Audit: Paediatric Blood Culture Documentation Improvement

Paediatrics

Improving Documentation of Paediatric Blood Culture Collection

Clinical Audit

Audit Lead:<br/><br/>Supervisor: <br/>

Doose Abege (F2)<br/><br/>Dr Anna Sibley<br/>

Department:

Paediatrics

Date:

May 2026

02

BACKGROUND

Background

Why Blood Cultures Matter

Blood cultures are essential in diagnosing sepsis and bacteraemia

Contamination can lead to:

Unnecessary antibiotics

Increased length of stay

Why Documentation Matters

Accurate documentation is required to:

Interpret results

Identify contamination vs true infection

03

NATIONAL GUIDANCE

National Guidance

Standards Derived From

UK Health Security Agency (UKHSA)

NICE (Sepsis Guidance)

Royal College of Paediatrics and Child Health

Key Principles

Use aseptic technique (ANTT)

Take cultures before antibiotics where possible

Ensure traceability (who performed procedure)

Follow appropriate blood volume guidance

04

AIM

Aim

To assess and improve the quality of documentation of paediatric blood culture collection.

ASSESS

IDENTIFY GAPS

IMPROVE

05

Methodology

Methodology

Retrospective audit design

Electronic patient records (Cerner)

101 paediatric blood culture episodes

ED samples excluded prior to data collection

Duplicate names = separate sampling episodes

101

Paediatric Blood

Culture Episodes

06

AUDIT CRITERIA

Audit Criteria & Standards

Expected Documentation Fields

Clinician performing procedure

Time of collection

Site / source

Aseptic technique used

Skin preparation method

Clinical indication

Volume of blood taken

Timing relative to antibiotics

STANDARD

≥ 80%

Compliance Required

07

RESULTS

Documentation Rates

Target (≥80%)

All criteria fall significantly below the ≥80% standard

Clinician

36

Time

33

Site

32

Skin Cleaning

31

Technique

29

Indication

0

Volume

0

Before Antibiotics

3

08

RESULTS

Complete Documentation

101

cases

26%

Complete Documentation

74%

Incomplete Documentation

The majority of blood cultures lack adequate documentation

09

RESULTS

Who is Documenting?

Out of 36 documented clinicians (36% of 101 episodes)

Clinician Type

Number

% of Documented

% of Total

Phlebotomists

21

58%

21%

Doctors

12

33%

12%

Nurse

1

3%

1%

ANP

1

3%

1%

HCA

1

3%

1%

TOTAL

36

100%

36%

Phlebotomists

Doctors

Others (Nurse, ANP, HCA)

Phlebotomists account for 58% of all documented collections

10

Results

Major Documentation Gap

64%

65 of 101 cases

No Clinician Documented

36%

36 of 101 cases

Clinician Identified

Significant lack of accountability in the majority of blood culture episodes

11

CLINICAL CONTEXT

Blood Culture Volume Requirements

Recommended Paediatric Volumes (Age-Dependent)

Neonates

0.5–1 mL

Infants

1–3 mL

Young Children

3–5 mL

Older Children

up to 10 mL

Key Point

Inadequate blood volume reduces culture sensitivity and may lead to false negatives

Volume documented in

0%

of cases

12

INTERPRETATION

Results Interpretation

Consistently Poor Documentation

Documentation is consistently poor across all measured criteria. No single field meets the 80% standard.

Critical Parameters Missing

Indication (0%) and Volume (0%) were never recorded — both are essential for clinical interpretation.

Clinical Consequence

Unable to interpret positive cultures or distinguish contamination from true infection.

Documentation failure directly impairs clinical decision-making

13

CLINICAL IMPACT

Clinical Impact

Uncertain Antibiotic Use

Risk of over-treatment/ Increase antibiotic course length

Missed Bacteraemia

Risk of under-treatment/ False negatives related to small volumes

Prolonged Hospital Stay

Increased bed days and cost, increased antibiotic use

Poor Antimicrobial Stewardship

Contributing to antibiotic resistance

Reduced Patient Safety

Critical patient safety concern

"These risks are preventable with improved documentation practice."

14

KEY LEARNING

Key Learning Points

Not Embedded in Practice

Documentation is not part of routine clinical workflow for blood culture collection.

Accountability Gap

The majority of samples lack identification of who performed the procedure.

Critical Fields Never Recorded

Volume and clinical indication — the most clinically significant fields — are recorded in 0% of cases.

Simple Interventions Can Help

Improvement is achievable through structured templates and targeted education with minimal cost.

15

RECOMMENDATIONS

Recommendations

Cerner Auto-Text Template

Introduce standardised auto-text for blood culture documentation in Cerner EPR.

Targeted Staff Teaching

Deliver education sessions for all staff groups performing or ordering blood cultures.

Document: Indication

Ensure clinical indication is always recorded at time of collection.

Document: Technique & Volume

Record aseptic technique used and exact blood volume collected.

Document: Timing

Note timing relative to antibiotic administration — before or after.

Re-Audit Post-Intervention

Conduct follow-up audit in 2–4 weeks to assess impact. Target ≥80% compliance.

Consider mandatory documentation fields in Cerner as a system-level change.

16

ACTION PLAN

SMART Action Plan

ACTION

LEAD

TIMESCALE

MEASURE

STATUS

Introduce Cerner auto-text

FY2 + IT Team

1 week

Template live

Planned

Teaching session

FY2 + Registrar

1 week

Attendance recorded

Planned

Posters/reminders

FY2

1 week

Visible in clinical areas

Planned

Re-audit

FY2

2–4 weeks

≥80% compliance

Planned

System change discussion

Consultant

1–2 months

MDT review completed

In Progress

17

ASSURANCE

Assurance Obtained

Evidence-Based

Real-world clinical data from 101 episodes analysed. Clear measurable gap identified.

Proportionate Intervention

Proposed interventions are low-cost, sustainable, and scalable across the department.

Closed-Loop Audit

Re-audit planned in 2–4 weeks to confirm improvement and close the audit loop.

No direct patient harm identified during audit period

Action plan is underway with clear leads and timescales

18

ASSURANCE

Overall Assurance Level

LOW ASSURANCE

MODERATE ASSURANCE ★

HIGH ASSURANCE

Reasons for Moderate Assurance

Significant documentation gaps identified across all criteria

Potential impact on patient safety — critical fields never recorded

No direct harm identified during the audit period

Assurance will increase to HIGH following re-audit demonstrating ≥80% compliance

x

x

x

19

Conclusion

Conclusion

Documentation of paediatric blood culture collection is significantly inadequate, with critical clinical parameters rarely recorded — limiting clinical interpretation and impacting patient safety.

0% Indication Documented

0% Volume Documented

74% Incomplete Records

Action is required to protect patients and support clinical decision-making.

20

ACKNOWLEDGEMENTS

Acknowledgements

Paediatric Team

For their support in data collection and clinical input throughout this audit.

Phlebotomy Team

Whose documentation practices were central to this audit and who will be key to improvement.

Supervising Consultant

For guidance, oversight, and support in driving this quality improvement project.

This audit was conducted as part of a quality improvement programme in Paediatrics.

Thank You

This project highlights a simple but critical gap in routine practice. With low-cost interventions such as structured documentation templates and targeted education, there is strong potential to significantly improve patient safety and antimicrobial stewardship.

— PAEDIATRIC BLOOD CULTURE DOCUMENTATION AUDIT, MAY 2026

Questions?

Department of Paediatrics

Blood Culture Documentation Audit

May 2026