In-service training to improve phlebotomy technique

Crous, Lizelle
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Competence of nursing staff working in the laboratory came under the spotlight with the introduction of the phlebotomist technician-learning programme. In modern medicine doctors rely on clinical laboratory services to assist them with managing patient care. They use information from the laboratory to diagnose and treat patients and it is therefore of the utmost importance to ensure quality specimens are produced enabling accurate test results. Phlebotomy is considered a skill and not a discipline and needs workplace training programmes and policies to prevent errors. Sample collection takes place in the first phase of the testing process, pre-analytical, and is mainly performed by nursing staff, and when looking at error statistics, 60 – 70% of recorded errors are taking place in the pre-analytical phase, causing negative outcomes for the patient and involves risks that ranges from no harm detected to death. Despite in$service training, problems were identified that is related to the phlebotomist’s technique when performing a venepuncture. Therefore, establishing if nurses’ phlebotomy technique can be improved through a training programme would provide valuable information in the attempt to improve quality results. The purpose of this study was to identify technique variations of nursing staff and develop a training programme directed to correct phlebotomy technique variations and finally to test the effectiveness of such training programme. The methodology used was a quantitative, experimental, pilot intervention study to provide guidance in answering the research questions based on a one group pre-test post-test design. Data was collected by means of peer video recordings of the nurses employed by the laboratory (n=20) in the workplace, based at outpatient departments of the laboratory, which was then evaluated by independent evaluators against a criterion based observational checklist. Compliance to standards on the venepuncture procedure was identified during the pre-test with an average score of 61.9%. The training programme developed to address all deviations from the standards proved to be effective as the post-test mean score was 85%. The results suggests that knowledge and skills were acquired however further investigations are needed for guidance in standardisation of training programmes and the interval programmes should be presented.
A research report submitted for fulfillment of the partial requirements for a degree of Masters in Nursing at the Faculty of Health Sciences, School of Therapeutic Sciences at the University of the Witwatersrand