Impact of a large-scale educational intervention program on venous blood specimen collection practices

Abstract

BackgroundPhlebotomy performed with poor adherence to venous blood specimen collection (VBSC) guidelines jeopardizes patient safety and may lead to patient suffering and adverse events. A first questionnaire study demonstrated low compliance to VBSC guidelines, motivating an educational intervention of all phlebotomists within a county council. The aim was to evaluate the impact of a large-scale educational intervention program (EIP) on primary health care phlebotomists’ adherence to VBSC guidelines. We hypothesised that the EIP would improve phlebotomists’ VBSC practical performance.MethodsThe present study comprise primary health care centres (n = 61) from two county councils in northern Sweden. The final selected study group consisted of phlebotomists divided into an intervention group (n = 84) and a corresponding control group (n = 79). Both groups responded to a validated self-reported VBSC questionnaire twice. The EIP included three parts: guideline studies, an oral presentation, and an examination. Non-parametric statistics were used for comparison within and between the groups.ResultsEvaluating the EIP, we found significant improvements in the intervention group compared to the control group on self-reported questionnaire responses regarding information search (ES = 0.23-0.33, p < 0.001-0.003), and patient rest prior to phlebotomy (ES = 0.27, p = 0.004). Test request management, patient identity control, release of venous stasis, and test tube labelling had significantly improved in the intervention group but did not significantly differ from the control group (ES = 0.22- 0.49, p = < 0.001- 0.006). The control group showed no significant improvements at all (ES = 0–0.39, p = 0.016-0.961).ConclusionsThe present study demonstrated several significant improvements on phlebotomists’ adherence to VBSC practices. Still, guideline adherence improvement to several crucial phlebotomy practices is needed. We cannot conclude that the improvements are solely due to the EIP and suggest future efforts to improve VBSC. The program should provide time for reflections and discussions. Furthermore, a modular structure would allow directed educational intervention based on the specific VBSC guideline flaws existing at a specific unit. Such an approach is probably more effective at improving and sustaining adherence to VBSC guidelines than an EIP containing general pre-analytical practices.

Personnel’s Experiences of Phlebotomy Practices after Participating in an Educational Intervention Programme

“…Participants in this study achieved improvements in clinical practice; they pointed out that they were more diligent in accurately identifying a patient. These results are confirmed by our previous study showing that phlebotomy personnel significantly improved control of patients' photo identification [ 25 ]. Unsafe practice during patient identification procedures could lead to blood specimen collection taken from the wrong patient [ 8 ]; therefore, the identification procedures are of importance to ensure patient safety.…”

“…Transfer errors can be explained by deficiencies in the organisational structure [ 33 , 34 ], for example, communication failures [ 31 ], but this has not been addressed in our present study. In a previous intervention study performed by our research group [ 25 ], phlebotomists from the intervention group reported less use of printed, presumably outdated instructions and more use of information via the internal network. However, for implementation of an intervention aiming to improve transfer of information between units or people, more research is needed.…”

“…On evaluation of the EIP, we found minor to medium improvements in sample quality and phlebotomy guideline adherence [ 19 , 25 ]. It is hoped that this qualitative study will add further depth to understanding of phlebotomy in general, and the EIP's effect on participants' phlebotomy practice in particular.…”

Joint EFLM-COLABIOCLI recommendation for venous blood sampling

“…Education increases the level of confidence and improves quality of procedures [110]. Nevertheless, the effects are usually short-term and this is why education should be continuously repeated [111].…”

The preanalytical phase – Past, present and future

“…This may be via direct education sessions, eLearning or via direct feedback through sample reports or verbally. 12,21 Some tests require specific patient preparation, e.g. fasting or other lifestyle or medication adjustment for a period prior to testing.…”