, school of medicine, Xiamen University, Xiamen, Fujian, China (People's Republic); Li Yang, Guangzhou Women and Children's medical center,Guangzhou Medical University, guangzhou, Guangdong, China (People's Republic); Shasha Han, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (People's Republic); Hui Liu, Guangzhou women and children's medical Center, Guangzhou, Guangdong, China (People's Republic); Kevin Tang, Bao 'an district maternal and child health Hospital, Shenzhen, Guangdong, China (People's Republic); Zengxiao Zhao, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China (People's Republic); Mingsheng Tang, Dongguan maternal and Child Health Care Hospital, Dongguan, Guangdong, China (People's Republic); Jing Huang, Guangzhou Women and Children's medical center, Guangzhou, Guangdong, China (People's Republic); Shahzeb Siddiqui, Childrens Hospital of Philadelphia, Lansdale, PA, United States; Huayan Zhang, Children’s Hospital of Philadelphia-University of Pennsylvania, Philadelphia, PA, United States; John Chuo, Perelman School of Medicine, University of Pennsylvania, Doylestown, PA, United States

Background: Children have varying degrees of anxiety and stress during venipuncture for blood specimen collection, leading to non-cooperation and prolonged procedure. Such stress is associated with physiological and psychological harm to children and increases the risk of additional blood draws, which are associated with extra burden for both nurses and children. This quality improvement project aims to implement and refine interventions to increase preschool children's cooperation during venipuncture, thereby reducing the time needed during specimen collection.

Objective: Our SMART(IE) outcome is to shorten the time during blood specimen collection for preschool children in outpatient clinics by 20% within 5 months.

Design/Methods: Approved by the Ethics Committee of Guangzhou Women and Children's Medical Center (GWCMC), this project was conducted in the outpatient phlebotomy room from April to September 2024 at Baiyun Hospital, GWCMC. The quality improvement team consists of multidisciplinary medical and nursing staff from GWCMC and QI mentors from the Children's Hospital of Philadelphia. Interventions include playing cartoons to distract children's attention during blood collection; providing specialized video to educate parents; training nurses and correct parents’ way to hold children – which were improved using PDSA cycles. Time for blood collection was measured from tourniquet application to blood draw. Nurses assessed the children's level of cooperation during blood collection using the Frankl compliance scale (FCS). The number of assistants required for the procedure was recorded and satisfaction from nurses was assessed with a questionnaire. Control charts were created for outcome, process and balance measures using QI macros™ for analysis and presentation.

Results: Blood draw from 180 children were enrolled into the project. Average blood collection time decreased from 158.8 to 108.8 seconds (31.5% reduction) after 9 P-D-S-A cycle, over 5 months. The average FCS score for children before and during blood collection increased from 2.4 to 3.2 and 2.4 to 2.9, respectively over 5 months. 4 nurses participated in the project and completed education. In addition, the average number of assistants required for the procedure decreased from 1.3 to 1. Nurses were highly satisfied with the project and felt the video animation to be most effective.

Conclusion(s): Interventions such as distracting children and parent education videos can improve children's cooperation during blood specimen collection, shorten the time it takes to collect blood and reduce stress time. Parents can act as valuable partners in this endeavor.

Table 1. PDSA cycle table


Figure 1. Control chart of duration of blood drawing change.
X-R graph showing the change in average blood draw time between April 2024 and September 2024. Each sample point consists of 5 patients, and the time at which the intervention was implemented is labeled in the graph. The middle line (mean) has been adjusted for the occurrence of certain variants. The red lines indicate the upper and lower control lines.

Figure 2. Control chart of the average number of assistants required per child for blood draws.
X-R graph shows the change in the average number of assistants required per child for blood draws between April 2024 and September 2024. The red lines indicate the upper and lower control limits. The middle line (mean) is adjusted when exceptional variation occurs.

Table 1. PDSA cycle table


Figure 1. Control chart of duration of blood drawing change.
X-R graph showing the change in average blood draw time between April 2024 and September 2024. Each sample point consists of 5 patients, and the time at which the intervention was implemented is labeled in the graph. The middle line (mean) has been adjusted for the occurrence of certain variants. The red lines indicate the upper and lower control lines.

Figure 2. Control chart of the average number of assistants required per child for blood draws.
X-R graph shows the change in the average number of assistants required per child for blood draws between April 2024 and September 2024. The red lines indicate the upper and lower control limits. The middle line (mean) is adjusted when exceptional variation occurs.