We have a similar problem with A&E but it is much worse with samples
from our Medical assessment unit (> 30% haemolysed). They use Healthcare
assistants to take all of the samples. We have discovered a number of
problems including use of venflons, injecting samples from syringes into
Vacutainers etc.
An underlying problem was that these staff were 'trained' using a
document which did not originate in the laboratories and therefore did
not contain any information about pre-analytical issues. You may find
your nursing staff use something similar to 'extend the scope of
practice' to include phlebotomy. After reading the document and
answering a multiple choice test (with the answers available on the next
page) they were free to try taking blood under supervision of 'more
experienced' staff who were also trained using the same inadequate
package. After 10 'reflective practice' phlebotomies the newly trained
staff were regarded as competent to practice phlebotomy unsupervised.
I have now obtained significant input into the documentation and have
included sections on Common errors, Patient identification, Infection
Control, compliance with Medical Devices legislation, common practical
difficulties, Order of sample draw, Which samples to use (Including
Laboratory Handbook & Intranet as further sources of information ). We
are also working towards including practice on the dummy arm and
supervised practical experience conducted by the laboratory trained
phlebotomists.
Does anyone else think that phlebotomy training for ward staff should be
placed under laboratory supervision much like point of care testing?
Richard Stott
Principal Biochemist & Clinical Governance lead.
Doncaster Royal Infirmary.
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