Quality Care Through Clinical Audit: Blood Sampling Practices By Nurses In The Emergency Department Of A University Affiliated Teaching Hospital

Objective: We aimed to conduct an audit to investigate whether the steps of phlebotomy performed by nurses in our emergency department were in line with the WHO guidelines on drawing blood. Based on our investigation, we could then make interventions to ensure that the guidelines were followed diligently. This would be followed by a repeat audit to determine if there was an improvement in adherence to the guidelines. Methods: This clinical audit was conducted in the Emergency Department of the Holy Family Hospital, Rawalpindi. Nurses working in the department were included in the audit. Medical and nursing students, along with doctors were excluded. The initial audit was conducted from 1st to 7th July 2021. A total of 54 instances of phlebotomy were observed and analyzed. The results of this analysis were used to devise interventions for improvement. Interventions included an interactive training session for the nursing staff, installation of visual cues in the department, ensuring better availability of equipment and formation of a team to ensure that the guidelines are being followed. A repeat audit was performed from 23rd to 30th August 2021 in which a total of 58 instances of phlebotomy were covertly observed. The chi-square test was used to compare the percentages between the initial audit and the repeated audit. A p-value <0.05 was considered significant. Results: Steps that were least adhered to by the nursing staff were the performance of hand hygiene (16.7%), asking patients to form a fist (79.6%), putting on well-fitting sterile gloves (0.0%), disinfecting the site of phlebotomy (59.3%) and the removal of gloves (3.7%). After intervention, a significant improvement was noted in all these steps in the second audit. Conclusion: Many of the steps recommended in WHO guidelines were frequently being missed by the nursing staff in our emergency department as observed in the first audit. However, adherence to the guidelines was better during the repeated audit after appropriate interventions. Further interventions and continuous auditing are the key to further improving adherence to the WHO guidelines.