Klinisk Biokemi i Norden · 2 2015
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VBS practices and implement national and local VBS
practice guidelines of all VBS personnel within the
Västerbotten County Council, Sweden. To evaluate
the prevention program, it is necessary to develop
functional outcome measures tested for validity and
reliability. The occurrence of sample haemolysis and
a self-reported questionnaire have hitherto not been
used in such an evaluation process. Also qualitative
research based on the personnel’s own experiences of
VBS was also lacking.
Methods
In the four studies that was part of the thesis we
used both quantitative as well as qualitative met-
hods. The study settings were primary healthcare
centres in northern Sweden. Participants were VBS
personnel. Data consisted of the VBS questionnaire
of self-reported practices (19, 20), medical records
of low-level haemolysis index (specimens quality
indicator) in serum samples (21), and interviews
about VBS practices (22). The VBS questionnaire
was developed in accordance with the national gui-
deline (23). First, we tested the VBS questionnaire
for validity and reliability. Thereafter, we evaluated
the impact of the educational intervention program.
We compared a self-reported VBS questionnaire of
two county councils with a before-after approach.
The personnel were divided into an intervention
group (n = 84) and a corresponding control group
(n = 79). In order to test changes in blood specimen
quality we monitored haemolysis in serum samples
(2008, n = 6652 samples and 2010, n = 6121 samples)
from 11 Primary health care centres. Finally, thirty
VBS personnel from ten Primary health care centres
reported their experiences. Data were analysed using
descriptive, comparative and multivariate statistics in
three of the studies. In the last study, the interview
questions were open-ended. The interviews were ana-
lysed by qualitative content analysis (GraneheimH &
Lundman, 2004). Educational substance was based on
the guideline the National Handbook for Healthcare
and local directives, directives almost identical to the
CLSI H3-A6 guideline. The educational intervention
program was mandatory and included three parts: 1)
Table 1. Percentage of haemolysed specimens (HI ≥ 15, free Hb ≥ approx. 150 mg/L) and HI 95th percentile in 11 PHCs
before (July–September 2008) and after (July–September 2010) the EIP.
PHCs
2008
n
1
HI ≥
15 (%)
HI
95
th
PHCs
2010
n1
HI ≥
15 (%)
HI
95
th
P
PHCs all
6652
10.5
19
PHCs all
6121
11.8
22
0.022
Rural
2039
15.8
23
Rural
1902
12.8
22 0.007**
Urban
4613
8.2
18
Urban
4219
11.4
22 <0.001*
1
472
6.4
16
1
559
5.9
16
0.864
2
713
7.2
16
2
628
8.3
19
0.502
3
1223
7.6
17
3
989
9.7
21
0.063
4
477
9.0
18
4
396
9.6
19
0.834
5
307
17.6
24
5
363
12.0
22
0.059
6
609
7.9
18
6
606
16.5
27 <0.001*
7
1138
8.3
18
7
1089
13.3
23 <0.001*
8
458
13.7
24
8
348
16.1
24
0.409
9
362
13.8
21
9
364
12.1
21
0.561
10
649
14.9
21
10
541
10.9
21
0.049
11
244
32.0
34
11
238
24.4
31
0.080
Rural = PHCs 4, 5, 9–11: Urban = PHCs 1–3, 6–8
n
1
= number of specimens, P = chi square for independence
*significantly increased percentage of haemolysed specimens,
**significantly decreased percentage of haemolysed specimens
