Sinead Lay, Case Manager at Medical Protection, assesses the rationale behind widening access to phlebotomists in general practice.
Given the current national shortage of GPs in Ireland, those working in general practice are looking at ways to improve access to blood tests and reduce waiting times for patients. One such way is to delegate the taking of blood to allied health professional colleagues, such as phlebotomists.
There is no doubt that introducing phlebotomists into general practice in this way has several potential benefits:
• It can improve the efficiency of the blood testing process, with phlebotomists able to perform the procedure quickly and efficiently. This can reduce waiting times for patients, as well as freeing up GPs to focus on other aspects of patient care.
• Phlebotomists can often perform the procedure more quickly and efficiently than GPs, given they are specialised in this practice and do it so frequently.
• Some patients, especially the more anxious ones and those having regular blood tests, may appreciate the same person taking their blood each time.
• The introduction of phlebotomists may potentially also improve the quality of blood tests. Phlebotomists’ specific training techniques help to ensure that the samples are of high quality and so maximise the number of samples taken that are suitable for laboratory testing. This can reduce the need for repeat tests.
Any procedure, whether it be straightforward or complex, carries benefits and potential risks to both the patient and the phlebotomist. While the risks associated with phlebotomy in general practice are generally low, there are still some potential risks, which include the following:
• Misidentification of blood samples resulting in accidently drawing blood from the wrong patient or mislabelling blood samples, which can have serious consequences for patient safety and result in inaccurate test results.
• Not obtaining full informed consent from the patient. If a patient is not made aware of the potential risks associated with the procedure and an adverse incident occurs, the patient may be more likely to make a complaint or pursue a claim.
• One of the primary risks of phlebotomy in general practice is bleeding or haematoma formation at the site where the blood was drawn. This can occur if the needle damages the vein or if there is an underlying bleeding disorder. Patients who are taking anticoagulant medications, such as warfarin, may be at increased risk of bleeding.
• Another risk of phlebotomy in general practice is infection, particularly if proper infection control practices are not followed. Infection can occur if bacteria or other microorganisms enter the bloodstream through the puncture site, potentially leading to serious complications.
• There is also a risk of fainting or dizziness during or after phlebotomy, particularly in patients who are anxious or have a fear of needles.
• There is a risk of nerve or tissue damage if the needle is not inserted correctly or if the procedure is performed by an inexperienced or poorly trained phlebotomist.
Tips to reduce risks in phlebotomy procedures in general practice:
Before performing phlebotomy, healthcare providers should verify the patient's identity using at least two patient identifiers, such as the patient's name, date of birth or medical record number. Blood samples should be labelled with the patient's identifying information, including the patient's name, date of birth and medical record number, to ensure accurate test results.
• Phlebotomists should also ensure they have obtained informed consent from the patient before performing phlebotomy. This involves explaining the procedure, potential risks and benefits, and obtaining the patient's consent to proceed with the procedure. It would also be helpful to check their understanding of what bloods they are having taken and how they can get the results of these tests.
• To minimise the risk of bleeding and/or haematoma formation, phlebotomists should take appropriate precautions, such as ensuring that they are aware of any medication the patient may be on that would increase the risk of bleeding and ensure that they are following the appropriate protocol post blood withdrawal. The phlebotomist should apply pressure to the puncture site to prevent bleeding and minimise the risk of hematoma formation.
• Phlebotomists should follow appropriate infection control procedures as per practice policy. Equipment such as needles, blood tubes and other supplies should be prepared and used according to the standard operating procedures. It is crucial to use sterile equipment and follow the recommended technique for venepuncture. They should also dispose of used equipment and materials according to the HSE and WHO guidelines for medical waste management.
• You should ensure that any healthcare providers who perform phlebotomy in general practice have received appropriate and accredited training and certification to ensure that they can perform the procedure safely and effectively. Training should include not only the technical aspects of blood collection but also infection prevention and control measures. It is crucial to ensure that phlebotomists are knowledgeable about the HSE and WHO guidelines and their application in practice.
In addition to these general principles, the HSE and WHO guidelines provide specific recommendations for safe phlebotomy practices, such as the use of safety-engineered devices, hand hygiene and sharps injury prevention. The guidelines also emphasise the importance of ongoing education and training for phlebotomists to maintain their competence and knowledge.
The introduction of phlebotomists into general practice can help to address the issue of skills shortages in the healthcare workforce. With an aging population and increasing demand for healthcare services, there is a growing need for trained professionals to perform specialised tasks such as blood drawing. By introducing phlebotomists into general practice, healthcare providers can help to address this shortage and ensure that patients receive the care they need, from an appropriate healthcare professional.
In conclusion, phlebotomy is one of the most performed procedures in general practice in Ireland. It is however important that complacency does not overtake best practice when performing such routine procedures. Safe phlebotomy practices are critical to prevent harm to patients and phlebotomists alike and to ensure the quality of blood samples for laboratory testing. The HSE and WHO guidelines provide a framework for safe phlebotomy practices in Ireland, and it is essential to follow these guidelines rigorously. By adhering to these guidelines, healthcare professionals can minimise the risks associated with phlebotomy and ensure the best outcomes for patients.