759 - Just-in-Time Video Training to Improve Patient Sample Collection in the NICU

Publication Number: 759.5730

Jennifer M. Bencze, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Blake Cirks, Madigan Army Medical Center, Tacoma, WA, United States; Nora L. Watson, Walter Reed National Military Medical Center, Bethesda, MD, United States; Alaa Bencze, AM Media Production, Bethesda, MD, United States; Mathew Guggenbiller, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, San Diego, CA, United States; Zachary Weber, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Theresa M. Urbina, Madigan Army Medical Center, Lakewood, WA, United States

Background: Properly collecting neonatal serum and saliva samples in the Neonatal Intensive Care Unit (NICU) is essential to obtain accurate laboratory results and eliminate the need for repeat sample collection, which can be detrimental to this vulnerable population. Providing just-in-time video instructions is a novel technique to reduce errors in sample collection in the neonatal population.

Objective: To evaluate if concomitant use of just-in-time video instruction with written instructions reduces errors in neonatal serum and saliva sample collection when compared to written instructions only.

Design/Methods: This study is embedded within an ongoing multi-center prospective study analyzing the correlation between salivary and serum gentamicin levels in neonates. For the initial 18 months, only written instructions detailing saliva and serum sample collection were provided at the bedside of enrolled infants, serving as this study’s baseline. Subsequently, a video instruction demonstrating collection and documentation techniques, based on the written instructions and accessible via quick-response (QR) code on the written instructions, was added. A blinded laboratory technician and documentation scorer independently assessed all samples and documentation for errors. The primary outcome measure is the frequency of insufficient sample volumes after centrifugation. Interim analysis evaluated the hypothesis of decreased frequency in the primary outcome in the video instruction period versus the baseline written instruction period using a one-sided Fisher’s exact test (alpha=0.05).

Results: 158 samples from 36 neonates were collected using written instructions only and 78 samples from 13 neonates using written and video instructions. Preliminary analysis showed a statistically significant reduction in insufficient saliva sample volumes, decreasing from 19% (15/79) in the written instruction group to 5% (2/39) in the written and video instruction group (p = 0.03) (Figure 1). There was no change in serum sample errors. Data collection is ongoing until the target enrollment of 60 neonates is achieved.

Conclusion(s): Preliminary findings from this ongoing study suggest that just-in-time video instruction significantly improves the adequacy of saliva sample collection in NICU patients but not serum sample collection. As saliva sample collection is less common in this population, this may indicate a utility for just-in-time video instruction in rarer bedside procedures as opposed to common ones.

Figure 1: Saliva Sample Results
The graph shows the number of insufficient saliva samples with written instructions only compared to written plus video instructions, with a decrease in insufficient samples from 19% (15/79) in the written instruction group to 5% (2/39) in the written and video instruction group (p = 0.03).