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Klinisk Biokemi i Norden · 2 2015
Avhandling:
Improving venous blood sampling practices
Karin Bölenius
Department of Nursing, Department of Medical Biosciences, Clinical Chemistry
Umeå University, Sweden
Summary
My thesis “Improving venous blood
specimen collection practices –
Method development and evalua-
tion of an educational intervention
program”, available at:
.
diva-portal.org/smash/record.jsf?p
id=diva2%3A705815&dswid=9859
is, to my knowledge, the first that has evaluated the
impact of a large-scale educational intervention pro-
gram on venous blood sampling practices. By using the
frequent occurring near-miss markers it was possible
to compare and benchmark venous blood sampling
practices down to the individual healthcare unit and
hospital ward. Our results indicate that monitoring
and take action against near misses in venous blood
sampling practices is a well-functioning preventive
action to prevent errors to occur. The general educa-
tional intervention program opened up opportunities
for reflection about health care safety and improved
venous blood sampling practices in primary health
care centres with larger deviations from guidelines.
Educational intervention programs that provide time
for reflection and discussion could therefore further
improve venous blood sampling practices. Directed
educational intervention programs focused on spe-
cific venous blood sampling practice flaws might be
even more effective.
The thesis,
has led to deeper and
extended knowledge of the impact of an educational
intervention program on venous blood sampling
practices. The methodology used and the results of
the thesis can be used when considering venous blood
sampling practice interventions.
Background
Laboratory services influence clinical decisionmaking
(1, 2). Almost 60%–80% of the most important deci-
sions in diagnosis, administration, and medication
are based on laboratory test results (1, 3). Error rates
in laboratories varies between 0.05% and 10% (4, 5).
Deficiencies in venous blood sampling (VBS) practices
may lead to the need of a repeated collection and delay
in diagnosis and treatment. Compromised test results
also mean additional patient suffering and increased
costs for the society as well as for the individual patient
(6). VBS is strictly regulated by guidelines (7, 8). VBS
personnel often deviates from those guidelines (9, 10,
11, 12) which increases the risk for an error to occur.
Some reasons for the low compliance to guidelines
have been found to be e.g. personnel disagreeing with
recommended guidelines and considering them unne-
cessary (13), lack of time, and lack of support from the
clinic or their superiors (14). More-over, errors in VBS
usually depend on human mistakes in relation to the
system (15), indicating that they are preventable.
The majority of errors within the total testing
process occur in the pre-analytical phase (3). Some
examples of the pre-analytical errors encountered
are incorrect analysis ordered (12), incorrect patient
preparation procedures such as insufficient patient
rest, use of information from outdated sources (11,
16), and use of wrong type of collection tube (5). A
common reason for specimen rejection and renewed
sampling is specimen haemolysis, which in most cases
is caused by incorrect specimen collection procedures
(17, 11). Common specimen handling errors include
incorrect test tube labelling (10, 11), incorrect test
request management, missing tubes, and transpor-
tation errors (18).
Our previous studies demonstrated the phleboto-
mists’ self-reported VBS practices performance was
poor as it did not adherence to VBS guidelines (9, 10,
11, 12, 16). This motivated a short but large-scale edu-
cational intervention program intending to update
