title: Impact of a large-scale educational intervention program on venous blood specimen collection practices.
abstract: BACKGROUND
  Phlebotomy performed with poor adherence to venous blood specimen collection (VBSC) guidelines jeopardizes patient safety and may lead to patient suffering and adverse events. A first questionnaire study demonstrated low compliance to VBSC guidelines, motivating an educational intervention of all phlebotomists within a county council. The aim was to evaluate the impact of a large-scale educational intervention program (EIP) on primary health care phlebotomists' adherence to VBSC guidelines. We hypothesised that the EIP would improve phlebotomists' VBSC practical performance.
  
  
  METHODS
  The present study comprise primary health care centres (n = 61) from two county councils in northern Sweden. The final selected study group consisted of phlebotomists divided into an intervention group (n = 84) and a corresponding control group (n = 79). Both groups responded to a validated self-reported VBSC questionnaire twice. The EIP included three parts: guideline studies, an oral presentation, and an examination. Non-parametric statistics were used for comparison within and between the groups.
  
  
  RESULTS
  Evaluating the EIP, we found significant improvements in the intervention group compared to the control group on self-reported questionnaire responses regarding information search (ES = 0.23-0.33, p < 0.001-0.003), and patient rest prior to phlebotomy (ES = 0.27, p = 0.004). Test request management, patient identity control, release of venous stasis, and test tube labelling had significantly improved in the intervention group but did not significantly differ from the control group (ES = 0.22- 0.49, p = < 0.001- 0.006). The control group showed no significant improvements at all (ES = 0-0.39, p = 0.016-0.961).
  
  
  CONCLUSIONS
  The present study demonstrated several significant improvements on phlebotomists' adherence to VBSC practices. Still, guideline adherence improvement to several crucial phlebotomy practices is needed. We cannot conclude that the improvements are solely due to the EIP and suggest future efforts to improve VBSC. The program should provide time for reflections and discussions. Furthermore, a modular structure would allow directed educational intervention based on the specific VBSC guideline flaws existing at a specific unit. Such an approach is probably more effective at improving and sustaining adherence to VBSC guidelines than an EIP containing general pre-analytical practices.
authors.affiliation: Department of Nursing, Umeå University, Building A, 4th floor, 901 87 Umeå, Sweden. karin.bolenius@umu.se.
authors.forename: Karin
authors.initials: K
authors.lastname: Bölenius
authors.forename: Marie
authors.initials: M
authors.lastname: Lindkvist
authors.forename: Christine
authors.initials: C
authors.lastname: Brulin
authors.forename: Kjell
authors.initials: K
authors.lastname: Grankvist
authors.forename: Karin
authors.initials: K
authors.lastname: Nilsson
authors.forename: Johan
authors.initials: J
authors.lastname: Söderberg
mesh_terms: D000328:Adult; D000368:Aged; D001800:Blood Specimen Collection / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017056:Medical Laboratory Personnel / Q000193:education* / Q000592:standards; D008875:Middle Aged; D018962:Phlebotomy / Q000592:standards; D015397:Program Evaluation; D011795:Surveys and Questionnaires