Klinisk Biokemi i Norden · 1 2017
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specialised training in phlebotomy. Blood sampling
takes place at either the outpatient phlebotomy ward
or at the hospital wards, but are carried out by the
same phlebotomist staff. Due to work rotation all
phlebotomists were not observed the exact same
number of times.
During a three-month period (September –
November 2014) blood sampling was observed at
the outpatient phlebotomy unit and at the hospital
wards, respectively. Three blood collections by the
same phlebotomist were observed at each session, and
all observations were performed by the same trained
staff specialist (Tine Lindberg Seemann) using a
structured checklist.
The observation checklist for phlebotomy QC was
constructed based on the scheme designed by the
EFLMWG-PRE (9) and adjusted to local procedures
resulting in an observation scheme containing 19
observation items (Figure 1). Observation item #2
concerning patient identification was mandatory to
be correct, as it was assessed as potentially severely
harmful. If patient identification was performed
incorrect, the observer intervened immediately and
assured correct identification. Otherwise, this was
strictly an observational study without interruption
by the observer. Results were recorded as yes/no for
all phlebotomists in each setting and later calculated
for the two settings, respectively.
Follow-up study
Based on the pilot study the observation scheme
was optimised by removing four items that was all
correctly performed in the pilot study and altering
one item resulting in a new observation scheme con-
taining 15 items (Figure 2). The follow-up study was
performed during a three-month period (January –
March 2016) by the same procedure as described for
the pilot study except the alteration that only two
blood samplings were observed at each session (for
logistic reasons).
Statistical analysis
The results of the observational study are reported
as percentage incorrect phlebotomies per item out
of the total number of observations, reported for the
phlebotomy ward and the hospital wards, respectively.
Differences between results at the two settings
(the phlebotomy ward and the hospital wards) were
analysed with Fisher’s exact test. Also, changes in
observations between the pilot study and the follow-
up study was analysed using Pearson’s Chi-Square
test. A p-value < 0.05 was considered significant;
analysis was performed using GraphPad Prism 6 (La
Jolla, California, USA).
Results
Pilot study
A total of 126 phlebotomies, 59 at the phlebotomy
ward and 67 at the hospital wards, were performed
by 39 different phlebotomists. The errors are shown
in Figure 3.
• At the phlebotomy ward, the most frequent error
was performing hand hygiene contrary to the
described procedure (item #3, 42%). Second-most
Foto: Henrik Alfthan.
