Quality improvement project: Reducing non-conformities of the samples for haemostasis testing in a secondary healthcare centre through the nurses’ education in phlebotomy

Abstract

Introduction: Poor compliance to the current guidelines and lack of knowledge among nurses about proper blood sampling is set as the study hypothesis. Here is presented a quality improvement project with following aims: a) to identify the most prevalent non-conformity of the samples for haemostasis testing, b) to identify the cause of sample non-conformity, c) to perform corrective action(s) and d) to assess the effectiveness of the corrective action(s). Materials and methods: The rate of non-conformity of samples collected for haemostasis tests was established for hospital wards with inpatients. Phlebotomy practice was audited throughout anonymous questionnaire among hospital’s nurses who perform phlebotomy. Education about blood sampling was performed as a 1-hour lecture in different small groups each working day within one month. Education effectiveness was assessed through the evaluation of sample quality and is considered effective if more than half of the hospital wards significantly reduced their sample non-conformities rate. Results: Clotted sample constituted 84% of sample non-conformities. The questionnaire revealed nurses’ poor knowledge in phlebotomy. There was no difference in nurses’ knowledge regarding the level of education or work experience. Reduction in sample non-conformities was observed in 7 out of 9 wards 4 months after education; this improvement was statistically significant for 5 wards. Conclusion: Clotted sample as the most prevalent non-conformity of the samples for haemostasis testing is caused by the lack of knowledge of the nurses in several parts of the phlebotomy process. Specific education of the motivated personnel in small groups was successful and long-term effective.

A survey on the practice of phlebotomy in Lithuania and adherence to the EFLM-COLABIOCLI recommendations

“…Simply knowing the error rate is insufficient for improving the quality of VBS; it is crucial to identify the sources and reasons behind these errors. Our findings support previous studies that have also demonstrated the association between inadequate training and lower quality of the blood sampling procedure ( 24 - 26 ). Continuous training is also recommended by the World Health Organisation (WHO) as a best practice for enhancing the quality of blood sample collection ( 2 ).…”

Phlebotomy- A gateway to laboratory diagnostics

“…Research done in a tertiary care hospital in Turkey showed higher number of nurses (78%) who are unaware of proper identification procedure [4]. Two more studies performed in India and Croatia found 86.6% and 70% phlebotomists respectively who knew the proper identification process, which is much higher than our results [12,13].…”

“…Another study done in Turkey showed a mere 6% of nurses which were aware of correct mixing protocol [11]. However, an analysis done in Europe found 47% subjects with correct response [13]. Probably missed especially in hours of heavy workload.…”

Design, Development, and Evaluation of the Blood Collection Management Workstation

“…45 Some studies reported that the lack of knowledge of the practice (doctors or nurses) in several parts of the phlebotomy process was also the leading cause of error in the pre-analytical phase. 46,47 Another national study revealed that the knowledge on phlebotomy among Chinese nurses was unsatisfactory in some areas. 48 Thus, although innovative technology is required, standardized phlebotomy education programs were also highlighted.…”