Open Access Research article

Impact of a large-scale educational intervention program on venous blood specimen collection practices

Karin Bölenius1*, Marie Lindkvist23, Christine Brulin1, Kjell Grankvist4, Karin Nilsson1 and Johan Söderberg4

Author Affiliations

1 Department of Nursing, Umeå University, Building A, 4th floor, 901 87 Umeå, Sweden

2 Department of Statistics, Umeå University, Umeå, Sweden

3 Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden

4 Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden

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BMC Health Services Research 2013, 13:463  doi:10.1186/1472-6963-13-463

Published: 5 November 2013



Phlebotomy performed with poor adherence to venous blood specimen collection (VBSC) guidelines jeopardizes patient safety and may lead to patient suffering and adverse events. A first questionnaire study demonstrated low compliance to VBSC guidelines, motivating an educational intervention of all phlebotomists within a county council. The aim was to evaluate the impact of a large-scale educational intervention program (EIP) on primary health care phlebotomists’ adherence to VBSC guidelines. We hypothesised that the EIP would improve phlebotomists’ VBSC practical performance.


The present study comprise primary health care centres (n = 61) from two county councils in northern Sweden. The final selected study group consisted of phlebotomists divided into an intervention group (n = 84) and a corresponding control group (n = 79). Both groups responded to a validated self-reported VBSC questionnaire twice. The EIP included three parts: guideline studies, an oral presentation, and an examination. Non-parametric statistics were used for comparison within and between the groups.


Evaluating the EIP, we found significant improvements in the intervention group compared to the control group on self-reported questionnaire responses regarding information search (ES = 0.23-0.33, p < 0.001-0.003), and patient rest prior to phlebotomy (ES = 0.27, p = 0.004). Test request management, patient identity control, release of venous stasis, and test tube labelling had significantly improved in the intervention group but did not significantly differ from the control group (ES = 0.22- 0.49, p = < 0.001- 0.006). The control group showed no significant improvements at all (ES = 0–0.39, p = 0.016-0.961).


The present study demonstrated several significant improvements on phlebotomists’ adherence to VBSC practices. Still, guideline adherence improvement to several crucial phlebotomy practices is needed. We cannot conclude that the improvements are solely due to the EIP and suggest future efforts to improve VBSC. The program should provide time for reflections and discussions. Furthermore, a modular structure would allow directed educational intervention based on the specific VBSC guideline flaws existing at a specific unit. Such an approach is probably more effective at improving and sustaining adherence to VBSC guidelines than an EIP containing general pre-analytical practices.

Adherence to guidelines; Education; Implementation; Intervention; Phlebotomy; Pre-analytical errors; Primary healthcare; Venous blood specimen collection