Training activity information
Details
Quality assure the pre-analytical process of sample preparation for blood gas analysis
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Appropriate handling and storage of blood gas samples to minimise preanalytical errors
- Infection prevention and control using universal precautions as per national and local policies
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to quality assuring the pre-analytical process for blood gas samples.
- Consider how the learning outcomes apply, specifically in relation to preparing POCT devices safely and practicing safely, recognising that this process is crucial for accurate results in blood gas analysis.
- Discuss with your training officer to gain clarity of what is expected of you in relation to specific criteria or procedures that define a successfully quality assured pre-analytical process for blood gas samples.
What is your prior experience of this activity?
- Think about what you already know about blood gas sample collection, handling, and preparation.
- Consider possible challenges you might face during the activity, such as difficult sample collection or issues with sample integrity.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you encounter issues regarding anticoagulation requirements, transport conditions, or sample integrity.
- Acknowledge how you feel about your ability to undertake the quality assurance process in the context of this training activity.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as developing or improving skills related to QA of these pre-analytical processes.
- Identify the specific insights you hope to gain into how different pre-analytical errors impact results or the complexities of sample preparation for different patient conditions.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of this activity or similar tasks.
- Identify important information you need to consider before embarking on the activity, such as anticoagulation requirements, mixing procedures, transport conditions, or the required timing of analysis.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst quality assuring the pre-analytical process of sample preparation?
- Are you encountering situations such as:
- You notice anything unusual about the sample itself (e.g., haemolysis, clots, air bubbles)?
- There are issues with sample labelling, transport time, or temperature control that feel surprising?
- The process compares differently to preparing samples you’ve handled before?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to handling the sample, such as rejecting the sample or flagging the issue if you notice a pre-analytical error? Did dealing with a sample issue affect your confidence or ability to complete the preparation process correctly?
- Consider the steps you are taking in the moment, such as rejecting the sample or flagging the issue if you notice a pre-analytical issue.
- How are you feeling in that moment? For instance, are you finding it difficult to handle the sample issue appropriately? Is it affecting your confidence in completing the preparation process correctly?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully preparing a sample suitable for analysis, adhering to protocols and working within your scope of practice? Or are you needing support because the sample contamination or preparation issue requires senior clinical or laboratory input to resolve?
- What are you learning as a result of the unexpected development? For example, are you mastering a technique for identifying common pitfalls or critical steps in sample preparation from the unexpected issue?
On action
What happened?
- Begin by summarising the key steps you took when quality assuring the pre-analytical process of sample preparation for blood gas analysis.
- Consider specific events, actions, or interactions which felt important, such as identifying a sample handling error (e.g., incorrect mixing) or noting improper transport conditions.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately rejecting a sample that showed signs of coagulation or air contamination.
- How did you feel during this experience, e.g., did you feel acutely aware of the risk of pre-analytical errors or stressed by the need to secure a new sample quickly?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding ensuring the quality of the pre-analytical process for blood gas analysis. What strengths did you demonstrate, e.g., immediate recognition of sample contamination and proper disposal procedure?
- What skills and/or knowledge gaps were evident, e.g., knowledge about potential complicating pre-analytical errors, including incorrect handling and sample maintenance?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in minimising the risk of pre and post analytical errors?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether a borderline sample with minimal air bubbles was acceptable for analysis, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to reinforcing sample handling protocols to minimise pre-analytical errors.
- What will you do differently next time you approach handling or quality assuring blood gas samples, for instance, by proactively verifying anticoagulation requirements and mixing procedures with the collecting clinician?
- Do you need to practise any aspect of the activity further, such as identifying and differentiating signs of sample haemolysis or key learning outcomes related to performing blood gas analysis?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of handling or preparing samples for other types of analysis (e.g., laboratory samples) since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, observing a laboratory rejection of a sample due to clotting forced you to re-evaluate the speed and thoroughness of your anticoagulation and mixing process during your first attempt at this training activity.
- Considering what you understand about sample integrity, quality assurance, and analytical processes now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your sample handling protocols and risk recognition for pre-analytical errors based on further learning and experiences? For example, how you proactively developed a more robust checklist for transport conditions and required timing of analysis based on further learning and discussion of previous reflection actions.
- Has discussing unexpectedly haemolysed blood gas samples or the impact of complicating pre-analytical errors for abnormal blood gas results with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a misleading blood gas result caused by air contamination refined your understanding of the critical importance of meticulous sample preparation.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent sample handling and analysis experiences, contributed to your overall confidence and ability in recognising and mitigating the risk of pre-analytical errors, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated precision, adherence to protocol, and ability to recognise and mitigate pre-analytical errors now enables you to confidently discuss potential complications (e.g., incorrect handling or pre-analysis sample maintenance) during an OCE or related assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to blood gas sample preparation and quality control? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Senior Clinical/Laboratory staff immediately when severe sample contamination or preparation issue compromises the integrity of the data, recognising this requires specialist input to resolve.
- Looking holistically at your training journey, how has this initial sample preparation QA experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to performing blood gas analysis and practising safely? For example, how this foundational experience has supported your development in ensuring the accuracy of results by applying careful risk management techniques across the monitoring process.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Prepare point of care testing (POCT) devices for safe use in monitoring critically ill patients. |
| # 2 |
Outcome
Perform blood gas analysis to monitor critically ill patients. |
| # 8 |
Outcome
Practice safely in accordance with guidance and legislation to minimise risk in all elements of patient care. |