Klinisk Biokemi i Norden · 2 2015
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of patient’s photo identification (
p
= <0.001). All fin-
dings above regarding identification procedures were
significantly improved for the intervention group,
but no differences were found in the between-group
comparisons with the control group (20).
Blood specimen quality
The total percentage of specimens with heamolysis
index ≥ 15 during July to September 2010 was 11.8%
compared to 10.5% in 2008 (
p
= 0.022) (Table1), show-
ing a degredation of blood specimen quality following
phlebotomy. Rural primary health care centres had
a higher percentage of haemolysed specimens before
the intervention and higher reduction of haemolysis
in the univariate analyses; therefore, it was essential
to compare rural with urban primary health care
centres. Divided into groups, rural Primary health
care centres demonstrated a significant (
p
< 0.001)
reduction in haemolysis (Odds ratio = 0.74, CI =
0.651–0.851) after intervention, whereas the urban
Primary health care centres demonstrated a signifi-
cant (
p
< 0.001) increase (OR = 1.45, CI = 1.912–1.765)
in haemolysis (21).
Experiences of venous blood sampling practices
Primary healthcare VBS personnel’s experienced that
the education opened up opportunities for reflec-
tions on safety. They
became aware of risks, achieved
improvements in clinical practice
and
felt strengthened
in working as usual
. Reflections on safety revealed
during the analysis could be identified in almost all
subthemes and in relation to the educational inter-
vention program.
The participants
become aware of risks.
They rela-
ted that low accuracy and communication problems
could be risky when performing identification pro-
cedures. Participants reflected on environmental
disturbances, stressful and noisy atmosphere, defi-
cient workplans
and pointed them out as risks for
VBS practice errors. They described the physical
environment as varying from arranged to comple-
tely unfamiliar places. Lack of knowledge such as
not knowing the content in the VBS guidelines was
experienced as risky. More-over, transfer of informa-
tion was described as a risk for misunderstanding
and sample delay, patients and/or the professionals
sometimes received wrong or no information at all.
Participants reflected on safety and reported that
they had
achieved improvements in clinical practice
.
To have standardised ways of working was described
as important to ensure quality,. Participants descri-
bed how they improved in following guidelines, such
as using venous stasis for a shorter period of time and
inverting test tubes more in line with the national
guidelines. One PHC had bought bags especially for
sampling, with space for all materials and a carrier
to store the tubes standing as instructed. The parti-
cipants described better routines, such as performing
one thing at a time, and reflected on improvements
in planning, being well prepared, making systematic
checks, and having all the materials available. The
participants described being more careful after the
education and having learned about the importance
of comparing the identity with the test request. They
were also more accurate in labelling test tubes.
Some participants felt that they already worked as
instructed, while others thought that they had not
learnt anything new during the education or just did
not want to change their routines. The VBS education
motivated and reminded them of consequences that
could appear in daily VBS practices (22).
Conclusions
My thesis is as far as I know the first to evaluate the
impact of an educational interventional program
aimed at improving VBS practices. Self-reported VBS
questionnaires and monitoring of low-level venous
specimen haemolysis reflected VBS practices and
could be used to evaluate the educational intervention
programs impact on VBS practices. By using near-
miss markers that occur in high frequency instead
of studying the low frequencies of reported adverse
events makes it possible to compare and benchmark
VBS practices also at the level of individual primary
health care units and hospital wards. It was obvious
that the educational intervention program ope-
ned up opportunities for reflection on safety. The
general educational intervention program had an
impact on several VBS practices, while some VBS
practices remained unchanged. There are still seve-
ral areas in VBS practices that need improvement
through further and continuous interventions, with
the understanding that changes take time. In addi-
tion, educational intervention programs that provide
participants time for reflection and discussion based
on specific VBS practice flaws may be effective.
Several of the results could also be explained from a
system perspective, indicating that e.g. deficiencies in
