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Nurse led venesection: a quality improvement project.

ABSTRACT: Venesection is a widely practised procedure, involving the removal of a unit of blood in order to treat haemochromatosis and polycythaemia. It is still well regarded due to a lack of better alternatives and a small side effect profile. At Barnet General Hospital, venesection has recently been a physician led service, unlike its neighbouring hospital at Chase Farm Hospital, which has a well run nurse led service. The current service being run at Barnet Hospital was beset with problems, including delays in service provision and discharge, using junior doctors who may not be comfortable with or have knowledge of pre and post procedure checks. Furthermore, the medical day treatment unit is comprised of highly skilled nurses. 100% of nursing staff felt comfortable gaining venous access, but none had any formal training. Following a practical tutorial, followed by formal teaching, the nurses now run the venesection service. This has been done at no cost to the hospital, has sped up discharges and this has subsequently led to the capacity of the unit to venesect patients to increase by 100%.

SUBMITTER: Patel C

PROVIDER: S-EPMC4693056 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Nurse led venesection: a quality improvement project.

Patel Chandni C Morgan Dafydd D

BMJ quality improvement reports 20151022 1

Venesection is a widely practised procedure, involving the removal of a unit of blood in order to treat haemochromatosis and polycythaemia. It is still well regarded due to a lack of better alternatives and a small side effect profile. At Barnet General Hospital, venesection has recently been a physician led service, unlike its neighbouring hospital at Chase Farm Hospital, which has a well run nurse led service. The current service being run at Barnet Hospital was beset with problems, including ...[more]

PMID: 26734402

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Project description:Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the "Phlebotomy Box," a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre- and post implementation of the phlebotomy box. Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance. In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic, sustainable intervention that could be easily replicated in other Trusts.

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Nurse led venesection: a quality improvement project.

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Nurse led venesection: a quality improvement project.

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