Retrospective study showed that blood sampling errors risked children's well‐being and safety in a Swedish paediatric tertiary care

Hjelmgren, Henrik; Nilsson, Anna; Andersson, Nina; Ritzmo, Carina; Ygge, Britt‐Marie; Nordlund, Björn

doi:10.1111/apa.14528

Cited by 7 publications

(12 citation statements)

References 24 publications

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“…In this study, clotting was the most frequent cause of PAE, consistent with other reports (Hjelmgren et al, 2019;Rooper et al, 2017;Salvagno et al, 2008). However, to the best of our knowledge, PAE have never been analyzed between CBS and VBS Two or more sample tubes 3.12 (1.84-5.31) 0.85 <.001…”

Section: Discussionsupporting

confidence: 90%

“…The primary outcome PAE was defined by the laboratory due to any of the following specific types of errors: clotting, hemolysis, incorrect filling level, missing sample, or erroneously labeled sample tube as described elsewhere (Hjelmgren et al, 2019). Uncommon PAE represented in the study were defined as "other," and included damaged samples, samples with thrombocyte aggregation, and sample analyses that were not executed.…”

Section: Definition Of Outcomesmentioning

confidence: 99%

“…The success of CBS depends on securing the blood flow and circulation, usually by warming the puncture area (Becht & Anderson, 1996). We have published data from a laboratory register and found high numbers of PAE, mainly related to clotting, in Swedish pediatric hospitals (Hjelmgren et al, 2019). While the register lacks detailed information of methods used for blood sample collection, we decided to test our hypothesis that clotting errors are associated with CBS due to low blood flow and volumes.…”

Section: Introductionmentioning

confidence: 99%

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Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study

Hjelmgren

Nilsson

Myrberg

et al. 2021

Specialist Pediatric Nursing

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Purpose: The blood sampling procedure is complex and prone to failure, as reflected by preanalytical errors in pediatric hospital care. The primary aim was to evaluate if the risk of preanalytical errors was higher with capillary blood sampling than with venous blood sampling, and secondary, explore specific factors associated with preanalytical errors, both overall and stratified by capillary and venous blood sampling.Design and Methods: This observational pediatric hospital study collected outcomes from medical records and blood sampling surveys from year 2014 to 2016. The risk of preanalytical errors was analyzed with adjusted-odds ratio (adj-OR) by multivariable logistic regression with 95% confidence intervals (CIs).Results: Overall, 128 (13%) preanalytical errors were identified among 951 blood samples. The proportion and adj-OR of errors was significantly higher in capillary compared with venous blood samples, 72 (20%) of 354 versus 56 (9.4%) of 597, p = .001, adj-OR 2.88 ). Blood collection with multiple sample tubes was significantly associated with increased risk of preanalytical errors (n = 97 of 601, 16%), while log weight (kg) significantly decreased the risk of preanalytical errors adj-OR 0.66 (CI 0.50-0.86), indicating a protective effect of increasing weight. However, stratified analyses indicated a protective effect of increasing log weight for venous blood sampling adj-OR 0.52 (CI 0.38-0.72), but not capillary blood sampling, adj-OR 1.08 (CI 0.76-1.55). Conclusion:This study indicates that capillary blood sampling collection increases the risk of preanalytical errors. Further, a child's increasing body weight reduced the risk of preanalytical errors, while multiple sample tube collections significantly increased the risk of preanalytical errors.Practice Implications: This new information may help nurses improve their knowledge concerning blood sampling collection in pediatrics. Altogether, this study also indicates that implementing more venous blood sampling and improve the cases of capillary sampling could reduce the number of preanalytical errors in pediatric hospitals. K E Y W O R D Sblood sampling collection, capillary blood sampling, children, nursing, pediatric hospital care, preanalytical errors, risk factors, venous blood samplingThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Section: Discussionsupporting

confidence: 90%

Section: Definition Of Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study

Hjelmgren

Nilsson

Myrberg

et al. 2021

Specialist Pediatric Nursing

Self Cite

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“…We previously reported a 5% prevalence of rejected laboratory blood analyses due to PAEs, especially due to clotted samples and test tubes which was filled incorrectly, in a paediatric tertiary hospital [ 10 ]. For hospital organisations, all laboratory costs represent approximately 5% of the total budget, but the diagnostic importance is extensive, as tests may influence 60–70% of all medical decisions [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Direct costs of blood drawings with pre-analytical errors in tertiary paediatric hospital care

