Implementation and evaluation of a best practice initiative. Venipuncture in the well baby

Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study

PURPOSE

The blood sampling procedure is complex and prone to failure, as reflected by preanalytical errors in pediatric hospital care. The primary aim was to evaluate if the risk of preanalytical errors was higher with capillary blood sampling than with venous blood sampling, and secondary, explore specific factors associated with preanalytical errors, both overall and stratified by capillary and venous blood sampling.

DESIGN AND METHODS

This observational pediatric hospital study collected outcomes from medical records and blood sampling surveys from year 2014 to 2016. The risk of preanalytical errors was analyzed with adjusted-odds ratio (adj-OR) by multivariable logistic regression with 95% confidence intervals (CIs).

RESULTS

Overall, 128 (13%) preanalytical errors were identified among 951 blood samples. The proportion and adj-OR of errors was significantly higher in capillary compared with venous blood samples, 72 (20%) of 354 versus 56 (9.4%) of 597, p = .001, adj-OR 2.88 (CI 1.79-4.64). Blood collection with multiple sample tubes was significantly associated with increased risk of preanalytical errors (n = 97 of 601, 16%), while log weight (kg) significantly decreased the risk of preanalytical errors adj-OR 0.66 (CI 0.50-0.86), indicating a protective effect of increasing weight. However, stratified analyses indicated a protective effect of increasing log weight for venous blood sampling adj-OR 0.52 (CI 0.38-0.72), but not capillary blood sampling, adj-OR 1.08 (CI 0.76-1.55).

CONCLUSION

This study indicates that capillary blood sampling collection increases the risk of preanalytical errors. Further, a child's increasing body weight reduced the risk of preanalytical errors, while multiple sample tube collections significantly increased the risk of preanalytical errors.

PRACTICE IMPLICATIONS

This new information may help nurses improve their knowledge concerning blood sampling collection in pediatrics. Altogether, this study also indicates that implementing more venous blood sampling and improve the cases of capillary sampling could reduce the number of preanalytical errors in pediatric hospitals.

Implementation in nursing and midwifery. A scoping review / Implementationsprojekte in der Pflege und Hebammenarbeit. Scoping review

Background

Evidence-based expertise in nursing and midwifery is growing but is not automatically turned into practice. The importance of implementation research is therefore increasing. International research results on factors facilitating implementation have not yet been sufficiently presented.

Objective

This scoping review will explore the findings on successful preparation, realisation and maintenance of interventions in nursing and midwifery.

Method

Based on an existing systematic approach, relevant data bases were accessed to identify original studies relating to implementation research in nursing and midwifery. The process of study selection and the characteristics of the included studies were charted.

Findings

In the four reviews and 38 studies which met the inclusion criteria, various factors leading to successful implementation are identified. Based on the included studies, four facilitating factors can be pinpointed: (1) workplace culture (16 entries), (2) leadership culture (28 entries), (3) resources (4 entries), and (4) training (22 entries). Depending on the specific phase of the implementation process (preparation, realisation, or maintenance), these factors will vary in importance.

Conclusion

This scoping review provides an orientation for the field of implementation research and it maps the design, themes and results of the studies included. It should be noted that few studies take into consideration the relevant theories, as well as the influence that the researchers and the target group may have on the implementation process, or provide an exact description of the setting in which the implementation takes place.

Capillary blood draws in the NICU: the use of the Innovac quick-draw whole blood collection system versus traditional capillary blood draws

PURPOSE

(1) To determine the rate of damaged and discarded capillary blood draws in the NICU; (2) to compare the rate of damaged and discarded samples between traditional capillary blood draws and the Innovac Quick-Draw device; (3) to determine whether in-service training for nurses on capillary blood draws decreased the rate of damaged and discarded blood samples.

DESIGN

During Phase I of the study, the rate of capillary blood draws by the traditional method was determined. At the completion of Phase I, the manufacturer provided in-service training to senior nurses in the NICU with the use of the Innovac Quick-Draw device. Additional in-service training was also provided for the traditional capillary blood draw technique. Within a month of in-service training, an openly randomized study (Phase II) was carried out comparing traditional versus Innovac device capillary blood draws.

SAMPLE

All infants admitted to the NICU between June 2008 and June 2009 were eligible to be in the study. There were no exclusion criteria based on weight, gestational age, or gender because the sampling method was the only variable being assessed. Phase I lasted two months, whereas Phase II lasted approximately four months.

MAIN OUTCOME VARIABLE

Occurrence of damaged capillary samples with the Innovac device versus the traditional method.

RESULTS

In Phase I, the rate of damaged and discarded samples was 10 percent (28/278). In Phase II, the rate of damaged and discarded samples for traditional and Innovac device was 7.2 percent and 10 percent, respectively. Comparisons between traditional and Innovac for different type of samples were as follows: complete blood count, 11.0 percent (12/104) vs. 13.4 percent (14/104); serum electrolytes, 6.4 percent (6/94) vs. 9.5 percent (9/95); C-reactive protein, 5.7 percent (4/70) vs. 8.0 percent (5/62); and liver panel, 5.3 percent (7/131) vs. 8.3 percent (9/108). There were no statistically significant differences of damaged and discarded samples for the overall or individual sample type comparisons.

An ounce of prevention: decreasing painful interventions in the NICU

Despite a proliferation of literature relative to pain physiology, assessment, and treatment, pain management in NICUs remains inconsistent--most often focused on assessment and treatment rather than prevention. The acceptance of pain as an inevitable part of NICU hospitalization is part of the culture in many NICUs. This article is intended to encourage discussion of pain prevention in the NICU, with a goal of creating a new "minimal-pain" NICU culture. The focus of NICU pain management programs should be on decreasing the number of painful events the NICU patient experiences. Areas for consideration include assessing the performance of procedures by novice versus experienced NICU personnel, reevaluating the role of pediatric residents in the treatment of NICU patients, evaluating the use of umbilical lines and peripherally inserted central catheters to reduce the frequency of peripheral punctures, and evaluating the admission process for ways to reduce neonatal pain and stress. This article discusses the physiology of pain in the neonate, identifies adverse outcomes related to repeated pain, and proposes practice changes that can prevent unnecessary pain in neonatal care.