Venous blood sampling in Norway - an observational study

Abstract

Background: Clinical procedures and clinical guidelines have as the overarching goal to improve patient safety and reduce errors. Lack of compliance increases the risk of delays, analytical errors and misdiagnosis. Methods: A structured checklist based on CLSI H3-A6 guidelines was used to observe venous blood sampling in three hospitals in Norway. Sampling was done in various settings; an emergency department, a clinical ward, an outpatient phlebotomy unit and in clinician’s offices. Three different groups of health professionals were observed; biomedical laboratory scientists, nurses and medical secretaries. To identify the most critical step in the blood sampling process a risk analysis was conducted. Results: A total of 108 observations were carried out. Average error rate was 26 %. Patient identification and tube labelling were rated as the most critical steps in the sampling process. Identification errors were most frequent in clinician’s offices and half of the medical secretaries performing phlebotomy (51 %) did not identify patients according to recommended guidelines. The errors related to test tube labelling policy was more prevalent in clinical wards (58 %) and at clinician’s offices (36 %). Conclusions: According to our results, the overall level of compliance of phlebotomy procedures with CLSI H3-A6 guideline in Norway is low. The most critical steps were patient identification and tube labelling.

Keywords

• pre-analysis
• risk analysis
• patient identification
• tube labelling
• blood sampling