Survey of national guidelines, education and training on phlebotomy in 28 European countries: an original report by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PA)

Abstract

Background: European questionnaire survey was conducted by the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for the Preanalytical Phase (EFLM WG-PA) to assess how phlebotomy is performed in EFLM countries, including differences in personnel, level of education and skills, and to investigate the presence and compliance of national phlebotomy guidelines on this matter. Methods: A questionnaire was constructed containing questions elucidating different aspects of the organization behind the phlebotomy praxis on a national basis, including questions on the staff performing phlebotomy, the education of these staff members, and the existence of and adherence to national guidelines. All 39 EFLM member countries were invited to participate. Results: In total 28/39 (72%) EFLM member countries responded. Seven out of the 28 (25%) have national phlebotomy guidelines and five have implemented other guidelines. The estimated compliance with phlebotomy guidance for the laboratories in the countries that have national guidelines available is poor, regardless to whether the phlebotomy was under the laboratory control or not. Most countries were interested in EFLM guidelines and to participate in a pilot EFLM preanalytical phase external quality assessment (EQA) scheme. In the responding EFLM member countries, the majority of phlebotomy is performed by nurses and laboratory technicians. Their basic education is generally 4 -5 years of high school, followed by 2 -5 years of colleague or university studies. Only a third (10/28; 36%) of the participating member countries has any specific training available as a continuous educational resource. A specific training

Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)

“…The median number of audits per country was 33 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). The total number of audits was 336.…”

“…Currently, there is a wide range of different professions with varying level of experience and education who are involved in blood sample collection procedures at the European level. Due to such heterogeneity, there is obviously a need for continuous education and training of healthcare personnel involved in phlebotomy procedures [21]. It has been demonstrated that education leads to improved adherence to guideline recommendations for patient identification, tourniquet release and test tube labelling [22].…”

Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE)

“…A first WG-PRE European survey assessed the presence and compliance with national guidelines and the educational level and staff category by which phlebotomy was performed [80]. It identified a continuing need to assess compliance with guidelines, to adapt the existing CLSI H3-A6 document to make it more suitable for use in specific countries and to institute training programs for phlebotomy practitioners.…”

Harmonization in laboratory medicine: more than clinical chemistry?

“…The use of harmonized standard operating procedures (SOP), assuring multiple identifiers, as well as automated systems for patient/sample identification and information technology facilities, should obviate the risks of patient misidentification and "wrong blood in tube", true nightmares for any clinical laboratory [21]. Major advancements have been achieved in standardizing patient preparation, sample collection and handling procedures, thanks also to the efforts of working groups, in particular, the WG-PRE of the EFLM [22][23][24][25][26][27]. Finally, further work to optimize and standardize sample transportation procedures [28,29], and to harmonize criteria for evaluating the quality of biological samples and accepting/rejecting them has been largely promoted and reported, also by means of automated workstations and serum indexes [30,31].…”