Pre-analytical errors in blood sampling procedures in paediatric hospital care

Abstract

Introduction: Blood tests are important for diagnosing and treating children who are hospitalised with illnesses. The blood test process follows the specific phases of pre-analysis, analysis and post-analysis. Most blood test errors occur in the pre-analytical phase. Such pre-analytical errors (PAE) can affect children’s safety due to delayed clinical decision-making support or discomfort related to repeated blood sampling.

Aim: The overall research aim of this doctoral thesis was to investigate the frequency and consequences of PAE in paediatric hospital care. In specific, the following research questions were set out to be answered: • How frequent is PAE?; • Which type of blood sampling methods, capillary or venous, is most affected by PAE?; • What are the annual costs associated with blood tests affected by PAE?; and • What are nurses’ experiences with blood sampling procedures and related PAE?

Methods: Information about how frequently PAE occurs was retrieved from the laboratory information system FlexLab™, which contained data from blood analyses ordered from Astrid Lindgren Children’s Hospital from 2013 to 2014. Information on the type of blood sampling method and associated PAE factors was retrieved from a blood sampling survey and the medical record Take Care™. The costs associated with blood tests affected by PAE were calculated using hospital information from combined data sources and supply systems (Flexlab™, Tableau softwareÓ and Medicarrier AB). Clinical observations were also used to estimate the time healthcare personnel spend on the blood sampling process. A qualitative approach was used to explore the participating nurses’ views and experiences with PAE and with the blood sampling process.

Results: The frequency of PAE was 61,656 (5.4%) of 1,148,716 blood analyses sent to the laboratory from Astrid Lindgren Children’s Hospital (2013-2014). Clotting represented 31,605 (51.3%) of all PAE. Based on 951 blood samples from two paediatric inward departments, the capillary sampling method had a significantly higher risk of PAE than venous blood sampling, at 72 (20%) of 354 vs 56 (9.4%) of 597, p = 0.001, adj-OR 2.88 (CI 1.79-4.64). The annual cost of PAE was estimated at approximately 84,000 euros. The highest expense was personnel cost (65%), which amounted to 55,000 euros annually. Focus group interviews demonstrated that blood sampling was a challenge for nurses, revealing that they need more information about how to reduce PAE.

Conclusion: The results of this thesis demonstrate that the high frequency of PAE is primarily related to clotting. Capillary blood sampling carries a higher risk of PAE than venous blood sampling. The consequences of PAE include substantial annual costs to paediatric hospital care. Nurses need both theoretical and practical training on how to avoid PAE when conducting capillary and venous sampling.