Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03476005
Other study ID # #1710
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date July 5, 2017
Est. completion date July 3, 2018

Study information

Verified date July 2018
Source University College Cork
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Incorrect labelling of blood samples occurs at a rate of 1% in the general laboratories and 6% in Blood Transfusion Laboratories. The most serious error 'Wrong Blood in Tube' (WBIT) occurs when blood is taken from the intended patient, but labelled with another patient's details. Consequences may include, misinterpretation of a patient's diagnosis or clinical status, incorrect referral or treatment of a patient, or in the worst case scenario, incorrect cross matching for blood of the wrong blood group, which may lead to catastrophic outcomes, including death.

The root causes for these errors is failure to identify the patient correctly and failure to correctly label the blood tubes at the bedside. To date, despite significant initiatives, it has proved very difficult to eradicate or reduce the error rate. Our project involves a novel, technology enhanced learning approach using proficiency based progression in a prospective randomised controlled methodology to significantly reduce this error.

This approach to learning is more efficient and effective than the traditional approach of repeated practice and is made possible with metric-based simulations. This project will reduce the incidence of adverse events and avoidable medical errors associated with sampling and labelling errors including WBITs. This will be achieved by training healthcare practitioners to a proficiency standard in venepuncture. Thereby minimising the failure of health care professionals to identify the patient correctly and failure to correctly label the blood tubes at the bedside.

This project's impact will deliver reduced sampling and labelling errors -including WBITs by a factor of 40-69%. Reductions of this magnitude will have profound national and international implications on how these types of skills are acquired and quality assured. This would result in improved patient safety and savings of over €500,000 at Cork University Hospital and if applied nationally result in exchequer savings of millions of euro annually.


Description:

The goal of the study is identification, development and operational definition and then validation of phlebotomy performance Metrics which will be used to characterize the optimal performance of healthcare practitioner's execution of phlebotomy. These validated Metrics will serve as an educational and training tool to improve and quality assure phlebotomy training. The validated metrics will be used to produce validated metric-based simulations which will be used to establish a training benchmark based on experienced clinicians' performance. It will also be used to underpin deliberate practice in simulated training.

By introducing proficiency-based progression training supported by technology enhanced learning we aim for reductions in the error rates of wrong blood in tube of 40 to 69%.

Objective 1 To characterize the process of taking a blood sample correctly and the correct process for labelling a blood sample bottle and laboratory request form to reduce the incidence of wrong blood in tube.

This will involve metric development and metric validation of the process of taking a blood sample correctly and the correct process for labelling a blood sample bottle and laboratory request form - as a result of a consultative process, including qualitative analysis of WBIT errors.

Objective 2 To quantitatively define a proficiency benchmark and then to design training to the proficiency standard and assessment of proficiency up to and including real time feedback to the doctor and patient in the clinical arena.

Objective 3 Design a new approach to training including assessment using technology enhanced learning, incorporating online learning and simulation based training of taking a blood sample to a proficiency standard.

Objective 4 To implement the training and assessment in the highest risk groups and document the effectiveness of the intervention.

The training will be delivered to all interns commencing work at Cork University Hospital on July 10th 2017 as proficiency based progression simulation training with additional systematic proximate feedback.

Data from each training group will be identified using the laboratory tracking quality system and using comparison with the historical data from the previous year(s).

Objective 5 To use the research data generated to recommend an evidence based training and competency assessment approach to health care providers in Ireland, together with evidence based individual feedback for any residual errors. This will allow us to internationally address the universal problem of sample mislabeling and WBIT.


Recruitment information / eligibility

Status Completed
Enrollment 94
Est. completion date July 3, 2018
Est. primary completion date July 3, 2018
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group N/A and older
Eligibility Inclusion Criteria:

All historical interns blood samples from July to Sept 2016 All interns who receive training and working at Cork University Hospital from July to Sept 2017

Exclusion Criteria:

Interns in 2017 who do not attend for training

Study Design


Related Conditions & MeSH terms


Intervention

Behavioral:
proficiency based progression training
proficiency based progression training supported by technology enhanced learning

Locations

Country Name City State
Ireland CUH Cork

Sponsors (1)

Lead Sponsor Collaborator
Patrick Henn

Country where clinical trial is conducted

Ireland, 

Outcome

Type Measure Description Time frame Safety issue
Primary WBIT Wrong blood in tube 3 months
Secondary wrong bottle type incorrect bottle type used 3 months
Secondary under filled samples number of under filled samples which did not allow analysis 3 months
Secondary clotted samples Number of clotted samples 3 months
Secondary haemolysed samples number of haemolysed haematology samples 3 months
Secondary Mislabelling Mislabelling of forms/bottles in blood bank 3 months
See also
  Status Clinical Trial Phase
Recruiting NCT05699005 - Individualized or Conventional Transfusion Strategies During Peripheral VA-ECMO Phase 1
Recruiting NCT06403163 - Transfusion Surveillance in Anaesthesia
Not yet recruiting NCT02587845 - Use of Transexamic Acid in Hip Replacement Phase 3
Completed NCT03365999 - Oral Tranexamic Acid vs. Oral Aminocaproic Acid to Reduce Blood Loss and Transfusion After Total Knee Replacement. Phase 2
Completed NCT03784794 - Patient Blood Management for Massive Obstetric Hemorrhage N/A
Not yet recruiting NCT02139995 - West-China Transfusion Score for Critically-ill Patients Phase 3
Completed NCT04513249 - Effects of Therapeutic Plasmaexhange on Viscoelastic Tests in Non-coagulopathic Patients
Not yet recruiting NCT03934112 - Impact of Transfusional Practice on the Morbidity and Mortality of Patients in Intensive Care Unit
Completed NCT03394274 - Restrictive Versus Liberal Transfusion, Major Surgeries N/A
Not yet recruiting NCT06399536 - Individualized ANH for Non-cardiac Surgery N/A
Withdrawn NCT04388722 - Monitoring Noninvasively for Infusion and Transfusion Optimization N/A
Recruiting NCT03999229 - S-Nitrosylation (SNO) Therapy During Autologous Blood Transfusion Phase 1
Not yet recruiting NCT04413721 - Effects of Packed Red Blood Cell Storage Duration on Pediatric Living Donor Liver Transplantation N/A
Recruiting NCT02461264 - Transfusion Strategy in Hematological Intensive Care Unit Phase 3
Terminated NCT01915654 - Impact of RBC Transfusion Less Than 14 Days on Morbidity and Mortality in Cardiac Surgical Patients N/A
Not yet recruiting NCT05696210 - Evaluation of the 1-year Prognosis of Patients Under Veno-arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock With Blood Transfusion Requirement
Completed NCT04286984 - Implementation of a Patient Blood Management Program in Gastric Cancer Surgery
Completed NCT03764813 - Cord Blood Transfusion In Preterm Neonates (CB-TrIP)
Withdrawn NCT04383756 - Utilization of Donor Whole Blood for Blood Transfusion in Deceased Donor Liver Transplantation Early Phase 1
Completed NCT03815773 - PRospective Multicenter Observational Study on Transfusion Practice in Vv-ECMO Patients: The PROTECMO Study