Blood sampling in adult critical care: a mixed methods study

Lennox, Sarah; Bench, Suzanne

doi:10.1016/j.ijotn.2022.100923

Cited by 3 publications

(15 citation statements)

References 17 publications

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“…The aim of this study was to investigate adult nurses' views and experiences related to POCT in critical care. Results align with those of the limited previous work in this area, 8,9 whilst further illuminating the impact of POCT on wider aspects of patient care provision. In line with previous studies, 8 frequency of sampling and sampling volumes…”

Section: Discussionsupporting

confidence: 82%

“…However, the limited research published to date suggests that the added workload associated with POCT may increase the risk of error. 5,[7][8][9] Performing POCT also detracts nurses from other care duties potentially increasing the risk of adverse incidents such as pressure ulcer formation, and reducing the time available for psychological support and timely recognition of deterioration amongst other things. 5,[7][8][9] A United Kingdom (UK) focus group study with nurses working in intensive care units (ICUs) and emergency departments also highlighted significant frustrations around equipment availability, and challenges with maintaining training and competence requirements.…”

mentioning

confidence: 99%

“…5,[7][8][9] Performing POCT also detracts nurses from other care duties potentially increasing the risk of adverse incidents such as pressure ulcer formation, and reducing the time available for psychological support and timely recognition of deterioration amongst other things. 5,[7][8][9] A United Kingdom (UK) focus group study with nurses working in intensive care units (ICUs) and emergency departments also highlighted significant frustrations around equipment availability, and challenges with maintaining training and competence requirements. 8 Further research investigating nurses' perspectives of POCT more widely is required to better understand its impact on the nursing role and patient care and to explore how best the value of POCT can be optimized.…”

mentioning

confidence: 99%

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Nurses' perceptions of point of care testing in critical care: A cross‐sectional survey

Bench

Lennox

2022

Nursing in Critical Care

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BackgroundNurses working in critical care (intensive or high dependency care units) perform a multitude of tasks including point‐of‐care testing (POCT), where diagnostic tests are performed at or near a patient's bedside. POCT can speed up clinical decision‐making, but errors can occur at any point in the pre‐analytical phase.AimTo investigate nurses' perceptions of current POCT practice in critical care pre and post the COVID‐19 pandemic.MethodsAn online cross‐sectional survey of critical care nurses undertaken 2019–2021. Nurses across Europe were invited to participate during a conference and via communication from professional organizations.ResultsA total of 158 critical care nurses responded to the survey. All respondents who stated their location reported being residents of the UK. Alongside challenges related to training and competence, frequency of sampling and sampling volumes were key concerns, seen to be associated with increased blood wastage and nursing workload, potentially increasing the potential for error, and leading to poorer patient and staff outcomes.ConclusionResults from this study highlight the impact of POCT on nurses' workload, patient care provision and staff wellbeing.Relevance to Clinical PracticeAlongside exploring feasible and effective training models, innovative roles, which provide technical support, including undertaking POCT could enable nurses more time to provide care to patients and families. Any future changes in workforce allocation must, however, be fully evaluated from the perspective of both patient and staff outcomes.

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Section: Discussionsupporting

confidence: 82%

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confidence: 99%

mentioning

confidence: 99%

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Nurses' perceptions of point of care testing in critical care: A cross‐sectional survey

Bench

Lennox

2022

Nursing in Critical Care

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“…We included a total of 81 records representing 70 studies: 50 nonrandomized interventional studies (19–68) and 20 observational studies (69–88) ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Forty-one out of the 50 (82%) included nonrandomized interventional studies (20–25, 27, 28, 30–32, 34–47, 49–54, 56–58, 60–64, 67) and 15 out of the 20 (75%) included observational studies (69, 71, 73–76, 78–82, 84–87) reported patient-centered outcome measures. Findings are presented in Supplemental Table 7 (http://links.lww.com/CCM/H318) and summarized as follows.…”

