Pediatric Phlebotomy Services: Optimizing Sample Quality and Improving the Patient and Parent Experience (original) (raw)
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Background: Pre-analytic phase errors (46-68%) constitute the majority of the total errors in the laboratory. Pre-analytic phase errors should be standardized by clinicians and laboratory professionals. Pediatric blood samples taken in emergency and inpatient services or outpatient clinics are rejected in the laboratory due to clot, hemolysis, fibrin, etc. and generate the need to take a new sample from the patient. As a result of this, there is a delay in diagnosis and treatment due to the difficulties of re-taking blood from the patient and prolonged results. In our study, we aimed to determine the precautions to be taken by examining the reasons of refusal of samples rejected due to nonconformity by the laboratories obtained from the pediatrics department of our hospital. Methods: The rejected pediatric samples in the Rejected samples were obtained retrospectively from the hospital information system. Sample rejection rates and conditions were evaluated, and if necessary, laboratory-based and clinician-based measures were evaluated. Results: In the laboratory, 3314 pediatric blood samples were rejected in that time period for various reasons. Of the rejected samples, 1617 (49%) were clotted, 798 (24%) were inadequate sample, 312 (10%) were defective or incomplete test prompt, 150 (4%) were hemolyzed, and 437 (13%) were rejected for other reasons (wrong bar code, wrong tube, having fibrin, cold transport, not an urgent request, etc.). Of the 1617 rejected pediatric clot samples, 684 (42%) came from the emergency department, of which 471 consisted of blood gas.
Patient Experience Journal
A phlebotomist's words and actions play a crucial role in success of a blood draw and in providing a supportive patient experience. This study examined use of comfort measures during a pediatric blood draw. The phlebotomist's use of soft words, positioning, distraction, coaching/support were observed with sixty children between 3-14 years of age during a blood draw. The level of fear /anxiety before and during the blood draw was recorded by an RA. The child's level of fear/anxiety was observed and reported by the parent/caregiver after the procedure. Comfort measures provided by phlebotomists, the parent/caregiver's report of their child's usual response, and the parent's level of fear with needles were compared. Comfort measures were offered inconsistently across age groups. Distraction was the most frequent measure (85%), followed by coaching/support (72%). Positioning was used more often with younger children (42%) than with older children (7%). Despite the high use of comfort measures, many children (56%) had levels of 2-4 fear/anxiety. The parent/caregiver often predicted their child's level of fear/anxiety. Phlebotomists can benefit from interdisciplinary collaboration opportunities and developmentally appropriate education, including comfort measures, to mitigate patients' pain and fear. Given the importance of creating a positive patient-family centered environment, introductions, and interactions to build a trusting rapport are crucial. Additionally, this research highlighted the importance of self-advocacy by pediatric patients and families. When providers ask and listen, and children are brave enough to share their voice...the human experience will improve on all sides.
Journal of Clinical Laboratory Analysis, 2016
Objectives: Assessment of specimen rejection rates is an important laboratory quality measure for laboratories because of a potential negative impact on patient care. Here, we examined reasons for specimen rejection at a single, tertiary care healthcare institution and propose a framework for designing an efficient intervention. Methods: During a 1-year period, we identified all specimens rejected at our hospital and performed an analysis of a wide range of associated variables: reason for rejection, patient location, type of phlebotomist, tests ordered, priority status, collection container used, transport time. Results: Clotted and hemolyzed specimens accounted for the majority of rejected specimens, but significant differences in reasons for specimen rejection existed between patient care areas. Eighty-five percent of rejected specimens came from the Emergency Department and eight other inpatient care areas. Registered nurses drew approximately 85% of rejected specimens, while laboratory phlebotomy staff drew only 4%. Conclusions: While hemolysis and clotting are primary causes for specimen rejection, collection of all available data regarding specimen rejection data is essential for laboratories determining which factors are most significant causes of specimen rejection.
Outpatient phlebotomy success and reasons for specimen rejection
Archives of pathology & laboratory medicine, 2002
To determine the rate with which blood collection is successful on the initial phlebotomy encounter, the rate with which laboratory personnel judge specimens unsuitable for analysis, and the practice characteristics associated with fewer unsuccessful collections and fewer rejected specimens. Clinical laboratories participating in the College of American Pathologists Q-Probes laboratory improvement program prospectively characterized the outcome of outpatient phlebotomies for 3 months or until 20 unsuccessful phlebotomy encounters occurred. By questionnaire, participants provided information about test ordering, patient preparation, and specimen collection. Institutions in the United States (n = 202), Canada (n = 4), Australia (n = 3), and South Korea (n = 1). Percentage of successful encounters and percentage of unsuitable specimens. Of 833289 encounters, 829723 were successful. Phlebotomies were unsuccessful because patients were not fasting as directed (32.2%), phlebotomy orders w...