Hjelmgren,

Heintz,

Ygge

et al. 2023

PLoS ONE

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Background Blood drawings is a common hospital procedure involving laboratory and clinical disciplines that is important for the diagnosis and management of illnesses in children. Blood drawings with pre-analytical error (PAE) can lead to increased costs for hospitals and healthcare organisations. The direct cost of blood drawings after a PAE is not fully understood in paediatric hospital care. Aim The aim of this study was to estimate the average direct cost of PAE per year and per 10,000 blood drawings in tertiary paediatric care. Methods A cost analysis using a bottom-up approach was conducted on the basis of combined information from the hospital’s laboratory register for the period 2013–2014 and clinical in-ward observations at a tertiary children’s referral hospital in Sweden, the Astrid Lindgren Children’s Hospital. For the analysis, we hypothesised the re-collection of all blood drawings with PAE and included the average costs of the sampling materials, the time of the healthcare personnel, the laboratory analyses, and in-ward premises based on the time spent on the blood sampling procedure. Results The annual cost of PAE was estimated to be 74,267 euros per 54,040 blood drawings, which corresponds to 13,756 euros per 10,000 blood drawings or 1.5 euros per draw. The personnel cost represented 60.1% (45,261 euros per year) of the cost due to PAE, followed by costs for hospitalisation (25.2%), laboratory analyses (8.1%), and materials (5.7%). Conclusion PAEs lead to substantial increases in the costs in tertiary paediatric hospital care. If these PAEs can be avoided, costs related to the re-collection of blood drawings with PAE may be re-allocated to other health-promoting activities for children visiting hospital institutions.

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“…The pre-analytical phase includes prescription of a blood sample test, preparation and execution of blood sample collection, as well as safe transportation of the blood sample to the laboratory where the analytical phase starts (3). Unfortunately, the pre-analytical phase in blood sampling collection from children has been found to be commonly affected by pre-analytical errors, which could risk patient safety and comfort (4). Possible consequences of pre-analytical errors are many: delayed treatment, wrong diagnosis, repeated sampling and increased costs (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Nurses’ Experiences of Blood Sample Collection from Children: A Qualitative Study from Swedish Paediatric Hospital Care

Hjelmgren

Ygge

Nordlund

et al. 2021

Preprint

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Background: Blood sampling collections are necessary and important for diagnosis and treatment in paediatric hospital care. Nurses play an active role in helping the children with the blood sampling experience. Unfortunately, the blood sampling collection procedure is often affected by pre-analytical errors, leading to consequences such as delayed diagnosis, treatment and hospital stay, as well as repeated sampling. Moreover, children state that needle procedures are the worst experience of their hospital stay. Nurses working in children’s hospitals are responsible for conducting most of the needle related procedures but their experience of errors occurring during blood sample collection is unknown. The aim of this study therefore was to describe paediatric nurses’ experiences of blood sampling collections from children. Method: We used a qualitative study design with a (reflexive) thematic analysis (TA) method. Three focus group interviews were conducted, with 19 nurses from Sweden working at two different paediatric hospitals, focusing on their experiences of the blood sample collection procedure. Results: From the three focus group interviews we analysed patterns and meanings of the following themes: Paediatric blood sampling is a challenge for the nurses, Nurses’ feelings of frustration with unsuccessful samplings, Nurses believe in team work, Venous blood sampling was experienced as the best option, and Nurses’ thoughts and needs regarding skills development in paediatric blood sampling. Conclusion: The narrative results of this study illustrate that nurses working in paediatric hospital care face a big challenge in blood sampling collection from children. The nurses felt frustrated due to unsuccessful blood samplings and frequently could not understand why pre-analytical errors occurred. Nevertheless, they felt strengthened by colleagues in their team and shared feelings of responsibility to help each other with this complex procedure. The implications of this study are that paediatric hospital care needs to focus on improving guidelines for and increasing competence in blood sampling children and helping nurses to understand why samplings may be unsuccessful and how this can be avoided.

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Retrospective study showed that blood sampling errors risked children's well‐being and safety in a Swedish paediatric tertiary care

Abstract: Samples with PAEs were frequently clotted and insufficiently filled, and the distribution of errors varied within working shifts and specific analyses. The overall quality control in paediatric blood sampling was barely acceptable.

Cited by 7 publications

References 24 publications

Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study

Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study

Direct costs of blood drawings with pre-analytical errors in tertiary paediatric hospital care

Nurses’ Experiences of Blood Sample Collection from Children: A Qualitative Study from Swedish Paediatric Hospital Care

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