In 2000, the hospital’s point-of-care group put together a four-color compendium for 1500 nurses on blood gas testing at the point of care with the help of their blood gas vendor.

“We needed to have previously dispersed information put into one, easy-to-use format,” says Gunilla Lundström, one of group’s three POC instructors. “The vendor had already some information we could work on and gave us great input along the way. But the fact that we were well prepared also helped the process,” she says.

The positive experience the group had with its blood gas vendor ended up fueling a cooperation with other vendors to help develop additional training materials, e.g. on how to use glucosemeters at the point of care.

Below are their tips.

Do your homework

“Before we put together the training material, we needed to have a better understanding of how the wards measured blood gas at the point of care,” says Rolf Thämlitz, head of the Core Lab.

“At that point in time, 13.7 % of all blood samples taken at the wards presented some form of preanalytical error. Therefore, we needed to identify the typical mistakes that were being made and the knowledge nurses were lacking in order to collect blood specimen correctly.”

After talking to the nurses at the different wards, the group gained a clear picture of their users’ needs. “This phase was really important for the process,” Rolf explains.

“There is a lot to be said about testing at the point of care, but you have to limit your message to some key areas. Therefore, it is important to find out what the true needs of users are before putting together any kind of training.”

Know what you want to say

Based on user input, the POC group at the Malmö University Hospital decided that for the blood gas material to be an effective tool in preventing preanalytical errors, it should cover all steps from sample mixing to transport and storage. “We also wanted to briefly cover QC,” says point-of-care instructor Agneta Hägglöf. “Not only how to do it, but also why.”

Claim the material

Not until the content had been determined, did the group contact the vendor.

“I told the vendor about our project, what we hoped to gain from it and the areas we wanted to cover. Then I asked if the local rep could provide us with any information,” says Agneta. “Back then, we did not really know which format the material would take.”

The vendor sent the group a series of PowerPoint slides, covering the specified content areas. Once they received the material, the group avidly began adapting it by making drawings, adding some of their own training information and removing elements that did not reflect the hospital’s standards and procedures.

“We were lucky that we could use a lot of the vendor’s standard material and focus our attention on adapting information, rather than starting from scratch,” says Agneta.

“However, that is not always the case. So it is important to be critical of the material you receive from vendors, to ask questions, make changes. The vendor might help you, but in the end you are the one in charge of the content.”

Discuss your possibilities with the vendor

During the following three months, the POC group and the vendor were in constant dialogue about optimizing and formatting the content.

Rolf explains: “Here it is really an advantage if you have a good relationship with the vendor. By that I mean that you should be able to trust the veracity of the information you get and at the same time be comfortable with sharing information about your organization. The better the vendor knows you, the more qualified the input he or she is able to give.”

After discussing different format possibilities with the vendor, the POC group decided on a four-color compendium. “We wanted something users could write on and use to look up information,” Gunilla says.

“We looked into how much it would cost to produce the initial 1500 copies we needed. Because the costs were quite high, we asked if the vendor would be willing to share the costs with us,” she explains. According to Gunilla, the vendor agreed and in turn received 250 copies, which have since been used to inspire other hospitals to develop similar materials.

Follow up on the usage of the material

In August 2000, the four-color blood gas compendium was printed. Since then, it has been amply used throughout the hospital. “The material is initially used during our training sessions,” explains Gunilla.

“Each nurse gets her own personal copy to write his or her comments in during training. Afterwards they get to keep their copies, which they use in their everyday work as a kind of minimanual on blood gas testing.”

According to Rolf, the feedback has been extremely positive. “The material was well received by the nursing units,” he says. “It definitely helped bridge the traditional gap between lab and nursing.”

The material also helped reduce preanalytical errors. “Preanalytical errors went from 13.7 % to 0.9 % as a result of the total preanalytical training, including the compendium,” says Rolf.

“Until now, about 1500 blood gas users have been trained in avoiding preanalytical errors in blood gas testing and more than 2500 healthcare professionals have received training in avoiding these errors in blood sampling and specimen handling.”

Give feedback to the vendor

According to Gunilla, the POC group has given continuous feedback to the vendor on how users have received the material and how it has contributed to a reduction in preanalytical errors. Meanwhile, the vendor helped update the compendium, when it was revised in 2004. “Following the developments surrounding the material has clearly enabled the vendor to help us revise the content,” she concludes.

Use experience to develop new tools

The POC group at Malmö has since worked with other vendors to develop training materials and is currently looking into a new training project with its blood gas vendor.

“Our next project with will be an e-learning module on preventing preanalytical errors,” says Rolf.

“The vendor has a module in English, which needs to be translated into Swedish and eventually adapted to our hospital. The idea is to use e-learning for self-study and competency testing. Even though our blood gas concept is not accredited, we are working as if it were, and therefore still want to follow up on the development of our users. Using e-learning will enable us to effectively supplement our training and document competency more efficiently.”

Advice for hospitals considering developing training materials with the help of vendors:

1.       Do your homework
2.       Know what you want to say
3.       Claim the material
4.       Discuss your possibilities with the vendor
5.       Follow up on the usage of the material
6.       Give feedback to the vendor
7.       Use experience to develop new tools

Interviewees

Gunilla Lundström, POC instructor
Agneta Hägglöf, POC instructor
Rolf Thämlitz, head of the Core Lab

Malmö University Hospital
205 02 Malmö
Sweden

Interviewer

Ana Cristina Magalhães
Radiometer Medical Aps
Åkandevej 21
2700 Brønshøj
Denmark