Transfusion …, 2007
Error is a direct reflection of system deficiency. Errors occurring in the phlebotomy area are grossly unreported. Though most of these errors does not lead to catastrophic outcome yet indicate system failure. The aim of the study was to identify errors that took place in phlebotomy area, analysing and classifying them. A prospective audit was conducted during an observational period of 8 months, in an overall cohort of 11 260 donors. The incidence of errors was 3Á1%. Fifty-five percent errors were technical and remaining 44Á9% were clerical. Of all the technical errors, 57Á7% were classified as minor, whereas remaining 42Á3% were of major category. Similarly, majority of clerical errors (89Á9%) were of minor category. The trained staff accounted for all major events (27Á8%). In the minor category, technical errors (73Á2%) were more commonly done by trained staff, whereas for clerical errors (58Á5%), newly recruited staff was responsible. Errors in phlebotomy area are benign but can compromise donor safety. The study helped to develop a consistent and straightforward classification system for errors and to reduce them by basic interventions. Errors committed mostly by our trained staff indicate the need of regular competency testing and an active system for detection of these deviations.
Improving Quality Patient Care and Safety by Reducing the Laboratory Samples Rejection Rate
Improving Quality Patient Care and Safety by Reducing the Laboratory Samples Rejection Rate , 2019
2. Abstract King Fahad Military Medical Complex Medical Laboratory received specimens totaling to 451,779 with 3,611 rejections and 496,113 with 3,934 rejections in 2017 and 2018 respectively from different departments such as inpatient, outpatient, accident and emergency and critical units for routine and stat testing. Rejected phlebotomy specimens are highly considered clinical laboratory problem and its unsuitability may lead to its direct implication to patient care i.e. delayed turnaround time, and treatment decision. A month to month fluctuated rejection rates was regarded with rates recurrently above 0.52% intervention threshold by College of American Pathologist. The aim of the study is to assess, analyze and evaluate the rejection ratios to the type of errors to less than 0.52% within one year (January-December 2019). A retrospective audit was conducted investigating the rejection rate in 2018 of blood specimens received at Chemistry, Hematology, Blood Bank, Serology and molecular/Genetics sections. As such, root causes of the problem initiated by conducting comprehensive analysis of the variable affecting specimen suitability. Pre-analytical process was studied finding the errors domain and provide clear picture of the problem and quality patient care and safety expectation. The pre-pre analytical and pre-analytical errors have found as main reasons of and largely related with procedures done outside laboratory who are but the majority of these errors are preventable along the process from the beginning of test requests to the admission of the specimens receives to the laboratory, caused the rejection of samples. The analysis was designed to identify all significant reasons that could affect the specimen rejection and allow the development of cost-effective intervention. Laboratory Specimens Rejection Project Paradigm and conceptualized strategies were developed by adapting Donebedian Avedis framework, an IPO/SPO model and PDCA methodology to put strategies into action for better outcome. The
Environment-Behaviour Proceedings Journal, 2020
The national target for sample rejection is less than 1%. Many studies reported rejection rates of 0.1% to 3.49%. This study was conducted at the UiTM Medical Specialist Centre from January 2019 to October 2019. The blood bank and haematology workstation both rejected 84 (5.7%) and 560 (3.38%) samples, respectively. The primary cause of sample rejection at blood bank was clotted samples, and at haematology workstation, was lysed samples. Most of the rejected samples came from the wards, followed by the emergency department. This study showed the need for improvement in venipuncture techniques and types of equipment.
Background: Preanalytical phase of biomedical analysis remains an important source of diagnostic errors that deserves special attention. This study aims to evaluate the training in phlebotomy and sample handling impact on the preanalytical non-compliances. Material and Methods: we performed a prospective study before and after staff training in phlebotomy and sample handling by systematically recording all clinical samples non-compliances. First, we assessed and describe the noncompliance baseline rate from January to December 2017 in the clinical biochemistry laboratory of Hôpital Sominé DOLO de Mopti. After two sessions of one week staff training in January 2018, we performed the same study from January to December 2018. We compared the proportions of non-compliances between the two assessments. Data were collected on the case report forms, captured in Excel and analyzed by R software for (Mac) OS X version 4.0.3. Pearson Ch2 or Fisher exact tests were used for the comparison of proportions. The statistical significance was set at p < 5%. Results: a total of 27,810 venous blood samples were received during the study period; 48% was for biochemistry, 41% for immuno-serology, 9% for blood cell count and 2% for coagulation tests. There were 3,826 instances of preanalytical non-compliances (13.76%) identified that led to sample rejection. Out of the 11 types of non-compliances investigated, 5 (45.4%) accounted for nearly 91% of the problems: insufficient sample volume (28.9%), hemolyzed samples (20.5%), inappropriate collection time (17.8%), sample clot (12.9%), and inappropriate sample collection tube (10.8%). We observed a significant difference in rates of non-compliance between inpatients and outpatients samples (44.4% vs 7.3%; p < 0.001). The proportion of non-compliance have significatively decreased after the two training sessions of hospital staff in phlebotomy and sample handling 3,826/27,810 (13.8%) vs 3,009/32,476 (9.3%); p < 0.001. Conclusion: we report a significantly higher rate of non-compliance in inpatients. Hospital staff training in phlebotomy and sample handling reduce the proportion of preanalytical non-compliance and thereby improve patient management and safety.