Section: Resultsmentioning

confidence: 99%

Routine Versus On-Demand Blood Sampling in Critically Ill Patients: A Systematic Review*

Hjortsø

Møller

Perner

et al. 2023

Critical Care Medicine

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OBJECTIVES: We aimed to provide an overview of the current evidence on routine versus on-demand blood sampling in critical care. We assessed the reported proportion of patients exposed to daily routine blood sampling, the tests performed, characteristics associated with more frequent blood sampling, and the reported benefits and harms of routine blood sampling compared with on-demand sampling. DATA SOURCES: We systematically searched the Cochrane Library, the Excerpta Medica Database, and the Medical Literature Analysis and Retrieval System Online for studies assessing routine versus on-demand blood testing in critically ill patients from inception to September 2022. STUDY SELECTION: Abstracts and full texts were assessed independently and in duplicate by two reviewers. STUDY EXTRACTION: Data were extracted independently and in duplicate by two reviewers using predefined extraction forms. DATA SYNTHESIS: Of 12,212 records screened, 298 full-text articles were assessed for eligibility. We included 70 studies; 50 nonrandomized interventional studies and 20 observational studies. Exposure to routine blood testing was 52–100% (very low certainty of evidence). Blood testing seemed to occur more frequently in medical intensive care settings with a median of 18 blood tests per patient day (interquartile range, 10–33) (very low certainty of evidence). Mixed biochemistry seemed to be the most frequently performed blood tests across all settings (five tests per patient day; interquartile range, 2–10) (very low certainty of evidence). Reductions in routine blood testing seemed to be associated with reduced transfusion rates and costs without apparent adverse patient outcomes (low certainty of evidence). CONCLUSIONS: In this systematic review, routine blood testing in critically ill patients was common and varied considerably. A reduction in routine blood testing appeared to be associated with reduced transfusion rates and costs without adverse effects, but the evidence was very uncertain.

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Improving Phlebotomy Practices Through Small-Volume Blood Tubes: A Survey-Based Study

ARSLAN,

ÖNCEL VAN,

ALPŞEN

et al. 2024

Medical Records

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Introduction: The blood collection for laboratory tests has been frequently performed due to evidence-based medicine. We aimed to conduct a survey on phlebotomy among phlebotomists and patients and to reduce unnecessary blood loss by using small-volume blood collection tubes. Materials and Methods: A survey among phlebotomists and patients was conducted to gather their opinions. Phlebotomists received training on the importance of the preanalytical process. The blood volume required for laboratory tests was reduced by 33.3%-50.0% in children and adults, and 63.0%-84.0% in newborns. Following this intervention, we investigated its effects on the blood transfusion ratio in the neonatal and adult intensive care unit (NICU and ICU) and the amount of laboratory medical waste generated. Results: A majority of phlebotomists (91.8%) reported difficulties in drawing blood from newborns, pediatric, oncology, hematology, and geriatric patients. Additionally, 68.9% of phlebotomists and 57.1% of patients expressed an opinion for reduced blood volume. Despite an increase in the number of laboratory tests (28.4%) and samples (15.7%), we observed a 17.8% reduction in the amount of laboratory medical waste. Although the number of patients in NICU increased statistically significant, the increase in transfusion rates was not significant. Although the number of patients in ICU increased, transfusion rates decreased, but neither was found to be statistically significant. Discussion: Post-graduation, phlebotomists should be educated regularly about the preanalytical process. Based on the opinions of both phlebotomists and patients, using small-volume tubes in patients with difficult blood collection may increase their satisfaction. Generally, laboratory medical waste may be reduced.

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Blood sampling in adult critical care: a mixed methods study

Cited by 3 publications

References 17 publications

Nurses' perceptions of point of care testing in critical care: A cross‐sectional survey

Nurses' perceptions of point of care testing in critical care: A cross‐sectional survey

Routine Versus On-Demand Blood Sampling in Critically Ill Patients: A Systematic Review*

Improving Phlebotomy Practices Through Small-Volume Blood Tubes: A Survey-Based Study

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