Skip to content
Accessible Unlicensed Requires Authentication Published by De Gruyter May 11, 2018

Evaluation of the clinical implementation of a large-scale online e-learning program on venous blood specimen collection guideline practices

Britta Willman, Kjell Grankvist and Karin Bölenius



When performed erroneously, the venous blood specimen collection (VBSC) practice steps patient identification, test request management and test tube labeling are at high risk to jeopardize patient safety. VBSC educational programs with the intention to minimize risk of harm to patients are therefore needed. In this study, we evaluate the efficiency of a large-scale online e-learning program on personnel’s adherence to VBSC practices and their experience of the e-learning program.


An interprofessional team transformed an implemented traditional VBSC education program to an online e-learning program developed to stimulate reflection with focus on the high-risk practice steps. We used questionnaires to evaluate the effect of the e-learning program on personnel’s self-reported adherence to VBSC practices compared to questionnaire surveys before and after introduction of the traditional education program. We used content analysis to evaluate the participants free text experience of the VBSC e-learning program.


Adherence to the VBSC guideline high-risk practice steps generally increased following the implementation of a traditional educational program followed by an e-learning program. We however found a negative trend over years regarding participation rates and the practice to always send/sign the request form following the introduction of an electronic request system. The participants were in general content with the VBSC e-learning program.


Properly designed e-learning programs on VBSC practices supersedes traditional educational programs in usefulness and functionality. Inclusion of questionnaires in the e-learning program is necessary for follow-up of VBSC participant’s practices and educational program efficiency.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


1. Bolenius K, Lindkvist M, Brulin C, Grankvist K, Nilsson K, Söderberg J. Impact of a large-scale educational intervention program on venous blood specimen collection practices. BMC Health Serv Res 2013;13:463.Search in Google Scholar

2. Gagliardi AR. Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice. Implement Sci 2012;7:57.Search in Google Scholar

3. Bolenius K, Brulin C, Grankvist K, Lindkvist M, Soderberg J. A content validated questionnaire for assessment of self reported venous blood sampling practices. BMC Res Notes 2012;5:39.Search in Google Scholar

4. Soderberg J, Brulin C, Grankvist K, Wallin O. Preanalytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling. Clin Chem Lab Med 2009;47:195–201.Search in Google Scholar

5. Wallin O, Soderberg J, Van Guelpen B, Stenlund H, Grankvist K, Brulin C. Preanalytical venous blood sampling practices demand improvement – a survey of test-request management, test-tube labelling and information search procedures. Clin Chim Acta 2008;391:91–7.Search in Google Scholar

6. Clinical Laboratory Standards Institute. Procedures for collection of diagnostic blood specimens by venipuncture; approved guideline, 6th ed. CLSI document H3-A6. Wayne, PA: CLSI, 2007.Search in Google Scholar

7. Wallin O, Söderberg J, Van Guelpen B, Stenlund H, Grankvist K, Brulin C. Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories. Scand J Caring Sci 2009;24:581–91.Search in Google Scholar

8. Van Dongen-Lases EC, Cornes MP, Grankvist K, Ibarz M, Kristensen GB, Lippi G, et al. Patient identification and tube labelling – a call for harmonisation. Clin Chem Lab Med 2016;54:1141–5.Search in Google Scholar

9. Bolenius K, Brulin C, Graneheim UH. Personnel’s experiences of phlebotomy practices after participating in an educational intervention programme. Nurs Res Pract 2014:14;538704.Search in Google Scholar

10. McVeigh H. Factors influencing the use of e-learning in post-registration nursing students. Nurse Educ Today 2009;29:91–9.Search in Google Scholar

11. Gruson D, Faure G, Gouget B, Haliassos A, Kisikuchin D, Reguengo H, et al. A position paper of the EFLM committee on education and training and working group on distance education programmes/e-Learning: developing an e-learning platform for the education of stakeholders in laboratory medicine. Clin Chem Lab Med 2013;51:775–80.Search in Google Scholar

12. Simundic AM, Church S, Cornes MP, Grankvist K, Lippi G, Nybo M, et al. Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: an observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE). Clin Chem Lab Med 2015;53:1321–31.Search in Google Scholar

13. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–88.Search in Google Scholar

14. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105–12.Search in Google Scholar

15. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008;62:107–15.Search in Google Scholar

16. Lain D, Aston J. Literature review of evidence on e-learning in the workplace. Brighton, UK: Institute for employment studies, 2004.Search in Google Scholar

17. Hadley J, Kulier R, Zamora J, Coppus S, Weinbrenner S, Meyerrose B, et al. Effectiveness of an e-learning course in evidence-based medicine for foundation (internship) training. J R Soc Med 2010;103:288–94.Search in Google Scholar

18. Salyers VL. Teaching psychomotor skills to beginning nursing students using a web-enhanced approach: a quasi-experimental study. Int J Nurs Educ Schol 2007;4:1–14.Search in Google Scholar

19. Means B, Toyama Y, Murphy R, Bakia M, Jones K. Evaluation of evidence-based practices in online learning: a meta-analysis and review of online learning studies. Washington, DC: U.S Department of Education, 2010.Search in Google Scholar

20. Moule P, Ward R, Lockyer L. Nursing and healthcare students’ experiences and use of e-learning in higher education. J Adv Nurs 2010;66:2785–95.Search in Google Scholar

21. Brown T, Zoghi M, Williams B, Jaberzadeh S, Roller L, Palmero C, et al. Are learning style preferences of health science students predictive of attitudes towards e-learning? Austral J Educ Technol 2009;25:524–43.Search in Google Scholar

22. Bloomfield J, Robert J, While A. The effect of computer-assisted-learning versus conventional teaching methods on the acquisition and retention of handwashing theory and skills in pre-qualification nursing students: a randomized controlled trial. Int J Nursing Stud 2010;47:287–94.Search in Google Scholar

23. Spain D, Crilly J, Pierce J, Steele M, Scuffham P, Keijzers G. Can a barcode scanner for blood collection improve patient identification integrity in the emergency department? A prospective before-and-after study. Emerg Med Australas 2015;27:47–54.Search in Google Scholar

24. Löfström E, Nevgi A. From strategic planning to meaningful learning:diverse perspectives on the development of web-based teaching and learning in higher education. BJET 2007;38:312–24.Search in Google Scholar

25. Laurillard D. Multimedia and the learner’s experience of narrative. Comput Educ 1998;31:229–42.Search in Google Scholar

Received: 2018-01-14
Accepted: 2018-04-06
Published Online: 2018-05-11
Published in Print: 2018-10-25

©2018 Walter de Gruyter GmbH, Berlin/Boston