Running head: RN AND PHLEBOTOMY SKILLS 1

RN and Phlebotomy Skills

Anne Waskiewicz

Frostburg State University

RN AND PHLEBOTOMY SKILLS 2

RN and Phlebotomy Skills

The question is: Will consistency in education and training for the RN team on the

Medical Surgical Unit result in more timely blood draws to optimize patient treatment?

To safely and effectively obtain blood samples from patients through a standardized

competency process for all registered nurses. Time delay in lab results or starting antibiotic

occur when the RN is unable to draw blood or obtain peripheral venous access. The population

we are targeting is the daytime Charge RN on the medical surgical unit where I am a currently

employed. The people affected by this step will be the staff RNs. The staff RNs will have a

resource available on the unit who are competent to draw blood and obtain venous access. It will

also provide an opportunity for all staff RNs to become competent in proper phlebotomy

techniques. We will show the impact (time, money, resources) when the RN is competent to

draw blood or obtain venous access. The results should provide more timely laboratory results

and/or implementation of necessary antibiotics or hydration for the patient population. The goal

is to have the Charge RNs on the unit competent in phlebotomy.

Our intervention would be to develop a standard evidence based practice process and a

competency tool to assure that all RNs receive consistent training and education to maintain

competency to safely obtain blood samples from our patient population (medical surgical

patients), and expand it to standard practice organization wide. We will utilize the unit practice

council, support and approval by the nurse manager, and ultimately approval by the Nursing

Practice Council for organization wide implementation.

The outcomes will show the impact (save time, money, additional resources) when the

RN is competent to draw blood or obtain venous access. The results should provide more timely
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laboratory results and/or implementation of necessary antibiotics or hydration for the patient

population. It should improve patient satisfaction.

Keywords: venous access, venipuncture, phlebotomy, competency, peripherally inserted

vascular therapy, blood draws, laboratory draws The material was researched from the

databases used were CINAHL Plus, Google Chrome and OVID. Research articles were obtained

from: The Joanna Briggs Institute (2008), Journal of Infusion Nurses (Nov/Dec 2013), The

Joanna Briggs Institute (2015), MedSurg Nursing (Nov/Dec 2011); Journal of Infusion Nurses

(Jan/Feb 2013).

The literature reviewed was pertinent to evaluating the importance and practical

application of peripheral venous access. The literature addressed the importance of proper

assessment of the patients venous anatomy. (JBI, 2015) The articles included obtaining

informed consent prior to starting any procedure. The educational benefits noted a decrease in

phlebitis and infiltration and an increase in patient safety. (Infusion Nurse Society, p. 419)

Recommendation #1. The first recommendation is to use the vascular resource team to

teach the staff which would take place in a variety of avenues. First the novice nurse will review

the hospital designed teaching packet (i.e. Healthstream), followed by attending a hands-on

training seminar including practical application on the hospital mannequins. After the training

seminar, the new trainees will be paired with a skilled phlebotomist and practice what they have

been taught. For the trainees to be able to draw blood on their own they must have successfully

completed a total of five lab draws, two IV starts and two blood cultures. This is just the

beginning of a skill which will contribute to the patients road to recovery and satisfaction on a

job well done. Competency is defined as a mastery of clinical nursing skills with a plan to
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achieve efficiency and organization using the skill set. Skill acquisition is a concept used to

define implementation of nursing interventions and clinical judgment. (Harpel, 2013) The

hospital staff will maintain this skill set by required yearly competency and the inclusion of this

skill in part of their annual evaluation.

Recommendation #2. The healthcare professional to have ongoing education, training

and assessment. In ever-changing Health Care, it is ones duty to stay current in their profession.

Nurses can stay up-to-date by reading nursing journal, attending conferences or a webinar. (U.S.

Dept. of Labor, 2015)

Another point discussed was the importance of hand hygiene. The simplest of things

(i.e. washing your hands) can save a person from unnecessary peripheral IV complications.

(Frieden, 2015) According to the CDC, Handwashing is like a "do-it-yourself" vaccineit

involves five simple and effective steps (Wet, Lather, Scrub, Rinse, Dry) you can take to reduce

the spread of diarrheal and respiratory illness, so you can stay healthy. Regular handwashing,

particularly before and after certain activities, is one of the best ways to remove germs, avoid

getting sick, and prevent the spread of germs to others. It's quick, it's simple, and it can keep us

all from getting sick. Handwashing is a win for everyone, except the germs. (Frieden, 2015)

Due diligence must be practiced in whatever capacity the profession of nursing leads.

Recommendation #3. Venipuncture training for clinicians should include anatomy and

physiology of veins, arteries, nerves and valves. (The Joanna Briggs Institute, 2008) In addition,

the clinicians should be familiar with the blood drawing equipment, the blood draw color code,

and in which order the labs should be drawn. (Quest Diagnostics, n.d.) Venipuncture is a

technique which takes much practice. The more practice the more proficient one becomes.

Venipuncture does not stop with drawing the blood specimen or starting an IV. Venipuncture is
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a tool to help the healthcare professional assess, diagnose and treat the patient. The clinician

begins as a novice and progresses to the expert level. (Benner, 1984) Once expert level is

achieved, there is further potential of using the skill to teach others, be involved in community

outreach or join a committee a local facility. Every opportunity in life adds another dimension to

the person one can become in this global community.

The need for skilled lab draws is prevalent and training will enhance not only successful

outcomes but increase patient satisfaction. The first step, although simple is good handwashing

practice; followed by a knowledge of anatomy and physiology of veins, arteries, valves. Next,

ensure the phlebotomist is equipped with the proper training and education and the tools to

perform the task. In an ever-changing healthcare environment, skills needed to perform

venipuncture require due diligence to perform at the highest level of possible. Once a

competency in venipuncture is attained, the individual must continue to maintain this skill.
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References

Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice.

Menlo Park: Addison Wesley.

Frieden, T. (2015, October 15). Handwashing. Retrieved from CDC:

http://www.cdc.gov/handwashing/index.html

Harpel, J. (2013). Best practices for vascular resource teams. Journal of Infusion Nursing, 46-50.

Joanna Briggs Institute. (2008). Management of peripheral intravacular devices. North Terrace:

Wiley-Blackwell.

Quest Diagnostics Blood collection. (n.d.). Retrieved from Quest Diagnostics Blood collection:

https://www.questdiagnostics.com

U.S. Department of Labor. (2015). careeronestop.org. Retrieved from careeronestop:

www.careeronestop.org