purpose of this paper is to present the Phlebotomy App as a proposed
development initiative at Warrington and to ask for the approval for the
allocation of funding from the COVID-19 Capital Programme.
funding will enable the introduction of a paperless, electronic system to monitor
the blood collection process and tracking of samples from vein to laboratory at
Warrington and Halton Teaching Hospitals NHS Foundation Trust (WHH), in the
Emergency Department, Theatres and ICU.
INTRODUCTION AND BACKGROUND
WHH recognises the impact
that advancement of technology can have on service improvement and this is
reflected in the Trust’s IM&T strategy with the aim to achieve Trust Health
Information Management Systems (HIMS) level 6/7. The Pathology Department has worked with
IM&T colleagues when identifying service areas that can transition to an
electronic system with ease and Phlebotomy is one such area.
The blood collection process (phlebotomy) is the first
and arguably the most important step in the production of accurate laboratory
blood test results, never at a more crucial time than during this current
COVID-19 pandemic. Unfortunately it is
the one process that is not completely within the laboratories control and errors
relating to a poor blood collection process, is probably our greatest source of
laboratory error and of major concern.
Of the 450,000
requests for blood tests made every year, a significant proportion are rejected
due to labelling issues and a large proportion require laboratory relabeling due
to print quality issues with the request forms and sample labels. This results
in processing delays and introduces additional patient risk from lab staff
potentially mixing up patient labels.
These common errors and issues are shared in most NHS
laboratories and in response to this, healthcare software providers have been
developing applications for mobile devices using iOS or Android platforms that
aim to ensure users follow a designated process every time to reduce the risk
This deployment greatly reduces the
infection control risk in both clinical areas and the laboratory.
With no paper request forms or labels,
there is less handling of the sample at the point of care. The pre-labelled sample tube replaces the need
for ICE labels; the labels currently need printing, peeling and attaching to a
blank sample tube. Printing of the ICE
forms is on occasion taking place outside of the clinical area – the
phlebotomy app not only removes the risk of cross infection but also negates the
practical challenge of undertaking this activity
whilst wearing full PPE.
Clinicians & Phlebotomists then place
the pre-labelled samples into a rack allowing the laboratory to load them
straight into the analyser without needing to touch the sample, delivering an
unquestionable benefit during this COVID-19 pandemic.
A risk in the blood collection process is ‘Wrong Blood
in Tube’, the electronic checks built into the Phlebotomy app makes this
incident virtually impossible. As a
result of the COVID-19 pandemic, the Trust has had to redeploy a significant
number of clinical staff to unfamiliar wards, this risk is heightened whilst
following the current process, adoption of the phlebotomy app will mitigate this
Scan4Safety is a vital part of the government’s
drive to make the NHS the safest and most transparent healthcare system in the
world by using barcode technology in healthcare settings. WHH has a dedicated project group to consider
Scan4Safety initiatives and it is also included in the Trusts Use of Resources
work following the Lord Carter Report.
The six official
Scan4Safety demonstrator sites have not yet explored electronic processes for
blood collection however, University Hospitals Plymouth NHS Trust have
introduced the electronic process for ‘blood tracking’ transfusions. The project overview can be found on
Scan4Safety website which details the numerous benefits that have been realised
from the introduction of the process.
The proposal is for WHH to introduce a paperless, electronic system to monitor the blood
collection process and act as local demonstrator site for the Cheshire and
Merseyside Pathology Network. The
Pathology Department at WHH has Executive approval to implement this process
which will provide Cheshire and Merseyside with valuable learning and be a
pivotal step in understanding the qualitative and financial benefits of
introducing electronic systems.